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TheDepartmentofMedicalEpidemiologyandBiostatistics

(MEB)

Abriefaccountofthedepartment’soriginatUppsalaUniversityand

developmentatKI1997-2018

by

Hans-OlovAdami

Foto:Stig-GöranNilsson

withcontributionsfrom

OlofNyrén,JuniPalmgren,Jan-EricLittonandNancyPedersen

Foto:PontusLindqvistFoto:BildmakarnaFoto:GunillaSonnebring Foto:Bildmakarna

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Content:

1. Summary 3

2. ThebirthofMEB1980-1989 4

3. Growthandrecognition:1990-1996 6

4. ThemovetoKarolinskaInstitutetin1997 9

5. TheseamlessintegrationatKI:1997-2002 12

6. Biostatistics–astrategicinvestment 15

7. IT-infrastructurebecomingabackboneofMEBresearch 18

8. TheWargentinBuilding:2002-2005 22

9. Consolidationandgrowthduring2006-2017 24

10. Prefects/HeadsofdepartmentatMEB 27

11. MEBinnumbers 28

12. Sourcesofinformation 31

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1. Summary

ThisbriefaccountofthehistoryoftheDepartmentofMedicalEpidemiologyand

Biostatistics(MEB)waschieflycompiledbyHans-OlovAdami,whowasthefounderand

primusmotorduringtheformativeyears.Colleagues,whoinfluencedthedevelopment

andthedirectionstaken,havecontributedtothenarrative.Theyarenamedwithin

bracketsaftertherespectivesections.

ThehistoryofMEBisunusual–probablyunique.Whatsubsequentlywastobecome

MEBgrewfollowingnoaprioriplanfromaone-manfirmtoadepartmentemploying

about250peopleinaboutthreedecades.Duringtheembryonicphase,agroupof

clinicalpractitionersworkedtogetherwithintheDepartmentofSurgeryatUppsala

University.Themainthrustwasoncancer–treatment,causesandcontrol–andthe

scientificapproachwasepidemiological.In1990,thisgroupbecameformally

autonomousalthoughitremainedadministrativelyapartoftheDepartmentofSurgery

until1994whenUppsalaUniversityestablishedanewDepartmentofCancer

Epidemiology.

Followingcontinuedgrowth,theentiredepartmentmovedtoKIin1997.Todistinguishit

fromotherepidemiologicallyorientedgroupsatKI,andtoreflectitsbroadeningscope,it

wasrenamedtheDepartmentofMedicalEpidemiology(MEP).Themoveallowedand

stimulatednotonlyaremarkableaccelerationofthedepartment’sexpansionbutalso

furtherincreaseddiversityoftheresearchportfolio.FruitfulinteractionswiththeKI

leadershipandotherdepartmentsbothattheKICampusandatthehospitalfueledthe

processandfertilizedtheresearch.Importantlandmarksincludedintegrationofthe

SwedishTwinRegistry,establishmentofanacademicbiostatisticsgroup-justifyinga

changeinournametotheDepartmentofMedicalEpidemiologyandBiostatistics(MEB)

–anddramaticprofessionalizationofourIT-infrastructure.Thisdepartmentisnowin

2018thebiggestacademicunitforepidemiologicandbiostatisticalresearchin

ScandinaviaandprobablyoneofthebiggestinEurope,stillundervitalexpansion,

scientificallyprolificandwell-funded.

(Hans-OlovAdami,OlofNyrén)

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2. ThebirthofMEB1980-1989

In1975,AdamireturnedtohisalmamaterUppsalaUniversityinordertofinishhis

surgicaltrainingwiththetraditionalacademiccomponentsandwithanambitionto

pursueaPhD.Atthetime,theresearchportfoliowithintheSurgicalDepartmentwas

limited–traditionallydominatedbyexperimentalresearchonanimals–and

epidemiologywaslargelyunknownbothwithintheSurgicalDepartmentandtheMedical

SchoolatlargeexceptforlimitedactivitieswithintheDepartmentofSocialMedicine.By

asimpleco-incidence,Adami’sPhDworkbecameacase-controlstudyofbreastcancer–

bytoday’sstandardshopelesslyunderpowered–fundedthroughacontractfromtheNCI

totheCytologyDepartmentaimedtoinvestigate“Possiblecorrelationsbetween

epidemiologyandmorphologyinbreastcancer”.HedefendedhisthesisinJanuary1978

andbecamedocentofsurgeryoneyearlater.Althoughhecontinuedthetrainingin

varioussurgicalsub-disciplinesthrough1986,scholarlyworkbecameincreasingly

attractiveandthepowerofepidemiologictheoryandstudydesignfascinating.

Inthebeginningofthe1980s,agrowingnumberofclinicalpractitionersbeganto

enthusiasticallyworktogetheronanincreasinglydiverseresearchportfolio.With

visionaryforesight,IngemarPersson,anOBGYNspecialist,initiatedaprospectivestudy

ofmenopausalhormonetreatmentalreadyduringhisresidency,beforejoiningthe

universitydepartment.Thisuniquestudy,supportedbytheMedicalProductsAgency,

wasthefoundationforseveralthesesstudyingendometrialcancer,breastcanceraswell

ascardiovascularandotheroutcomes.Italsocatalyzedearlycollaborationswiththe

NationalCancerInstituteattheNIHintheUS.LarsHolmbergjoinedthegroupasaPhD-

studentalreadyduringhisresidencyatFalunCentralHospitalbeforemovingtoUppsala

in1986.Anotherresearchgroupranaseriesofrandomizedtrialsonpepticulcerdisease

whilstOlofNyrénpursuedhisthesisworkonnon-ulcerdyspepsia.Incollaborationwith

theSwedishCancerRegistryattheNationalBoardofHealthandWelfareandtheNCI,we

alsoundertookthefirstlarge-scalesurvivalanalysesofcancerinSweden.Cancer

epidemiologicresearch,initsbroadestsense,remained,however,thebackboneofthis

informalbutgrowingresearchgroup.

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PartofthegrowingUppsalaCancerEpidemiologyUnitinthelate1980s,stillhostedintheSurgicalOut-patientDepartment.Standingfromleft:ChristerLjungman,LarsHolmberg,IngemarPersson,TordNaessén,Hans-OlovAdami,MagnusThörn,BrittGustavssonMcCurdy,TorgnyNordén,EvaAhlstad,AnneJennische,andfurthesttotherightLars-ErikHansson.Sitting:JohannaAdami,AlicjaWolkandUllaBergholm.

Needlesstosay,theexpandingactivitiesneededaphysicalinfrastructurewhich

unglamorouslybeganinthelate1970swithapart-timesecretaryandasecond-hand

electrictypewriter.Wedid,however,successivelyexpandthestafftoultimatelyinclude

threesecretariesandonecomputerprogrammer.Until1990,theactivitiesremained

physicallylocalizedtoonecorneroftheSurgicalOut-PatientDepartment.Throughfine

supportfromtheProfessorofSurgeryLarsThorénweinvadedsmallterritoriessuchasa

smallspace,originallybuiltforgurneys,byputtingupnewwalls.Theresearchers,

however,hadtoresorttotheirtypicallyjam-packedclinicalofficespace.AtUppsala

University’sDepartmentofStatistics,ProfessorReinholdBergströmbecamethegroup’s

anchor-pointinitsincreasinglyaudaciousexcursionsintonewstatisticalterritories.This

wasalsoaperiodofrapidtechnicaldevelopment.Wewereproudtoreceiveourfirstfax

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machine.Andevenprouderwhenwepurchasedausedwordprocessor,abigandrather

noisyScribonamachine,whichrevolutionizedtheprocessingofmanuscripts,grant

applicationsandmore.

