No Conscience


No Conscience


Leonard Zwelling

In her op-ed in The Wall Street Journal on December 3, Peggy Noonan notes the uptick in psychopaths “in the C-Suite.” She turns her focus on business only, omitting any examples she may have been able to glean from the political world.

She picks two in particular—Elizabeth Holmes of Theranos, the phony blood diagnostic company was first. Holmes should be starting her 11-year sentence in a prison near Houston soon and her partner in crime, Sunny Bulwani, just received a thirteen-year sentence.

Second is Sam Bankman-Fried of FTX, the imploded crypto-currency sham firm who will also likely serve time. She notes the common theme characterizing such people as wanting to be important and thinking that fame is coming to them. She also proactively wonders about Elon Musk. To be determined.

But a far more accurate force she writes about is these psychopaths’ lack of conscience. She quotes Father Roger Landry, the Columbia University chaplain, on the definition of conscience:

“a judgement of the practical reason applying moral principles to concrete circumstances leading to the conclusion to do or not do something.”

I think this does nicely.

Lately, I have had the same concern about the leaders of academic medicine who seem to have put a premium on their own longevity and the bottom line of their budgets and have forgotten why they are there in the first place. To remind everyone, academic medicine is about patient care, research, and education. Nowhere in there is there anything about money, professionalism, diversity, inclusivity, or work-life balance. What academic medicine is about is caring for the sick, finding out new truths, and conveying how to care for the sick and how to apply those truths to the next generation of academics and practitioners. Now is that so hard? Actually, it is, but it’s been the goal of academic medicine for over a century.

Instead, what I see is a drive to build bigger buildings, raise more money, acquire more power, and improve rankings in the artificial world of US News and World Report. This is frankly nonsense and suggests a massive suspension of conscience on the part of academic leadership and some real disordered thinking at the top.

I can take some solace in knowing that such behavior is not limited to academia given the examples Ms. Noonan uses in her piece. I can also take some hope in the fact that the American people fired another such person from the ultimate C-Suite in the White House in November of 2020. That individual proved his psychosis by trying to overturn the election on January 6 and almost did it. And he’s not done yet….

For a long time, I have thought that a certain amount of disordered thinking was a necessity in those seeking C-Suite occupancy. In business, politics entertainment (Harvey Weinstein), and academia the examples are many.

In the end, society needs to identify its leaders in a different way or judge them by a different set of values. The system is doing a poor job of sorting out the good from the bad. And when the system fails, many will be hurt. This is happening at academic institutions all over the country where true excellence is no longer the criteria for advancement, but getting along is.

One need go no further than 1515 Holcombe to see the ultimate result of poor leadership and mixed up priorities. Staffing is hard to maintain. Great faculty are being let go. Academic leadership slots go unfilled for years. Focus on the mission is lost in a haze of professionalism and diversity as well as arbitrary decisions in the absence of shared governance.

Leadership without conscience is not uncommon. We should somehow work out the way to make leadership WITH a conscience more common. It starts with those tasked with hiring these leaders. What’s wrong with them?

As this blog has stated many times, it is time for the Board of Regents in Austin to take a hard look at the leadership decisions it has made when it comes to MD Anderson and ask what the Board’s role is in overseeing the mission of the university’s cancer center. It’s got to do better than it has for the past 20 years. Their collective conscience should insist on it.

2 thoughts on “No Conscience”

  1. I agree with your concern and have one suggestion.
    As healthcare has become the conglomerate of larger and larger hospitals and assets, the driving force is economic. Most of the top institutions are led by either MBA types or physicians with MBAs. They are clever in managing their “medical plantation” with efficiency that sometimes requires changes, firing, and cuts that optimize their bottom line and their bonuses.. They are superb at words and marketing that rationalize their efforts.
    One solution used by several major medical institutions is that medical staff rate physicians for leadership skills each year. They rank order the top physician leaders in their peer group who eventually rise to the top. The Mayo Clinic is one respected medical system led by a physician who has gained peer support for their careers. They don’t bring in outside CEOs nor do they elevated physician CEOs who do not support “the needs of the patient come first.” I lived in the Mayo system and recommend this method.

    1. Our new president used to be at Anderson yet he’s a disaster. But faculty didn’t pick him or the last guy or the last guy…

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