Values and leadership
BMJ 2002; 325 doi: https://doi.org/10.1136/bmj.325.7376.1352 (Published 07 December 2002) Cite this as: BMJ 2002;325:1352All rapid responses
Rapid responses are electronic comments to the editor. They enable our users to debate issues raised in articles published on bmj.com. A rapid response is first posted online. If you need the URL (web address) of an individual response, simply click on the response headline and copy the URL from the browser window. A proportion of responses will, after editing, be published online and in the print journal as letters, which are indexed in PubMed. Rapid responses are not indexed in PubMed and they are not journal articles. The BMJ reserves the right to remove responses which are being wilfully misrepresented as published articles or when it is brought to our attention that a response spreads misinformation.
From March 2022, the word limit for rapid responses will be 600 words not including references and author details. We will no longer post responses that exceed this limit.
The word limit for letters selected from posted responses remains 300 words.
At the end of his interesting "rapid response", Peter Morrell asks:
"Who really needs a 'leader' for any good purpose in life?" Could Peter
Morrell give his own answer to this fundamental question?
Competing interests:
I generally appreciate reading Peter Morrell's "rapid responses"
Competing interests: No competing interests
Sir,
A few informative field notes about that infamous BMJ cover picture
and the editor who chose it, defended it and refused to apologise for it:
“Once at the helm, Hitler moved swiftly to eliminate rivals and
opponents.” [1; 970] Churchill described him as “this evil man, this
monstrous abortion of hatred and defeat.” [2; 621]
“Stalin is the clearest example in history of a pathological criminal
who rose to supreme power through the exercise of criminal talents.” [1;
959] As a “manipulator of political power, Stalin has every claim to be
judged the greatest man of the twentieth century.” [1; 960] He “proceeded
with a masterful display of cunning and cynicism…outmanoeuvred all his
senior rivals…and acted to discredit them…ruin them…or kill them.” [1;
960] Churchill described him as: “at once a callous, a crafty, and an ill-
informed giant.” [2; 621]
By contrast, Gandhi was a pacifist, a humanist, a simple religious
man, who lived humbly and made his own clothes, a “passionate advocate of
non-violent resistance…and civil disobedience through passive resistance
and hunger strikes…he struggled for reconciliation between Hindus and
Moslems and championed the cause of…Hindu ‘untouchables’…” [3; 229]
Mandela, a political prisoner for 26 years, was a “South African
lawyer and nationalist leader…who helped to dismantle apartheid and was
elected president in the first free elections in 1994.” [3; 296]
Many readers have found it unfair if not outrageous to blur the
boundaries between humane political values like free elections, non-
violent resistance and reconciliation, in the same article [or letters],
with those of murdering rivals, the cynical manipulation of political
power and the exercise of criminal talents. It is impossible to associate
Smith’s words: “never explain and never apologise…I'm wholly
unapologetic,” [4] with Gandhi or Mandela, but they resemble the callous
arrogance of Stalin and Hitler. Though he opines, “if I were fired as a
result [of placing such pictures] I'd suffer financially,” [4] yet clearly
he would never suffer as much as those poor human lives callously snuffed
out by Stalin or Hitler. Smith seems happier to be associated with despots
than benign democrats like Mandela and Gandhi. If he strongly objects to
this view, then he “may find it interesting to look deep in himself and
wonder why.” [4] Smith either must choose his ‘friends’ a little more
carefully, or be judged by the friends he does keep.
It is tempting to draw some moral lesson from all this. People
generally get into positions of power more by design than by accident.
They are certainly likely to be there by ruthlessly eliminating rivals,
and by barefaced cheek and ego rather than by possessing any genuine
talent. Indeed, it seems axiomatic that all ‘leaders’, as a breed, are
like this. Good leaders [almost an oxymoron] are very rare and at best can
attract talented people around them, even if lacking any talent
themselves. Also axiomatically, people who aspire to and lust after
powerful jobs often get there by destroying others and thereby render
themselves the least suited both as role models to others or as people
possessing humane leadership skills. New evidence for this aspect has just
emerged in an interesting little handbags-at-dawn spat between two rival
medical editors: "editors have too much power and they sometimes mis-use
it." [5]
The most talented people in all fields tend to be anonymous, of
modest means in no positions of power [examples: Blake, Chopin, Van Gogh].
