Category Archives: Global Health

The wikipedia pithy definition is: the health of populations in a global context.

Conflicts of interest in research leadership (Part II)

(The fond farewell. When enough is enough)

When I started my research career, a research leader’s retirement was a moment to celebrate. Their lives and their contributions were recalled through their research, their papers, their PhD graduates and Postdocs. The Festschrift was often published, literally celebrating their intellectual contribution to a field. Some of those researchers truly retired. Many took honorary appointments that gave them a desk or space in their old laboratory, and access to the library and email. They might mentor junior staff or be a part of a PhD student’s supervisory team. Many continued to do fabulous, original research. Others became the departmental raconteur, recalling embarrassing stories of now senior departmental researchers who were once their postdocs. The retired research leaders were appreciated but no longer had a formal role in the organisational structure.

My experience today with research leaders approaching an age that would, before, have been the time to retire — the time that I am beginning to see on my horizon — is somewhat different. The game now is one of holding back the younger researchers, and hanging on, limpet-like, to substantive position for as long as possible. It is cast as an age discrimination issue. If I am capable, and I am performing at a high level, then my age should not be a barrier to my continued leadership role.  Indeed, I have vastly more experience than junior colleagues, and it would be perverse to choose them over me.

While it is true, age need not be a barrier to the capable performance of one’s duties, it is also true that senior positions are rare, and if they are held by an increasingly ageing leadership, how will we train and develop younger cadres of leaders? Turning over leadership refreshes ideas and organisations.

I recall a radio interviewer with a well known Australian clinical researcher. He recounted how, as a junior researcher, his supervisor put him down as the first author on a significant scientific paper — a career launcher. He had not earned the spot, but the supervisor saw his potential and also recognised his capacity to influence the trajectory of a promising career. Without debating the ethics of that particular decision — it was a different time — there is little doubt that the paper launched one of Australia’s great scientific careers. Forty-plus years after those events, I have seen very capable, senior research leaders forsake their leadership role in favour of hanging on to power. They do not surround themselves with bright, eager, up-and-comers. They do not mentor and position their staff to take over. Instead, they retain non-threatening doers, many of whom will not even appear in the acknowledgements of their scientific papers.

In a post I wrote a little over a year ago I observed that in the interests of gender fairness, men had to be prepared to relinquish power. I have a similar view of intergenerational fairness. Those research leaders among us who were born in a twenty-year, golden age between about 1945 and 1965  have been extraordinarily lucky with the opportunities that we have had. In the interests of fairness and, frankly, in the interests of science, we need to know when to step away. We can still be a part of an exciting research agenda; maybe we do not need to be seen to lead it.

Perhaps the last act of truly great research leaders is to step back.

Staff who want to leave

Learning from a member of staff that she wants to leave can feel surprisingly hurtful. It can be particularly upsetting when he wants to stay within the organisation, just not in your unit.

As bosses, we very often spend far more time with our staff than we do with our own family or friends. We invest time and resources in their development. They become a part of our lives and our plans. When they announce their intention to leave, it can feel like rejection.

I thought you liked it here. You can’t leave now, I’ve invested too much in you. Your the only person who can… And finally, “How ungrateful!!!!”

I have been that person who my boss cursed for leaving, and I have been that boss who cursed (silently) the person who wanted to leave. I have also seen colleagues abuse, belittle and try to destroy the careers of staff who want to leave. No surprise really, with a boss like that, that a person wouldn’t want to stay. Pathological behaviour by a boss in one quarter portends pathology in other quarters.

The most relevant advice I ever received about leaving was from Steve Schwartz, former vice-chancellor or Murdoch, Brunel, and Macquarie Universities. “You have to remember, Daniel”, he said, “the person most interested in advancing your career is you.”

And that is the heart of it. As bosses, we do not act solely with the best interests of our staff in mind. Sure, we are not indifferent to their welfare but that is not the raison d’être of the workplace. When we engage them, challenge them, mentor them, and develop them, it is at least in part because we hope to have smarter more engaged and more productive staff in return.