Becausethein-flowofnewcollaborators,PhD-students,staff,andgrantsfromthe

SwedishCancerSocietyaswellastheNCIcontinued,itbecameincreasinglyclearduring

thelate1980sthattheSurgicalOut-PatientDepartmentwouldultimately–andprobably

soon–beunabletoaccommodateourneedsforphysicalspace.Thesustainabilityofthis

unexpectedlygrowingresearchgroupimprovedin1986whentheSwedishCancer

Societymadeanation-wideannouncementforanewlyestablishedseniorresearch

positionincancerepidemiologyandappointedAdami.Wethereforeinteractedwiththe

supportivedirectoroftheUniversityHospitalGudmarLundqvistandfoundahouse

centrallylocatedinthehospitalareathatunderwentaprofoundrenovation.

(Hans-OlovAdami,OlofNyrén)

3. Growthandrecognition:1990-1996

Themovein1990intoourfirsttailor-madepremisesinanoldthree-storyhouse

centrallylocatedinthehospitalareawasalandmark.Thehouseitself,nowdemolished

sinceyears,hadalonghistory,onlypartlyknownbyus;ithadservedasapersonnel

canteen,anorthopedicwardandaslecturehalls.Moreimportantlyforourscholarly

work,themoveintothisspacious,functionalandestheticallyattractive(weemployed

ourowninteriordesigner)premisescoincidedwithtwodevelopments.Firstly,wewere

establishedasaneconomicallyandadministrativelyautonomousunit.Stillformally

withintheDepartmentofSurgery,wewereinpracticecompletelyindependent.This

presagedtheestablishmentin1994ofanewDepartmentofCancerEpidemiologywithin

theMedicalSchoolatUppsalaUniversity.Secondly,theSwedishCancerSociety

consideredtheirinvestmentsincancerepidemiologysuccessful,anddecidedtofunda

nationaltenuredprofessorshipincancerepidemiology.BecausetheSwedishCancer

Societyisformallyaprivatecharity,theappointmentprocesswashandledbythe

SwedishResearchCouncil.Followingnation-widecompetition,Adamiwasappointedby

thegovernmentinthespringof1990.Throughthisappointment,theunithaditsfirst

academicpositionwithsustainablefunding.The“national”characterofthisposition

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laterturnedouttobecrucialbecauseitallowedtheappointeetonegotiatewithany

universityinSweden.

Duringthesubsequentyears,growthcontinuedonalllevels.Thecoregroupcomprised

outstandingscholarswithalongclinicalbackground.IngemarPersson,OlofNyrén,Lars

Holmberg,AndersEkbomandlaterSvenCnattingiuswerepioneers.Notonlyclinical

practitionersjoinedustopursuetheirPhDworkbutincreasinglyalsooutstanding

medicalstudents.FromtheNationalBoardofHealthandWelfare,PärSparén,Headof

theNationalCancerRegistry,joinedtheDepartmentalreadyinthe1980sandwas

followedlaterbyPaulBlomquist.UltimatelyfourPhDstudentsalsotookayearoffto

pursueaMasterofPublicHealthattheHarvardSchoolofPublicHealth.

JohnBaron,adistinguishedepidemiologistandprofessorfromDartmouthUniversityin

theUS,fertilizedourresearchactivitiesduringaone-yearsabbaticalintheunit.AndLeif

Gustafsson,withabackgroundinthetechnicalsciencesandparticularlyindynamic

modeling,beganhislandmarkstudiesonthenaturalhistoryofcervicalcancerandthe

impactofPAP-smearscreeningdomesticallyandinternationally.Thiswasindeedthe

beginningofanever-expandingresearchprogramonthepreventionofcervicalcancer

stillcontinuingtodayundertheleadershipofPärSparénandJoakimDillner.Butalready

intheearly1990s,wewereprivilegedtoestablishadeepcollaborationwithJanPontén,

ProfessorofPathologyandChairmanoftheSwedishCancerSociety.Withsupportfrom

theNIH,thiscollaborationallowedustoinitiatelarge-scalestudiesontheroleofhuman

papillomavirusintheetiologyofcervicalcanceranditsprecursors.

Concomitantly,thenetworkofcollaborationsoutsideofUppsalaUniversitygrew.Leif

Bergkvist,subsequentlypromotedtoProfessorofSurgery,remainedbasedatVästerås

CentralHospitalbothbeforeandafterhisthesiswork.Andstronglinks,viablestilltoday,

wereestablishedalreadyinthelate1980swithÖrebroUniversity,particularlywiththe

DepartmentofUrology(Jan-ErikJohansson,Swen-OlofAndersson)andSurgery(Göran

Liljegren).CollaborationwiththeUSCenterforDiseaseControl(CDC)inAtlantabegan

whenPeterLaydein1984wastheopponentonIngemarPersson’sthesiswork,which

allowedtwograduatestudents(AndersEkbomandGöranLundegårdh)topursuepartof

theirthesisworkinthelate1980sinAtlanta.ThecollaborationwithCDCcontinuedinto

theearly1990s.

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Gradually,however,linkstotheEpidemiologyProgramattheNationalCancerInstitute

(NCI)inBethesda,USstrengthenedwitharichexchangeofpeople,pricelessfinancial

supportthroughintramuralcontractsandanimpressivescientificoutput,chieflybased

onrecordlinkagestudiesusingSwedishhealthdatabases;thisinternationallyunique

resourcehaduntilthenbeenusedpredominantlyforadministrativepurposes.Fueledby

Adami’sappointmentasadjunctprofessorintheDepartmentofEpidemiologyat

HarvardSchoolofPublicHealth,linkstoHarvardalsobeganin1992;theyhave

continuedandgrowneversincewithanimpactthatcanonlybeunderestimated.

Intheearly1990s,wealsobegantosuccessfullyapplyforlargegrants(RO1s)fromthe

NCIattheNationalInstitutesofHealth(NIH).Thiswasindeedaprerequisiteforthe

increasinglylargeepidemiologicstudiesthatweredeveloped.Ultimately,bytheendof

the1990s,wehadlaunchednation-wide(orlargeregional)case-controlstudiesof

cancersoftheesophagus,stomach,anus,kidney,prostate,breast,endometrium,ovary

aswellasNHLandHodgkin’slymphomas.

Duetothecontinuinggrowthitbecamegraduallyobviousthatwewouldsoongrowout

ofourconvivialpremisesinthehospitalarea.Thecrowdingdidindeedbecomeso

substantialthatweinitiateddiscussionswiththehospitaldirectorsometimein1994.

Oneyearlater,whenabout80individualswerelinkedpart-timeorfull-timetothe

Department,wemovedtobeautifullydesignedandspaciouspremisesinanewhouse

neighboringthePathologyDepartmentjustsouthofthehospitalarea,beautifully

decoratedwithcontemporaryartpurchasedduringaeuphoricone-daytourthrough

leadingStockholmartgalleriesunderspecialistguiding.Weconsultedwiththesame

interiordesignerandtheestheticvalueofourpremiseswereindeeduniqueforan

academicenvironment.

