Trust Is Gone
One of the true tragedies of modern life is the disappearance of basic trust in the population at large when it comes to government, science, and medicine.
The article above from The New York Times Magazine of May 29 relates the latest developments in one crucial area where trust has broken down. That is the success of the anti-vaccine movement to sow doubts about the safety and benefits of vaccination. Without going into the great detail of the article, over the past twenty or so years, the anti-vaccine movement has gathered strength and used social media to convince a broad swath of people that vaccines against many childhood illnesses—among the greatest scientific discoveries of all time–are dangerous, cause autism, and cannot be mandated by governmental authorities. Furthermore, this position has been hardened into a political one aligned with conservative, right-wing causes. It has become a libertarian trope that the government cannot make me do anything and that includes getting vaccinated. Not surprisingly, there has been a rise in the incidence of formerly eradicated childhood illnesses like measles because many people have chosen not to vaccinate their kids.
The anti-vaccine movement really took flight during the Covid pandemic where other governmental orders like mask mandates, quarantines, and social distancing were regarded by many on the right as infringing on their personal freedom even at the cost of worsening public health and the death of many of the unvaccinated from Covid. This has led to a major feeling of distrust between science and the people and a general mistrust of any authority figure—like a president. Of course, when President Trump suggested the ingestion of disinfectant to combat Covid, you can understand the people’s mistrust.
That makes the job of being president of anything very difficult because that job is to set strategy and concomitant policy and implement the policy through persuasion. If the people you lead mistrust authority, it is going to be very tough to move any organization.
Now consider academic medicine and the need for these highly complex organizations to make scientific progress while advancing and delivering the latest cutting-edge clinical care.
Leaders of academic medical centers have several responsibilities. First, they must preserve the entity they lead. That entails financial security through fund raising, patient care revenue, and research support. Second, the president must set a course to not just maintain the institution, but improve it, grow it, nurture it and all of its people. Third, the leader must set a personal example by being a beacon of integrity and wisdom in the areas of expertise covered by the academic center. All of them. These usually include patient care, research, and education. How do you do that when the people don’t trust you?
This has become the singular challenge of leadership today in medicine, business, and politics and most leaders are failing the test. Why? Many have acquired their leadership positions in a system not geared to reward excellence, but rather the system seems to support individuals who regress to the mean of ability—in other words they are not the best or the brightest. Certainly, that is the case among our national leaders in both parties. I saw this up close when I worked in the US Senate.
When I was once asked who among the Senators I had met really impressed me, I could only name one—the late, great Tom Coburn. Most of the others were nice enough and had great people skills, but simply weren’t leaders that anyone could follow. The Senate is no place to build leadership skills. It’s governed by consensus not leadership. No wonder Congress cannot get anything done. The putative leadership is inept and the followers lost. Remember both our current President and Vice President are former Senators.
By contrast, this lack of effective leadership gives rise to authoritarian leaders (Russia, China, Iran, Elon, Zuck and the like). When normal participatory governmental leadership breaks down, autocracy rises to fill the vacuum. All of this is compounded by the power of the internet and the inability of most social media platforms to govern the lies promulgated on their web sites.
We are in a dangerous time. When leadership and facts cannot be trusted, when the media is biased in all directions, and when the people do not trust what former founts of wisdom once espoused, where do we go? It’s frightening set of circumstances that would give rise to the anti-vaccine movement. It’s even more frightening to see what our legislative branch seems incapable of doing.
Somehow, we have to derive a better system of leadership development and selection. The current one isn’t working.