Inevitably, of your good staff, some will stay and some will leave. If your sensible, you were already a part of the discussions about long term career planning and you had plenty of warning– maybe not in detail, but at least in direction. When the time comes and they want to leave, do not curse them (outwardly). Congratulate them on their new opportunity and wish them well. If there is some outstanding work that desperately needs their skills to complete, you may be able to negotiate a better departure date. Do not try and bully them into staying.  When staff cannot leave, it is not employment, it is servitude.

Conflicts of interest in research leadership (Part I)

Family & Friends

This is the first in a series of pieces I am writing on research leadership. The first in the series is a couple of articles devoted to conflicts of interest. I also want to explore ideas of organisational strategy, gender, who can lead, and with my interest in the global south, on funding, collaboration, and global leadership.

When I started to think about writing this series, I remembered one of the best books I had ever read on leadership, Be in Charge: A Leadership Manual. It was written by Alexander Margulis. During his career, Margulis was Professor of Radiology at Cornell, Chair of Radiology at UCSF, and an accomplished scientist. His book is, unusually in the leadership literature, relevant to the research environment. I read it early in my career, the year it was first published, at a time when I was trying to overcome management issues with a large multi-country study I was conducting. It helped to crystallise in my mind basic ideas of successful leadership.

When the book was first published, its language and tone were already a little dated (and while he struggled against it, sexist). Re-reading it, it reminds me of the comfy slippers worn by the sage, bachelor uncle in a 1960s, US family, TV drama. I recommend that you push past all that; read it for its common-sense advice, and ignore it for its anachronisms. One of the things he reflects on, not in great detail, is the issue of conflicts of interest associated with family and friends in the workplace. To start off, I have extracted three short ideas:

Close friendships are a handicap except with clearly non-competing equals.

Do not have favorites.

Do not ever employ members of your family in your unit … If for some reason one of your family members has to be employed in your unit, you should not have any supervisory or controlling responsibilities for his or her performance.

For my entire career in Global Health, I have collaborated with my wife, and the question of conflicts of interest would occasionally raise its head. Global health has, in fact, had some great husband and wife teams. One of the most successful, and frankly, one of the most important for health globally was that of Ruth Bonita and Robert Beaglehole. There was never a hint of a conflict of interest, and the benefits of that collaboration were enormous.

The salvation for my wife and I was that we were never each other’s boss. We were either working in different institutions or, when we were at the same institution, we occupied parallel positions. We could work together, but we could not offer favours to each other. Monash University was so concerned about the potential for conflicts of interest that they stopped us co-supervising PhD students — something I thought was a particularly stupid interpretation of a conflict of interest that ignored where the real benefit of our collaboration lay for students. Nonetheless, we complied, and that perceived conflict went away without even a hushed whisper.

When my wife moved to take over the Director position of a United Nations policy institute, we briefly discussed whether we could continue the collaboration and whether I could seek a position in the same institute. In our heads, we could see how to navigate it, but the reality of the conflict of interest was too strong and the rules unequivocal — No! It is easy to see why the answer is, no: “Do not have favourites”. Couples can be more or less emotionally mature but, unless there is indifference between them, it is probably quite tricky not to favour the person you love over others. Even if that can be managed, it is probably difficult for the no-longer-favoured to understand why. At the very least, you each know your partner’s needs, desires, and handicaps more deeply than you do others. In that greater understanding, opportunities are created for perfectly rational moments in which help can be offered. The help that is not offered to others because you do not understand them as well. That loss of opportunity for others is simply unfair, and the kind of thing that gnaws away at organisational harmony.

For the Head of a Research Organisation, to have a family member working within the organisation will always be a challenge. If the family member is very junior, it may appear, at first, to make little difference. A helping hand from above would be so overt and so distasteful that it likely would not occur. However, the supervisor of the family member may believe that doing small (or large) favours for Junior will play well with the boss: a favourable appraisal, an opportunity to attend a conference, a room with a view. Even if the Head and the Supervisor are both completely honest, the perception of a conflict of interest, however unjustified, may arise. And perceived conflicts of interest can undermine the trust and confidence in the organisation.