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TheUppsalaCancerEpidemiologyDepartmentgatheredinthelecturehallofourneighboringPathologyDepartmentafterourmovetonewpremisesintheGluntenarea.Inthefirstrowwefindamongothers:YlvaTrolleandCeciliaMagnusson.Inthesecond/thirdrow:AndersEkbom,PaulBlomqvist,JohanAskling,SvenCnattingius,AnnAlmqvist,Hans-OlovAdami,JanPonténandPärSparén.Standinginthemiddleofthenextrow:ReinholdBergström,IngemarPerssonandAlicjaWolk.Andintheback:MichaelFored,OlofNyrén,MatsLambeochfurthertotherightElisabeteWeiderpass.

4. ThemovetoKarolinskaInstitutetin1997

UppsalaUniversitywasthealmamaterforvirtuallyallseniorresearchersandthe

majorityofgraduatestudents.AndmostofuslivedinUppsalasincedecadesandwere

firmlyanchoredinthecity.Therefore,itwasfrustratingandconcerningtogradually

realizethattheacademicenvironmentinUppsalawassuboptimalalthoughwewere

scientificallyprolificandprobablyoneofthelargestrecipientsofexternalgrants,both

domesticandfromtheNIH.Wehadessentiallynocontactswiththeleadershipofthe

MedicalSchool,norepresentationinitsgovernanceandnofinancialsupportfromthe

budgetoftheMedicalSchool.ThefinancialdiscriminationwasbecausetheDepartment

wasclassifiedasclinical,whileitwasgivennoaccesstotheALFfundingthatsustainedall

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otherclinicaldepartments.Therefore,comparedtoallotherdepartments,thenet-flow

ofmoneywasreversedandwentfromtheDepartmenttotheMedicalSchoolrather

thanfromtheMedicalSchooltotheDepartment.Thishopelesssituationledusto

considerKarolinskaInstitutetasanalternativeandprobablymoresupportiveacademic

home.

OnDecember13,1993,AdamihadasecretlunchinaboothofaStockholmrestaurant

withErlingNorrby,DeanoftheMedicalFacultyatKI,andUlrikRingborg,Prefectat

Radiumhemmet.Thepurposewastoexploreinterestsandopportunitiestomovethe

Department.Becausemutualinterestwasconfirmed,numerousinteractionsfollowed

duringthespringof1994.Andthesenegotiationswereopenlydisclosedtoallmembers

oftheDepartment.Wedidindeedcharterabusallowingallinterestedscholars,

studentsandstafftovisittheKarolinskaHospital,meetwithUlrikRingborgandacquaint

themselveswiththepotentialpremisesattheNorrbackaInstitutetwithawonderful

southernviewoverStockholm.

FollowingcontinueddiscussionsandinteractionsbothwithintheDepartmentandwith

theKIleadershipAdamimettheDeanatKIagaininMay1994nowtogetherwithboth

UlrikRingborgandBertilHamberger,aprofessorofsurgery.Themeetingmadeitclear

beyondanydoubtthattheKIleadershipwasnotwellcoordinatedandthatthe

conditionsforamoveofanentiredepartmentweresovaguethatadecisionwouldhave

beenirresponsible.Anotherimportantlessonwaslearnedduringthishalfyearlong

process,namelythatthenegotiationsforamovewithsuchdrasticsocialandother

consequencesforalargegroupofpeoplecannotbeopenlypursued;understandably,it

wouldcauseuncertainty,concernandworries.

BecausethecircumstancesinUppsaladidnotimprove,informaldiscussionsabouta

movecontinued,notablyamongseniorfacultymembers.Thisledtoanewandthistime

confidentialcontactwiththeKIleadershipinthesummerof1996whenHansWigzell,an

oldfriendofAdami,hadbecomeRectorandJanLindstenDeanofthefaculty.Adamiand

Nyrén,DeputyPrefect,ledthesenegotiationsthatnowproceededsmoothlyand

successfully.TheKIleadershipdidindeedaccommodateallourmajorrequirements

includingtobecomeanewdepartmentlocatedattheKICampus,toappointall

membersofthedepartmenttopositionsidenticaltothatatUppsalaUniversity,to

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receiveinitialfinancialsupportbeforebecomingfullyintegratedintotheKIfinancial

systemand,notleastimportant,toofferpremisesthatwouldaccommodateourever-

expandingneeds.

Inthemidfallof1996,thenegotiations–undertakeninstrictconfidencebothatthe

departmentinUppsalaandatKI–weresuccessfullyconcluded.Thefundamental

prerequisitesforamove,whichwouldclearlybeanunprecedentedeventinSwedish

academiaweretwo-fold:Adami’sprofessorshipwasnationalandtheentireDepartment

wasrunonexternalgrants.Atthisstage,allseniorresearchersintheDepartment

decidedtolockthemselvesuplikecardinalsduringoneday,forcedtocomeoutwitha

decisiontomoveornottomove.Weallrealizedthatthiswasprobablythelastchance

duringtheforeseeablefuturetomakethisdecision.

Themeetingtookplaceinahistoricallocationclosetothemainuniversitybuildingon

November21,1996.Followingonedayofconstructivediscussionsandcareful

scrutinizationoftheprerequisitesthegroup,comprising13individuals,votedinunison

foramovetoKarolinskaInstitutet.Thesameevening,Adamitriedinvaintomeetthe

DeanoftheMedicalFacultytoconveythemessageanddictatedalettertohimandto

theuniversityRektorStigStrömholminwhichheexhaustivelylaidouttheargumentsfor

ourdecisiontomove.Throughchannelsthatremainenigmatic,thislongdocumentwas

leakedtothelocalnewspaperUppsalaNyaTidning.

Thefollowingdaywasexplosive.Ourmovewasextensivelyfeaturedinthenewspaper.

Completelysurprisingly,however,theuniversityandtheleadershipoftheMedical

Facultyreactedwithfuryandaggressiveness.AdamiwasfiredasPrefectinvokingconflict

ofinterestduetothenewKIconnection.Theuniversitywasunwillingorunableto

acceptthattheonlyjustificationforourmove,attheexpenseofsubstantialsocial

sacrifices,wastofindaricherandmoresupportiveacademicenvironment.Althoughitis

beyondthescopeofthishistoricalaccounttoreviewthisdramaindetail,anintense

debatefollowedinthelocalnewspaperwhichprovidedunanimoussupportforusina

maineditorialentitled“Adami’slesson”.KIwasimmenselyhelpfulinarrangingtransferal

ofourresearchgrants.AndHansWigzellinteractedwiththegovernmentwhich

appointedAdamiasprofessorandprefectatKIfromMarch1,1997althoughthemove

wasplannedtotakeplaceimmediatelyafterthatsummer.

