“We should avoid surgery if we can”
Av In February this year, the Karolinska Institutet announced the opening of a new position specifically dedicated to working with life science. The role includes coordinating internal initiatives and representing the Karolinska Institutet externally. The person who was appointed for the job was Anna Martling, a medical doctor, professor of surgery and former Dean of Karolinska Institutet Nord.
Please tell us about your new job.
“Previously, I headed a project on implementing precision medicine in healthcare. It was a collaborative project between the Karolinska University Hospital and the Karolinska Institutet. In that role, I focused a lot on collaboration between the institute and the region, but also collaboration with the business community. This is a way of taking it further and broadening the scope of the assignment because there are several other strong initiatives running in the Stockholm area.”
Can you name a few?
“One example is the Karolinska ATMP centre, which is in Solna and Huddinge. Other examples are the Karolinska Comprehensive Cancer Center and the national programme for data-driven life science at Scilifelab.”
What is your role in these projects?
“I will coordinate our work with them, which can include finding synergies, as they often rely on the same things, such as the availability of certain expertise and basic infrastructure. I’m also considering how we can interact with the region and the business community in the most beneficial way.”
What are Karolinska’s strengths in life science?
“KI is a world-leading medical university that is of vital importance to Sweden. We account for around 50% of all medical research in the country today, and we cover everything from high-quality basic research to translational and clinical research.”
“We also train the employees of the future, and I think that is a crucial part. If you look at the medical university, we should stand for not only novel knowledge and research and development but also skills supply, which is crucial for the life science ecosystem.”
To succeed, the industry needs to bring in more expertise in relevant areas and recruit bioinformaticians, biostatisticians, mathematicians and physicists, among others
Which strong points do you see in Swedish life science?
“I would say that we have a great deal on hand. We have excellent research and healthcare in general, and our traceability at an individual level with personal identity numbers is a great advantage. One problem is that we may have been a bit too early in digitalisation, so we have to live with many different solutions that need to communicate with each other to make our data available. To make progress with this, we need both technological progress and new legislation.”
What other challenges can you see for Sweden as a life science nation?
“Looking at the development, we must deal with ever-increasing data, which applies to all stakeholders: healthcare, academia, the medtech sector and the pharmaceutical industry. To succeed, the industry needs to bring in more expertise in relevant areas and recruit bioinformaticians, biostatisticians, mathematicians and physicists, among others.”
“We are also becoming more tech-dependent in other ways. Diagnostics are increasingly driving development, requiring the pharmaceutical and medtech industries to work closer together while becoming more dependent on the high-tech platforms of medical universities.”
Anna Martling
Age: 55
Family: Husband, two sons and three bonus children. I also spend a lot of time with my siblings and their families.
Currently: Recently appointed Scientific Director Life Science at the Karolinska Institutet.
Career highlights: Received her PhD in 2003 with a thesis on rectal cancer and has been a professor of surgery since 2014. In 2021, she was named ‘Cancer Researcher of the Year’ by the Swedish Cancer Society. Dean of KI North 2019-2023.
Interests: Tennis, fitness, reading and true crime podcasts.
Last book read: "Nässlorna blomma" by Harry Martinsson.
You are a surgeon by profession. What was the attraction of surgery?
“I guess I was already interested in surgery when I was at primary school, and then I went to medical school and found it incredibly fun from day one. My interest in surgery grew during my studies and even more so during my general practice. I knew I wanted to do research because I find it stimulating to be able to contribute new knowledge to continuously improve healthcare for patients. I can’t say that I was goal-oriented from the start, but my journey brought me here, and I followed what I felt was important and what I enjoyed.”
Are you still performing surgery?
“I left ‘big surgery’ five years ago because it requires you to give it 100% and be involved in it all the time. I still have patients though, and I’m taking part in decisions about treatments and inclusion in studies and so on. Surgery is more than just performing operations; it is also about deciding who to operate on, being part of a multidisciplinary team and assessing patients after surgery.”
Surgery is in many ways an apprenticeship and a craft
Who are your role models?
“I have been fortunate to have good people around me, both tutors and colleagues. This has been important because surgery is in many ways an apprenticeship and a craft.”
“However, you also have to look at surgery in a broader perspective. It is part of multidisciplinary care. It is also a matter of judgment, and a good surgeon must possess much wisdom. I have had many role models in research and surgery, with whom I have had the privilege to work with and who helped me develop as a person.”
Can you name a few?
“Björn Cedermark, who was my supervisor when I did my PhD, was a wise person. If I’m to name another person who has meant a lot to my field, bowel cancer, it’s Bengt Glimelius in Uppsala, an oncologist with whom I still collaborate today and whom I greatly appreciate.”
Tell us about your own research.
“I have a large research group that conducts research into bowel cancer, from prevention to rehabilitation. Just like in precision medicine, it’s all about finding improved treatment methods, new biomarkers and fine-tuning to improve our ability to cure or prolong the lives of patients with bowel cancer.”
Looking ahead, how do you expect cancer care to evolve?
“We need to work on prevention in an entirely different way to prevent cancer. Roughly speaking, 30-40% of all cancers can be prevented by health promotion or early detection, and this is obviously the best approach. It is also a necessary step in order to ensure the best possible care for those who do develop cancer.”
“We are now entering an era when we no longer perform as many operations as possible but start using radiation in combination with chemotherapy or immunotherapy to make the tumours disappear completely so that surgery can be avoided.”
What is your view on this development?
“Surgery will still play an important role. However, I think we should avoid surgery if we can because surgery can have severe short- and long-term side effects that patients have to live with. So, for the good of the patient, it is often best to avoid surgery if possible. So, even though I’m a surgeon myself, I find this trend towards less surgery and more medical treatments positive.”
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