If the family member is not junior, but quite senior, the risks of a conflict of interest are even more pronounced. Senior Scientists need to negotiate with their supervisor or their supervisor’s supervisor (who may well be the Head of the Research Organisation) for resources to support their team. A new piece of equipment is needed, extra space, or a new hire. None of these is an issue except, as is always the case, when others are competing for the same resources. Only the other team wants the resources for a new vehicle, $50,000 of cloud computing, or a staff retreat.

Margulis has a blanket rule. Don’t do it. The reality may be more difficult. If my wife and I progressed in the same organisation and she applied for a senior position, should I resign? Should she be precluded from consideration for higher office? Should there be a process based on the Russian aphorism, Trust but Verify (Доверя́й, но проверя́й). Set up some oversight role that can monitor conflicts of interest arising between the Head of the Research Organisation and their lover. It doesn’t merely sound distasteful, it can’t work because any process operating from within the organisation can be subverted by the boss. The inherent power of the Head of the Research Organisation provides ample opportunities to offer favours and promotion to the Guards — and there is no one to Guard the Guards. Again, even if the Head is completely honest, perception creates the potential for conflict of interest.

Margulis focused on potential conflicts of interest where a more organisationally senior family member offered (or was perceived to offer) favours or advantage to a more junior family member. In organisational leadership, however, there is also a potential for lateral conflicts of interest to arise, from family members occupying ostensibly parallel but influential positions.

In a commercial organisation, family members holding parallel posts may not be an issue and may, in fact, be a significant “value add” for the organisation. If you are a member of the Murdoch family then having family members on the Board, others holding senior positions elsewhere in the company, others working in an entwined parallel organisation, need not be a conflict of interest. The whole family is focused on maximising the value of their holdings, and therefore (probably) supporting the maximisation of the value for all the shareholders. That at least would be the argument I would make, and if the majority of shareholders buy the argument, it is a non-issue. In a private, family-owned company, it is even less of an issue.

This is not so in your typical not-for-profit research organisation or university. A family member who is a Chair of Geology and another who is a Chair of English Literature are unlikely to create conflicts of interest within the organisation. They are not simply in parallel units, they are in parallel universes of academic and research engagement, and they are highly unlikely to have an opportunity to interact with each other in a compromising professional manner. This would not be the case, however, if one family member was, say, the Director of Purchasing and the other was the Director of Finance. Here, there would be ample opportunity for fraud. It would be equally challenging to avoid a conflict of interest if one family member were on the University Council, another was a senior executive in the university, and a third was the steward of the university’s union, representing academic staff. They might argue that, as with the Murdochs, this level of intertwining is an advantage for the organisation because it creates efficiencies and synergies. Nonetheless, it would create an unequivocal perception of a conflict of interest that the university’s Vice-Chancellor or President would inevitably have to confront.

There is an interesting twist to this notion of parallel units. A married couple were simultaneously Vice-Chancellors (Presidents) of two of Australia’s top universities. Each appointment was a testament to the extraordinary qualities of the individuals. In combination, it could also have created a perception of a potential conflict of interest. The Australian newspaper described them as wielding “vast influence as the vice-chancellors of two of Australia’s largest, most highly ranked and esteemed universities”.

Two notorious, rival institutions, constantly competing with each other over a larger slice of a diminishing pot of funding — and also sometimes successfully collaborating — were led by a married couple. The universities could have their internal strategies, strengths or weaknesses exposed by their leaders (the two people who were supposed to have their respective institutions’ best interests at heart) over a shared cup of coffee, a walk in the park, or a more active and intentional trade. For four years the couple simultaneously held these two university CEO positions (with a combined salary in 2018 of AUD$2.7 Million), and to my knowledge, there was never a hint of a realised conflict of interest. It must, nonetheless, stand out as a bizarre exception to the rule. It is impossible to imagine that close a  familial relationship would be countenanced between the CEOs of Alphabet and Amazon or Microsoft and Apple.