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5. TheseamlessintegrationatKI:1997-2002

LiquidationoftheentireacademicdepartmentatUppsalaUniversitywasnotatrivial

process.Inadvance,ameetingwiththeentirepersonnelhadbeenannouncedinthe

morningfollowingthedecisiontomove.Themessagewasobviouslydramaticbut

receivedwithimpressivetoleranceandunderstanding;everyoneseemedtorespectthat

theonlydrivingforcewastheambitiontopursuecutting-edgeresearchwhich,inthe

long-term,wouldbehardorimpossibleinanunsupportiveacademicenvironmentwith

vulnerablefundingthatreliedentirelyonsoftmoney.Atthetime,about80peoplewere

employedbutonlyAdamihadsecuredfundingthroughhistenuredprofessorship.For

variousreasons,chieflysocial,40peopleultimatelyhadtoquittheirpositionsandstayin

Uppsalawhilsttheremaining40,includingalldoctoralstudentsandallseniorfaculty

exceptLarsHolmbergwerewillingandabletojoininthemovetoKI.Transferalofall

researchgrantswascomplicatedtooalthoughstronglyfacilitatedbyKI:sUniversity

DirectorRuneFransson.SomeofficialstatementsfromtheUppsalaUniversityRector

were,however,soconcerningandprovocativetoourmainfunder,NIHintheUS,that

AdamihadtovisitBethesdainordertoexplainthesituation.

Whilstthelong-termplanwastoaccommodatetheneedforspacethroughconstruction

ofnewbuildings,theshort-termplanwastomoveintoGeorgKlein’srenownedTumor

BiologyBuildingattheKICampus.Duringthespringof1997,whenthishouseunderwent

renovationandtransformationfrompremisesdesignedforexperimentallaboratory

researchto“dry”epidemiologicresearch,wewereofferedpreliminarypremisesonthe

topfloorinaneighboringbuilding.Thesepremiseswereusedduringthespringchiefly

byAdamiandNyrénwhentheyspentafewdaysperweektopreparethemoveofthe

entireDepartmentafterthesummer.

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Hans-OlovAdamioutsideGeorgKlein’sformerTumorBiologyDepartment,nowthoroughlyrenovatedforepidemiologicresearch.

Wewillneverforgetthefirstvisitwhenkeystoourpremisesweretobehandedover

andweexpectedtomeetajanitor.Instead,whenwereachedthetopfloor,RectorHans

Wigzell,DeanJanLindstenandDirectorRuneFranssonwerewaitingforuswithaflower

–amovinglywarmwelcomeandmanifestationofoutstandingacademicleadership.

WhenHansWigzell’ssuccessasRectorwasshortlylaterfeaturedintheScience

Magazine,recruitmentoftheUppsalaDepartmentwasdescribedas“hisboldestmove”

(1).Needlesstosay,wereadthiswithpride.

ThemoveoftheentireDepartmentafterthesummerof1997wasanexcitingbut

uneventfulundertakingflavoredbyoptimism.TheintegrationatKIwasindeedseamless,

alldoctoralstudentsbecameregisteredatKI,teachingactivitiescontinued,seniorfaculty

enjoyedtheCampusatmosphereandwehiredayoungeconomistasourfirst

administrativeheadoftheDepartment;shewassucceededbyBirgittaSvenssonwho

sadlyleftusprematurelydueafulminantillness.ComputerprogrammingandIT-

infrastructurewereinitiallyanAchilles’Heelbecausethemarketforprogrammerswas

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incrediblycompetitiveatthetime,someofthemwereunabletojoininthemovewhilst

othershadanentirelydifferentacademicbackground.

WhilsttheDepartmenthadremainedanenclavewithinUppsalaUniversity,intense

academicinteractionsbeganimmediatelyatKI.Duringthemonthlymeetingsbetween

theKIleadershipandallDepartmentPrefects,about25atthetime,HansWigzell

convincedusthatthesumofKIwasgreaterthanitscomponents.Concomitantly,the

CampusDepartmentsstillhadregularfacultymeetingswhichalsofacilitatedintegration

andhelpedusbecomeacquaintedwiththefunctionandtheethosofournew

environment.Alreadyinthelate1997,AdamiwaselectedmemberoftheNobel

Assembly–andduringthethreefirstyearsalsotheNobelCommittee–whichprovided

anotherstimulatingaspectofacademiclifeatKI.

Agroupofoutstandingseniorscholars,allwithastrongclinicalbackground,joinedthe

movetoKI,buttheyremainedlectorswhilstAdamiwasholdingtheonlyprofessorial

position.Aroundthistime,however,anewlawmadeindividualpromotionspossible.As

acorollary,IngemarPersson,OlofNyrén,AndersEkbomandSvenCnattingiusreceived

theirwell-deservedpromotiontotenuredfullprofessorwhichrepresentedaquantum

leapintheacademicstructureoftheDepartment.AlicjaWolk,anutritional

epidemiologistfromWarsaw,hadjoinedtheDepartmentalreadyinUppsala,shehad

developedthedietarycomponentofvirtuallyalletiologicresearchprojectsandalso

becamepromotedtofullprofessor.Afewyearslater,Wolkdecidedtomovewithher

groupofdoctoralstudentstotheInstituteofEnvironmentalMedicine(IMM)whereshe

couldworkmoreautonomously.AlreadybeforeWolkleftMEPforIMMaremarkable

moveintheoppositedirectiontookplacewhenNancyPedersendecidedtotransferthe

prestigiousSwedishTwinRegistry,largestinworld,fromIMMtoMEP.Thismovealso

allowedustofosterthepromotionofPedersentoafullprofessorandPaulLichtenstein

tolectorandsomeyearslatertofullprofessor.

MEPanditspredecessorinUppsalahadaratheruniqueorganization(orlackthereof)

andfinancialstructure;therewerenoformalresearchgroupsandallresourceswere

pooledintoajointeconomy.Thisstructurehadfourimportantgoals.Firstly,toallow

everyscholartoputtogetherhisorherdreamteamforanyparticularprojectwithout

crossinganybordersofadministrativeorfinancialnature.Secondly,poolingofresources

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wasaprerequisitefordevelopmentoftheinfrastructurewhichbeganduringtheearly

yearsandhascontinuedeversince.Hence,wehadcultivatedgrowinggroupsofhighly

competentresearchadministrators,administrators,datacollectors,IT-staffand

biobankers.

Gradually,however,theIT-groupdidnotonlygrowbutalsobecamehighlyprofessional

withthehiringavJan-EricLittonasProfessorofBiomedicalComputingTechnologyasa

landmark.Thirdly,theDepartmenthadmusclesenoughtolaunchexpensivepreparatory

workspearheadinggrandstudiesthatcouldonlyfindsupportoutsideofSweden.This

wasbeautifullyexemplifiedbyaseriesofnation-widecase-controlstudiesofupperGI

cancers,hopelesslyrejectedbySwedishfundingagenciesbutsubsequentlyfunded

throughR01’satNIH’sNationalCancerInstitute.Finally,thestructureofMEBwas

intendedtofosteranethosofintegration,solidarityandintensecollaborations.

Unfortunately,thepliabilityandboldnessdescribedaboveisbecominglessandless

appreciatedintoday’sacademicandpublicgovernance.

