Navigating Systemic Failures: Unmasking the Dr. Macchiarinis in Our Lives

Did the Netflix docuseries give you an uncanny reflection to our own society?

I binge-watched the entire 3-part documentary, “Bad Surgeon - Love Under the Knife” with my husband last night, and all the way through the series, we must have blurted “what the f*ck?” on an average of 20 times per episode. I think there’s no doubt that Dr. Paolo Macchiarini is a psychopath. The shock factor wasn’t from the existence of such demented individual. I’m a bit of a true crime fan myself so I understand that the world isn’t in short supply of those with unhealthy and inhumane tendencies. Rather, the shock comes from the absence of reviews, of safety nets, of checks and balances, and of support for those who refused to remain quiet.

This is the reality of the world we live in. Not that it’s full of bad people (of that, we know!) but the modernisation and capitalistic nature of our society is the perfect breeding ground for those wolves dressed in emperor’s clothing.

And the hard truth is — any one of us can become “the enabler”.

For those of you who stumbled on my page but have yet to watch the documentary, let me give you a super quick summary;

Dr. Paolo Macchiarini, once celebrated as a pioneering surgeon, became infamous for his unethical medical practices. His career was marked by falsified research, unnecessary surgeries on healthy patients, fabricated success stories, as well as misrepresented his own professional history on his CV (he did not earn a master’s in biostatistics nor participated in a two-year fellowship in thoracic surgery). He lied his way through it all and was eventually found out after a few people got suspicious.

Spoiler alert: Seven of the eight patients who received his synthetic trachea transplant died as a result of the surgeries. The sole survivor had the implant removed.

And that were just the lies on the professional front. His personal stories got much crazier — one of him claiming to be part of a secret group of doctors that treat global leaders. Even Vatican City had to come out and denied their association officially. The full details can be found here, as Vanity Fair did an already great piece covering Benita Alexander’s side of the story. I think some of us can relate to her story from the perspective of dealing with a cheating partner. The shock and horror of “you’ve been lying to me this whole time?!”. But of course, Benita was dealing with a more sinister man than most of us would ever come across.

I also need to give Benita some credits to the things she decided to do after the whole ordeal blew up in her face. She gathered up her girlfriends and went on a spy mission to Barcelona to get proof herself! And to this day, it seems she still relentlessly puts in the needed efforts to get her story heard. That’s commendable, in my opinion — when you don’t let any fear hold you back from doing the right thing. Trust me, I saw the social media backlash she’s been receiving (How can a journalist be this dumb? All she talks about is her wedding!) and it is no wonder why people find it difficult to speak up.

What were some of the red flags in Dr. Macchiarini’s behaviours?

1. Charming and charismatic - his charisma often overshadowed his professional misconduct. It became his go-to tool for manipulating and winning trust of others.

2. Pathological lying - it is evident that his lying became habitual, even when it was unnecessary. It’s almost like a game to him scoring based on how much bullshit he can tell and how much he can get away with (evidently, by a lot).

3. Egocentricity and grandiosity - he has an inflated sense of self-importance and abilities. From the Pope, to Putin, to the Obamas — need I say more?

4. Lack of Empathy - if you view the situation like me, and you think that Machiarini knew all along that his synthetic windpipe does not work and operated on patients anyway, the scene with Hannah, the 2-year old Korean-Canadian girl who was born without a trachea, will hit you differently. For me, if he intentionally falsified his results, the projected confidence in his solution was a huge mismatch to the actual reality. To him, it was just part of a performance.

5. Manipulative Behaviour - he exploited the trust of patients, the medical community, and the institutions as well as those who formed personal relationships with him.

6. Impulsivity and Risk-taking - he performed high-risk surgeries without adequate evidence or consent. I viewed it as him putting a ‘ticking time bomb’ inside his patients knowingly.

7. Lack of Remorse or Guilt - he failed to feel guilty about harming others, often shifting blame and avoiding responsibility.

8. Superficial Relationships - he viewed relationships based on utility rather than genuine connection. He profiled Benita and targeted her as someone vulnerable and easy to manipulate — with his main motive utilising Benita’s journalistic and media influence to mask his “mistakes” and create a new media narrative and social persona.

Note: the traits I’ve listed above are interestingly similar to those of a psychopath, as outlined in psychological research and diagnostic criteria like the DSM-5 (Diagnostic and Statistical Manual of Mental Disorders) and the PCL-R (Psychopathy Checklist-Revised).

So, the next important questions we should ask are:

How in the world did it happen? What systemic failures allow a character like this to flourish?

Macchiarini’s case was not just about one individual’s moral bankruptcy, but also about how deep the systemic failure went. His groundbreaking claims were initially lauded without much scrutiny. His victims and the public were deceived by his assurance and the implicit trust in the very medical system that supported him.

These were some of the failures that were most apparent;

1. Inadequate vetting and oversight - when Macchiarini was appointed at the Karolinska Institute (KI) and the associated Karolinska University Hospital in Sweden, it appears that there was insufficient vetting of his background and previous work. Questions later arose about the authenticity of his claims and the quality of his research prior to his appointment.

2. Failure to heed warnings - there were early warnings from colleagues and other professionals about the risks associated with Macchiarini’s procedures, including concerns about the viability and ethics of his methods. These warnings were largely ignored or not taken seriously by the institutions.

3. Compromised peer review process - Macchiarini’s groundbreaking claims about successful trachea transplants using synthetic scaffolds and stem cells were published in reputable scientific journals. This indicated a failure in the peer review process, where the validity of his research methods and findings were not adequately scrutinised.

4. Institutional pressure for innovation - with a strong institutional desire at KI for groundbreaking medical discoveries, it is possible that this led to the development of culture where ambitious but unproven and risky research was encouraged or insufficiently questioned.

5. Delayed response to misconduct allegations - the response from the institutions were slow, and initially took to defend Macchiarini. There was a lack of transparency in communication within and between the institutions regarding the concerns raised about Macchiarini’s work. This lack of open dialogue contributed hugely to the continuation of his unethical practices. It took extensive media coverage and external investigations before significant actions were taken against him.

So you see? Addressing systemic failures requires vigilance at all levels.

Macchiarini’s plot makes Frank Abagnale’s escapades in “Catch Me If You Can” seem quaint in comparison. The archetype of today’s conman seems to have evolved far beyond our recollection of characters in movies like Ocean’s Eleven or Now You See Me. It seems that in the real world, these deceptive figures lurk in every corner of our society, from esteemed academic institutions, or seated in corporate boardrooms, to the highest tiers of medical establishments. (Also, if a conman kills, wouldn’t he be labeled as killer instead? Or serial if there are multiple deaths?)

This reality underscores the necessity of building resilience within our communities and promoting culture where questioning authority is not just accepted but encouraged. It’s crucial to look beyond the superficial allure of power and status, and instead, recognise and celebrate achievements rooted in being a genuinely good human being.