It may be that a Research Organisation would permit (potentially) conflicted relationships to arise in its leaders — and not simply allow them but countenance and endorse them. This action would require clear acknowledgement, clear justification, and clear guidelines for ensuring that it neither damaged the internal nor external working relationships of the organisation. The costs and benefits of permitting such a conflict would need to be carefully weighed and balanced. If it arose inadvertently it could have even greater reputational damage because it would bring the quality of governance into question.

What is the optimal number of broken jaws?

I was chatting with a friend recently about the COVID-19 response in different countries. Reflecting on her own country, she said, “It is so hard to know what is right!”; that is, it is so hard to know what the right response to COVID-19 should be.

The variation, for instance, in countries’ lockdown responses is substantial, but which country is doing the right thing? In some countries, there has been no lockdown. The government asked the people to be sensible. In other countries, the government legally confined people to their homes — only one person was allowed out at very specific (restricted) times to buy essentials. Given these two policy extremes (be sensible and house arrest), which one is the right one, and how do you know?

An economist, I have forgotten who once asked tongue-in-cheek, what is the optimal number of dead babies? The very purpose of such a crass question is to make you stop and think. What tradeoffs are you prepared to make to save the lives of babies? Sure, you could be lazy, condemn the questioner as immoral (for even asking you to think), and declare zero dead babies to be the right number. As a simple policy proposition, if zero dead babies is the right number, then all the resources of society should be aimed at preventing neonatal deaths. ALL RESOURCES! Until the policy goal has been achieved, there is more work to be done to reduce the number. One dead baby is too many!!! Farmers may farm, but only to produce the food that supports the workforce that is striving to reduce baby deaths to zero. Teachers may teach, but only to educate the people to fill the jobs to support the policy goal to reduce baby deaths to zero. There is very limited use for art, music, cinema, sport, fashion, restaurants, etc. They will all have to go! If five-year-old deaths increase, that is something to live with, just as long as we can save another baby.

At this point, you’re probably thinking, well that’s stupid. That’s not what I meant when I said the optimal number of dead babies is zero. What I meant was something more along the lines of, “In an ideal world there would be zero dead babies”. Equally, if you were asked about poverty or crime, or amazing works of art, you presumably would have stated the ideals in terms of zero poverty, zero crime, and lots more wonderful art. And this is quite a different proposition. An ideal world is not ideal in virtue of its achievement of a single goal. It is ideal in having achieved all sorts of different outcomes. And that is why the real and the ideal do not intersect. In the real world, we do not achieve the ideal anything. We seek to achieve many ideals, and realistically, we hope to make progress against them, knowing that there is always more to be done. In striving to improve the societal position against a basket of goals, we allocate limited resources and make trade-offs.

This is one part of the COVID-19 problem, and, as my friend observed, why it is so hard to know what is right. What is the right number of COVID-19 deaths? There are lots of important, rational debates to be had around this topic because it is about the tradeoffs we are prepared to make against a basket of societal goals against the myopic achievement of one. Muscular public health responses — effective house arrest — are very good at reducing the number of new COVID-19 cases. They are also very effective at increasing domestic violence, increasing depression, lowering child immunisation rates, degrading child education, increasing poverty and increasing unemployment. If the societal goal should be zero COVID-19 deaths, what is the optimal number of broken jaws, suicide attempts, measles encephalitis cases, illiterate and enumerate children, beggars, and soup kitchens?

All these issues, under normal circumstances, are things of concern to Public Health and maybe, one day, they will be again.

Another part of the COVID-19 problem is that, whether a government “did the right thing” will be determined in hindsight, and by making (inadequate) historical comparisons between the outcomes across countries’. In democracies, at least in the short-term, “did the government do the right thing?” will often be decided at the ballot box. This will surely get the answer wrong. In less-than-democracies, astute rulers will write the history books themselves ensuring that, without regard to the outcome, the government did the right thing.

One of the main reasons that “it is so hard to know what is right!” is that we rarely have a societal view about the long term goals we wish to achieve and the tradeoffs we are prepared to make. Furthermore, we are reluctant to accept the fact that one can do the right thing and still fail. We assume that the right course of action will, by definition, result in success. We are prospective Kantians and retrospective Utilitarians.