BecauseexpansionoftheDepartmentcontinued,itbecameapparentthatourneeds

couldnotbeaccommodatedintheformerTumorBiologyBuildingwhilewewaitedfor

theconstructionofourtailor-madebuildingsaroundtheformerDepartmentofAnatomy

andHistologytobecompleted.TheKIleadershipwasextraordinaryreceptivetoour

needsanddecidedtoputuptwostoriesofbarracksjustoutsideoftheTumorBiology

buildingwithaskywayconnectingthebarrackswiththeTumorBiologyBuilding.But

withinafewyears,alsothesebarracksweresocrowdedthatathirdfloorhadtobe

added.Inretrospect,itisalmostenigmaticthattheintegrationatKIandthecontinued

expansionintonewpremisescouldtakeplaceessentiallywithoutanyfrictionbetween

theDepartmentandtheKIleadership,perhapswithoneexception:Itwashardtocover

rentalcostsfromthesoftmoneywereceived,notablyfromdomesticfundingsources.

(Hans-OlovAdami,OlofNyrén)

6. Biostatistics–astrategicinvestment

Swedishmedicalresearch–basicandparticularlyclinicalandepidemiological–has

sufferedsubstantiallyfromthelackofheavyweightbiostatisticalsupport.Itisindeed

enigmaticthatallmedicalschoolsinthecountryseemtoreadilyaccepttheneedfor

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severaldozensofclinicaldisciplinestocovertheentirespectrumofhumandiseases.But

atthesametime,theyexpectscholarsinmedicinetoresumeresponsibilityfor

biostatisticalanalysesnotwithstandingthefactthatthisisacomplexacademicdiscipline

underrapidexpansion.Asmentionedpreviously,wehadtheextremeprivilegeto

collaboratewithReinholdBergströmintheDepartmentofStatisticsinUppsala,formally

ProfessorofEconometrics.Bergströmwasintellectuallybrilliant,absorbedbiostatistical

theoryandmethodsseeminglyinstantly,hadunimaginableworkingcapacityandalways

remainedcurioustosqueezeoutallimportantinformationfromanynewstudy.His

contributionswereacknowledgedthroughanHonoraryDoctorateinMedicineat

UppsalaUniversityandalreadyfromthelate1980shewasformallyemployed50%.Our

immenselyproductivecollaborationcontinuedafterthemovetoKIalthoughBergström

undertookmostoftheworkinUppsalawithonlyoccasionalvisitstoStockholm.

Unfortunately,Bergströmsufferedfromamalignantdiseasethatultimatelyendedhis

lifeprematurelyaroundMidsummerin1999.

AlreadybeforeBergströmleftusindeepsorrow,weacknowledgedthathigh-level

biostatisticalsupportwouldbecomeanotherAchilles’HeeloffutureworkatMEP.This

insightledtofruitfulinteractionswithJuniPalmgren,ProfessorofBiostatisticsatthe

StockholmUniversityDepartmentofMathematics.Reflectingourjointambitionto

establishthefirsteveracademicentityforbiostatisticalresearchinSwedenwithinMEB

weannouncedaprofessorshipinbiostatisticsdomesticallyandinternationally.Theyield

ofapplicantswasunimpressive,reflectingboththattherecruitmentbasewasessentially

non-existingwithinSwedenandthatstartingfromscratchwithnocriticalmasswas

unattractiveforsuccessfulandadvancedinternationalbiostatisticians.Attheendofthis

process,PalmgrenandAdamiinterviewedthetwotopcandidatesbutfeltforcedatthe

endofthedaytointerrupttheprocessandstartallover.

Atthiscriticalstage,theKIleadershipwasagainsupportiveandforesightfulbecause

theydecidedtoprovidesecuredfundingduringfiveyearsforastrategicprofessorship.

AndanewinternationalannouncementwithsuccessfuluseofPalmgren’simpressive

internationalnetworkgeneratedamuchstrongerteamofapplicants.Theoutcomewas

extraordinarysuccessfulbecausewewereabletohireYudiPawitan,professoratCork

17

UniversityinIrelandandhisspouseMarieReilly,alsopromotedtofullprofessorrather

soon.

YudiPawitan MarieReilly

OutsideofKarolinskaInstitutetthelackofacademicbiostatisticsinthecountrywassoon

recognized.Palmgrenwassuccessfulinsecuringtwolargeframeworkgrantsinapplied

mathematicsfromtheFoundationforStrategicResearch2003-2009.Thesegrants

covered10graduatestudentsinstatisticalsciencesupervisedbytheseniorsinthenewly

formedbiostatisticsgroupatMEBandbytheDeptofMathematicalStatisticsat

StockholmUniversity.Aroundthesametime,PalmgrentogetherwithprofessorStephen

LagakosattheHarvardSchoolofPublicHealth,securedSTINTfundingforanexchange

programinBiostatistics,allowingsixofthePhDstudentsfromStockholmtotakepartin

regularcoursesatHarvard,andstudentsfromHarvardtovisitMEBresultingina

generallyvividexchange.ThestrategicfundingfromKItogetherwiththeexternalgrants

allowedaflyingstartforBiostatisticsresearchandgraduateeducationatMEB.

Inparallel,theAppliedBiostatisticsgroupatMEBproveditsimportance.Fromthestart

in1997theMEBAppliedBiostatisticsgroupfocusedonserviceanddevelopmentwork,

withcentralsteeringandfundingbyMEBFaculty.Researchandappliedworkin

Biostatisticsquicklybecameintertwined,withanintimateconnectiontoepidemiological

research,whichinturnhascontributedtothelargenumberofpublicationsfromMEBin

highrankedjournalsandtoahighcitationindex.

18

BiostatisticiansatMEBhavebeenthoroughlyawareofthedevelopmentingenetics,

bioinformatics,e-scienceanddatascienceandhaveformedabroadnetworkof

collaborationsatKI,SciLifeLabandwithotheruniversitiesinStockholmandabroad.The

Biostatisticsgrouphasarrangedanumberofhigh-profileinternationalsymposiain

statisticalmethodologywithmedicalapplicationsandinmethodologicalaspectsof

register-basedresearch.ForoveradecadethegroupledbyprofessorRinoBelloccoin

Milan(alsolectoratMEB)hascontributedtoanAnnualInternationalSummerSchoolin

Italy,runtogetherwiththeHarvardSchoolofPublicHealth.

TheBiostatisticsgroupatMEBisstillin2018uniqueinSwedishacademia,bothinsize

andscientificachievement.Thegrouphasattractednewleadersatthelectorlevelwitha

supervisoryrole.Todaythegroupissuccessfulinsecuringitsownresearchgrantsfor

biostatisticsresearchandgraduateeducation.Inshort–duetotheearlyboost,

BiostatisticsatMEBisthriving.In2018thegroupcomprisesaround50personsofwhom

closeto20arePhDstudents,oftenrecruitedfromdepartmentsofstatisticsor

mathematicalstatisticsorfromuniversitiesoftechnologyandfundedbyexternalgrants.

IntheKIExternalResearchAssessment(ERA)evaluationin2010itwasstatedthatthe

biostatisticsgroupatMEBhasthepotentialtocontributemoretoeducationin

biostatisticsatKI–alsoatamoreadvancedlevelinparitywithinternationaleducationin

medicalbiostatistics.Uptonow,however,theoutspokenambitionatMEBtosetupan

internationalMasterPrograminBiostatisticshasbeenpostponedatKIcentrally.

BesidestheearlyprofessorsPalmgren,PawitanandReillyonenewprofessor,Paul

Dickman,hasbeenappointedandonenewprofessorshipinbiostatisticsisunder

internationalevaluation.BecausePalmgren,PawitanandReillywillallberetiredbefore

theendof2019itiscrucialtoaddcompetenceinthemostseniorlayer.Inorderto

securesustainabilityandcompetenceinstatisticalscienceitisimportantthatthegroup

maintainsacultureofpublishinginhighrankedbiostatisticaljournals–afeaturewhich

needsconstantreinforcement.Whileafocusontheoreticalepidemiologyisimportant

forpracticalwork,alllevelsofbiostatisticsresearchandgraduateeducationneedsto

buildonathoroughunderstandingofthefoundationofstatisticaltheory.

(JuniPalmgren,Hans-OlovAdami)

19

7. IT-infrastructurebecomingabackboneofMEBresearch

Computers,algorithms,andsoftwarewasnotkeepingupwiththeexponentiallyrising

tideofdatainepidemiologyatMEB.Therawmaterialinepidemiologicalresearchisthe

hugedatasetsthatwespendenormoussumsofmoneyandefforttocollect.The

additionofJan-EricLittontoMEBinApril2001–andpromotionin2002toprofessorof

biomedicalcomputingtechnology,thefirstofitskindinSweden–startedthebuildingof

KarolinskaInstitutet’smostextensivecomputingfacilitiesforresearch.

Databaseinfrastructurehasbecomeacriticalcomponentforcompetitivelifesciences

researchanddiscovery.Epidemiologicalresearch,particularlylongitudinalstudiesthat

mayrunforseveralgenerations,demandscompletelynewmethodsandsystemsto

handlethegatheringandstorageofhugequantitiesofinformation.Thelackofrobust

andwell-defineddatabasestrategiesmakessophisticateddataanalysiscumbersomeand

expensive.Modernepidemiologicaldatabasedesignhadindeedtorethinktheentire

conceptofdatamodelingandcohorts.Whiletheconceptsofdatawarehousingand

decisionsupporthadbeenaroundfordecades,theavailabilityofcheapdiskstorage

madelarge-scaledatawarehousingarealityforepidemiologyandbiostatisticstoday.

Tohandlethesegrowingdatasets,aStorageAreaNetwork(SAN)wasimplemented

includingfastcomputerssupportedbyanIBMSUR(SharedUniversityResearchProgram)

grantin2003.ViatheSURgrantwereceivedfourIBMpSeriesserversandaFastT

700/900SANstoragesolutionandsupportingsoftware.

ThecomputinggroupatMEBnowstartedtransformingthelargecohortsinamore

professional,uniform,andsustainableway.In2003thevariousdatabasesatMEB

containedcomplexinformation,oftenlongitudinal,fromover6millionindividuals.An

importantagreementwasalsomadewiththeleadingdatabasesoftwarecompany

OracleandKI,andthefistprofessionaldatabasemanger(JennyCarlsson)washired,the

firststeptoMEBsDatabaseadministrationpolicy.

TheSUR-grantalsoentailedastrategicrelationshipbetweenIBMSvenskaABandKIin

thecreationofajointresearchinitiativeinthelifesciences.Oneoftheoutcomeswasto

constructionthefirstBIMS(BiobankinformationManagementsystem)in2004.BIMS

implementsimportantadvancementsinthedefinition,structure,andstandardizationof

20

informationthathasbeengatheredfromamultitudeofsources,suchaspopulation-

basedregistries,biobanks,patientrecords,andlarge-scalemolecularmeasurements.At

thistime,nosystemsimilartoBIMS,designedforepidemiologicresearch,hadbeen

describedinthescientificliterature.2013-2017thisplatformwasfurtherdevelopedtoa

DatabaseInfrastructureforLargeProspectiveCohortsinSwedencalledmyResearch,an

informationserviceinfrastructureproject,financedbytheSwedishResearchCouncil,

andaffiliatedtoMEB.

In2002weproposedanewdatabasenetworkcalledHubandSpoke,andimplementedin

theEUprojectGenomEUtwin2002-2007.MEBwasoneofthetreeCentersofExcellence

inGenomicsinthe5thEUFrameworkProgramaimedtoconnect600.000twinpairsin

Europe.Eighttwincohorts,includingtheSwedishTwinRegistry,usedafederated

database.ThephenotypehubwasthecomputernetworkatMEBandthegenotypehubs

wereattheFinnishGenomeCenterinHelsinkiandtheMolecularMedicineGroupin

Uppsala.Withinthissetting,theresearcherscommunicateeffortlesslywiththetwin

cohortdata,collectedandupdatedoverthepast40years,storedinthesystematic,

harmonisedwaymakingtheeffortlessdependentonindividualdatacollectors.

Systematiccollectionofdemographicandlifestyledataiscentralinanyepidemiological

study.Thetraditionallyusedmethodssuchasface-to-faceandtelephoneinterviewsas

wellaspaper-questionnaireswereincreasinglyfailingtoproducegoodqualitativeresults

withinfinanciallyfeasiblelimits.Atoolthatwasbettersuitedforthepresentdynamic

populationswasneededandtheInternetpresentedapowerfulalternativeforthe

collectionofdata:e-epidemiologywasborn.TwoPh.D.students(AlexandraEkmanand

ChristinBexelius)didtheirthesesine-epidemiologybetween2002–2009withLittonas

themainsupervisor.Wedefinee-epidemiology,asthescienceunderlyingthe

acquisition,maintenanceandapplicationofepidemiologicalinformationusingdigital

mediasuchastheInternet,mobilephones,digitalpaper,digitalTV.e-epidemiologyalso

referstothelarge-scaleepidemiologicalstudiesthatareincreasinglyconductedthrough

distributedglobalcollaborationsenabledbytheInternet.In2005weconcludedthat

web-basedquestionnairesarefeasibletoolfordatacollectioninlargepopulationbased

epidemiologicalstudiesinSweden.

21

In2007,MEB–incollaborationwiththeSwedishInstituteforInfectiousDiseaseControl

(SMI)–initiatedanewtypeofstudyforinfluenzasurveillance.Inapilotstudy,anew

population-basednetworkofsentinelindividualswasestablishedformonitoring

infectiousdiseaseoccurrencesintheSwedishpopulation.Theaimofthisstudywasto

detectearlyinfluenzaepidemics/pandemics.Theinfrastructureinthesystemconsisted

ofcostandtimeeffectiveinformationandtelecommunicationtechnologies,suchas

InteractiveVoiceResponseandwebportals.

DuringKarolinskaInstitutet’s200year’sanniversaryin2010,MEBorganizedaseriesoflectures

ine-epidemiologyunderthetheme:“Adaptingepidemiologicalmethodsforthe21stcentury”.

LittonwasappointedBBMRI-ERIC'sfirstDirectorGeneralon22January2014-1August2017,

buildinguponeofthelargestinfra-structureforHealthinEurope.Beforeappointedasthe

DirectorGeneralforBBMRI-ERIC,LittonwastheExecutiveDirectorandheadofoneofthe

largestmedicalinfrastructureinSweden–BBMRI.se(TheBiobankingandMolecularResource

InfrastructureofSweden)withMEBasthehome.HealsocoordinatedtheNordicBBMRI

(Denmark,Sweden,Norway,Finland,Island,FaroeIslandandEstonia)between2009-2013.

(Jan-EricLitton,Hans-OlovAdami)

22

Followingextensiverenovationandexpansion,theformerbuildingshostingtheDepartmentsofAnatomyandHistologywererenamedtoWargentin.PehrWilhelmWargentin(1717-1783)acontemporarywithCarlvonLinnéwasasecretaryattheRoyalAcademyofSciencesduring34yearsandapioneerinpopulationstatisticswhichwasdevelopedinSwedenearlierthaninotherEuropeancountries.

8. TheWargentinBuilding:2002-2005

In2002,thelastphaseofMEB’sintegrationatKIbecamecompleted.TheKIleadership

hadfulfilledallcommitmentsmadebeforewedecidedtomovefromUppsala.Andthe

historicbuildingsthatinthepasthostedtheDepartmentsofAnatomyandHistologyhad

beenrenovatedandcompletedwiththeconstructionofanewfive-storybuildingwith

beautifuloffices,numerousmeetingrooms,abasementthatcouldaccommodatethe

needtosecurelystoreserversandothercomputerfacilities.Thecentrallylocatedopen

lightatrium(Ljusgården)wasauniquelyattractiveairyspacethatconnectedthe

buildings.ThesebuildingsalsoaccommodatedtheexpandingKIBiobankforwhichMEB

wasincharge.Inaddition,wehadneighboringlecturehallsandasuiteofguestrooms

whichfacilitatedaccommodationofvisitingscholarsandourfirstpostdocsfromHarvard

(LoreleiMucciandEllenChang)andIceland(UnnurWaldimarsdottir)whospentpart-

timeatMEB.

PartoftheMEBstafftwoyearsafterourmovetotheWargentinbuildings.

Importantexpansionofseniorfacultytookplaceduringtheseyears.Alreadybeforethe

move,wesuccessfullyrecruitedPerHall,anexperiencedoncologistandcancer

epidemiologistfromRadiumhemmet.Hallhasplayedapivotroleforfurther

developmentofMEB.BeginningalsobeforethemovetoWargentin,HenrikGrönberg,

newlyappointedProfessorofOncologyatUmeåUniversity,startedtospendpart-timeat

23

MEBwherehebecameadrivingforce,particularlyforourresearchprogramonthe

geneticsofprostatecancer.Afterthemove,weannouncedaprofessorshipincancer

epidemiology,Grönbergwasappointedfortheposition,quithisprofessorshipinUmeå

andmovedfull-timetoMEB.

EarlyafterourmovefromUppsala,acommitteewasappointed,chargedwiththe

missiontoestablishasatelliteepidemiologicunitattheHospitaltosupportclinical

research.ThisledtoaprofessorshipforwhichAndersEkbomsuccessfullyapplied,andto

theestablishmentofKEP(ClinicalEpidemiology),aunitthatabsorbednumerousformer

graduatesatMEBandplayedapivotalroleindevelopingtheremarkablysuccessful20-

weektrainingprograminclinicalepidemiology.Hence,KEPbecameanenormously

successfulinvestmentandhaskeptstrengtheningthemethodologyofclinicalresearch.

ThecollaborationbetweenMEBandKEPhasnotbeenintensebutcontinuedonmany

levelswithoutfriction.

Withoutgoingintodetail,theinfrastructureofMEBkeptexpandingbothqualitatively

andquantitatively.TheIT-groupgrewandbecamemorespecialized,includingagroupof

professionaldatabaseadministrators.Thegroupofdatacollectors,chieflynurses,werea

prerequisitefortheexpandingfieldworkanddatacollectionactivities.Unlikevirtuallyall

otheracademicdepartments,MEBinvestedinhighlyqualifiedsecretariesworking

closelywithseniorfacultymembersandplayingapivotroletofosteraneffective

managementoftheDepartment.

AdamihadremainedPrefectoftheDepartmentformallyfrom1994inUppsalabut

declinedtobere-appointedforanotherperiodwhenapproachedinthefallof2005.His

goalwastocounteractinbreeding,fosterrenewalandsecuremoretimeforhisown

research.Hence,NancyPedersenwaselectednewPrefectfromJanuary1,2006starting

anewerainthedevelopmentofMEB.Afewmonthslater,Adamiwasunexpectedly

approachedbyHarvardUniversityinBostonandaskedtobecomeChair(Prefect)ofthe

DepartmentofEpidemiologyattheHarvardSchoolofPublicHealth(2).Hetookupthis

positioninearly2007andlivedthereforfiveandhalfyears.

24

9. Consolidationandgrowthduring2006-2017

AfterAdamileftMEB,thePedersenandherexecutivegroupstartedthetaskofmeeting

thedemandsoftheKIadministrativestructure(whichfocusedonindividualresearch

groupsratherthanhavingaflatorganizationsuchasMEB)andatthesametime

fosteringthedevelopmentofthedepartmentinthesameethosasbefore.When

PedersenbecametheViceDeanofResearchatKIin2008,HenrikGrönbergbecamethe

prefect.PaulLichtensteinfollowedGrönbergastheprefectin2014.MEB’seconomy

stabilizedandimproveddespiteexpansionoftheinfrastructure(includingagrowing

appliedbiostatisticsgroup,professionalIT,databaseanddatacollection).Staffmeetings

movedfromonceamonthintheLjusgårdenheldbytheadministrativehead,toweekly

heldbytheprefectwiththeLjusgårdenfilledtothebrim.A“MEBeroftheYear”award

wasinstitutedtocelebratethosemembersofthedepartmentwhocontributedtothe

MEBspirit.

Duringthisperiod,MEBmadethestrategicdecisiontofocusonearlycareerpositions.

ThenumberofpostdocsatMEBwentfrom2-3tothecurrent24in2018,allofwhom

aresupportedbyexternalgrants.Inastrategicmove,MEBalsoestablishedcentrally

financedAssistantProfessor(forskningsassistant)positions,forthoseyoungscientists

whohavecompletedtheirpostdoc,andarenotyeteligibleforaseniorresearcheror

lecturerposition.MEBfinancesapproximately2ofthesepositionseachyear(fora2+2

yrsappointment).Throughtheyears,19youngscientistshaveheldthisposition,manyof

whomhavecontinuedasseniorresearchersatMEB,andcurrently(2018),15areatMEB.

Thescientificfocusofthedepartmentdiversified,withanexpandinginclusionofgenetic

andmolecularepidemiologyacrossvariousdisorderorientedareas.Otherthancancer

epidemiology,psychiatricandinfectiousdiseaseepiaswellasbiostatisticsgrew.New

professorswereappointedeachyearbetween2006and2016,ingeneticepidemiology

(PaulLichtenstein),psychiatricepidemiology(ChristinaHultman),medicalepidemiology

(PärSparén,WeiminYe,ElisabetheWeiderpassVainio,MatsLambe),cancer

epidemiologywithemphasisongeneticepidemiology(KamilaCzene),clinical

epidemiology(CatarinaAlmqvistMalmros,JonasLudvigsson),infectiousdisease

epidemiology(JoakimDillner,JohanGiesekeandKarlEkdahl(adjunct)),biostatistics(Paul

Dickman)and,forashortperiod,cardiovascularepidemiology(ErikIngelsson).

25

In2015,MEBwasfortunatetobecomethescientifichomeofCynthiaBulik(professorof

epidemiologyofeatingdisorders)andPatrickF.Sullivan(professorofpsychiatric

genetics),bothofwhomwereawardedprestigiousinternationalresearchprofessorships

fundedfor10yearbytheSwedishResearchCouncil.MEBalsohasbeenpriviledgedto

haveseveralguestprofessors,startingwithJuniPalmgren(biostatistics),andmore

recentlyNiklasLångström,MikaelLandén,UnnurValdimarsdottír,HenrikLarsson,and

BrianD’Onofrio(psychiatricepidemiologyorepidemiology).MEBisalsoproudtohave

twoofKI’shonorarydoctoratesaffiliated:ProfessorJuniPalmgrenandProfessor

MargaretGatz.

A2018gatheringofpartoftheMEBstaffinourAtriumLjusgården.

Withthisimpressivecollectionofscientificcapital,MEBhasalsobecomethehomeof

severalcentersofexcellence.MEBhoststhetranslationalresearchenvironmentCRisP.

FinancedbytheSwedishResearchCouncilthrougha10-yearLinnaeusgrant,CRisPwas

establishedin2008basedonasharedvisionofdecreasedbreastandprostatecancer

mortalitythroughindividualizedriskpredictionandprevention.TheCenterforEating

DisordersInnovation(CEDI),isdedicatedtoapplyingnovelandemergingmethodologies

andtechnologiestoelucidatecausalmechanismsunderlyingeatingdisorders.Catarina

AlmqvistMalmrosisresponsiblefortheSwedishResearchCouncilSIMSAM(Swedish

InitiativeforResearchonMicrodataintheSocialandMedicalSciences)node“SIMSAM

MEBfamilydesign”.And,since2010,MEBisoneofthekeydepartmentsintheStrategic

26

ResearchPrograminEpidemiology(SfoEpi),ofwhichNancyPedersenistheDirector,as

wellastheStrategicResearchPrograminCancer(StratCan),ofwhichKamilaCzeneisthe

Co-Director.

ThreeimportantKICoreFacilitiesareatMEB.Foundedinthe1960’s,theSwedishTwin

Registry,isthelargestofitskindandhasbecomeaninvaluableresourceformedical

research.Since2017itisan“infrastructureofnationalimportance”supportedbythe

SwedishResearchCouncil.ThroughMEB’spioneeringeffortsin2004,KIBiobank,a

modernandhigh-techinfrastructureforpre-analyticalhandling,storageanddistribution

ofhumanbiologicalsamples,wasestablished.KIBiobankisanessentialcorefacilityfor

manyofthelargecohortswithsamplecollectionsatKI,includingKARMA,STHLM2,

STHLM3,andLifeGene(whichisnowacorefacility),allatMEB.

Since2009,MEBalsoplaysaprominentroleinundergraduateandgraduateeducationat

KI.Thedepartmentisresponsibleforthescientificeducation,called"scientific

development"(VetU)inthemedicalprogramatKarolinskaInstitutet.VetUintroduces

studentstoscientificthinkingandascientificapproachthatmodernphysiciansneedin

theirdailywork.WithinVetUiscourseScientificMethodologyinMedicineandthe

DegreeProjectinMedicine.MEBisalsoresponsibleforthecourseDifferential

PsychologywithinthepsychologyprogramatKI.Finally,MEBisresponsibleforseveralof

thecourses,particularlythoseinbiostatistics,inthedoctoralprograminepidemiologyat

KI.

MEBhasbecomeknownatKInotonlyasanoutlierintermsoforganizationalstructure

andclimate,butthroughitsscientificexcellence.All@MEBareproudofthe“MEB

spirit”,whichfosterscollaborationratherthancompetition.Thisisreflectedbyanumber

ofparameters:thepositivereviewsinthegraduatestudentexitpolls,theironic

difficultiesinfindinginternalrepresentationonstudentcommittees(everycollaborates

witheveryoneandhenceinCOI),successingainingexternalgrants,andscientific

productivity.

(NancyPedersen)

27

10. Prefects/HeadsofdepartmentatMEB

Hans-OlovAdami

Uppsala1994-1996

KI1997-2005

NancyPedersen

HenrikGrönberg

2008-2013

PaulLichtenstein

2014-2017

PerHallandKamilaCzene,actingprefects

2017-2018

KristinaJohnell

2019-

2006-2007

28

11. MEBinnumbers

Thedepartmentemployedabout80peopleatthetimewhenwedecidedtomovefromUppsalatoKIin1997.Ofthese,around40joinedinthemove.Thedepartmentthengrewquicklyduringthefirstdecade.Butsincearound2011,thenumberofemployeeshasremainedfairlystableatabout250.

Until1999Adamiremainedtheonlyfullprofessoratthedepartment.Subsequently,thenumberincreasedcontinuouslyandhasnowremainedintherange15to20since2011.Inaddition,MEBhashadanumberofprominentinternationalscholarsasForeignAdjunctandVisitingProfessors.

0

100

200

300

1997 2002 2007 2012 2017

Numberofemployees

0

5

10

15

20

1997 2002 2007 2012 2017

Numberofprofessors

29

DuringtheearlyyearsatKI,approximatelytwodoctoralstudentsdefendedtheirthesisannually.By2018,theannualnumberisaround15andcumulativenumberhasreached180.AndifweincludealsothesisdefendedduringourearlyyearsinUppsalathedepartmenthasproducedaround200doctoralthesisby2018.

DuringthefirstyearsatKI,MEBpublishedbarelyahundredscientificpapersannually.Sincethen,thedepartmenthasexperiencedanabout5-foldincrease,nowwithanannualnumberofpublicationsintherangeof500to600.

0

50

100

150

200

1997 2002 2007 2012 2017

Cumulativenumberofdissertations

0

100

200

300

400

500

600

700

1997 2002 2007 2012 2017

Numberofpublications

30

ThemeanannualimpactfactorinthejournalsinwhichMEBresearchwaspublishedhas–withsomefluctuations–beenintherangeof6to8andconsistentlyhigherthanthemeanatKIwhichhasmerelybeenaround5.

WithafewexceptionsMEBhashadahigherannualcrownfactorthanKIatlarge.Thisdiscrepancyhasbecomesubstantialandconsistentsince2013.In2017,KIexceededtheinternationalaverageby90%whilstMEBsCFwas220%higherthantheinternationalaverage.

*Theaveragefieldnormalizedcitationscoreiscalculatedforallverifiedpublicationsexcludingpublicationyearequaltothepresentorthelastyear.Theworldaverageisabout1,0.

0

2

4

6

8

10

1997 2002 2007 2012 2017

Journalimpactfactor(JIF)MEBvs.KI

JIFMEB

JIFKI

0

1

2

3

4

1997 2002 2007 2012 2017

Crownfactor*(CF)MEBvs.KI

CFMEB

CFKI

1

31

12. Sourcesofinformation

1. JocelynKaiseretal.WorkingSweden'sPopulationGoldMine.Science2001:Vol.

293,Issue5539,pp.2375

2. Adami’srecruitmenttoHarvardwasfeaturedinNatureMagazinePublishedin

Nature444,120(1November2006).

3. EversinceNovember1994,aDepartmentNewsletterhasbeenpunctually

published,initiallywith10issuesperyearandmorelatelylessfrequentlybut

witheleganttypography.TheNewsletterhaskeptitsinitialnamePraesepeand

allissuesareavailableat:

http://intra.meb.ki.se/Socialeventsimages/Praesepe/Pages/default.aspx.