They fail to gain recognition, or successfully avoid it, by being too busy
with their brilliance. They are often indifferent both to power and to
wealth. Therefore, we can safely ignore the incoherent rants and ramblings
of so-called leaders as the inappropriate views of talentless fools and
plough our own furrow in life, confident that this is the right path for
us: a path of good heart rather than a path of ego, domination and self-
aggrandisement. Rare indeed are charismatic and gentle leaders like
Gandhi, Churchill and Mandela who inspire their people through acts of
kindness, reconciliation, magnanimity and forgiveness rather than
deranged, hateful or divisive rants.
The whole concept of ‘leadership’ is thus problematic, both for the
egomaniacs who need that particular ‘drug’ to get them through their
lives, and for the toadying fools who need to be told by others what to
say, feel, think and do. Who really needs a ‘leader’ for any good purpose
in life? People should think for themselves and make decisions by
democratic agreement or be autonomous.
Sources
[1] Norman Davies, Europe - a History, London: Pimlico, 1994
[2] Sir Isaiah Berlin, The Proper Study of Mankind: an Anthology of
Essays, London: Pimlico, 1998
[3] Geddes and Grosset, World History, Lanark: Geddes & Grosset,
1996
[4] Richard Smith, editor of BMJ, e-letter, The editor refuses to
apologise, 7 December 2002
http://bmj.com/cgi/eletters/325/7376/1352#27653
[5] Richard Horton, BMJ letter, Thanks for a great lunch, (21
December 2002)
http://bmj.com/cgi/eletters/325/7373/1124#27966
Competing interests:
None declared
Competing interests: No competing interests
Sir,
I am reliably informed by one of your vigilant readers, that I have
spelt "Gandhi" incorrectly, as "Ghandi". Apologies.
Phillip J. Colquitt
December 22, 2002
Competing interests:
None declared
Competing interests: No competing interests
Sir,
As an abstainer from meat eating, I was struck by seeing Hitler and
Ghandi, both vegetarians, on your cover(Dec. 7 2002) - how can two
vegetarians have such competing interests?
Phillip J. Colquitt
New Farm, Queensland, Australia.
Competing interests:
None declared
Competing interests: No competing interests
At first glance, I was surprised to see a picture of Hitler on the cover of BMJ. At second glance, I was shocked to see that he was in the company of Ghandi and Mandella. At third glance, I was horrified to read the caption below their pictures. While the cover was apparently developed to provoke thought and conversation, the choice of wording was in very poor taste. Publication covers should be designed to provide information and to encourage the reader to open the issue. Your cover did encourage me to open the publication; however, the information presented on your cover was misleading. I initally read the caption below the pictures as a "positive" statement, which infuriated me. After staring at the cover for a longer period of time, I came to understand what information the designer was trying to convey.
In a world where information is available more quickly than we can take it in, many readers do not have the time to take a second look. May I suggest that the covers of future issues be developed to provoke conversation without causing the reader to question the integrity of your publication.
Competing interests:
None declared
Competing interests: No competing interests
At the risk of prolonging this rather unfortunate discourse, I would
like to express my support for the Editor in his decision to place
photographs of Hitler and Stalin alongside those of Mandela and Gandhi on
the BMJ cover (Dec 7, 2002). The ostensible purpose for doing so was to
catch reader attention and force one to confront the issues of leadership
and health. Although it detracted from the accompanying article, I believe
he did succeed in this endeavour and many readers who are now baying for
blood, have missed the point entirely. I see no sensationalism in this,
but perhaps an accompanying piece with a different slant may have been
more appropriate.
Hitler and Stalin, despicable as they may be, were indeed leaders of
their times and had a wide following within their constituencies. That their
brand of “leadership” wrought havoc upon mankind in general and their
subjects in particular, is also a fact of history and has been repeated
sickeningly since. Richard Smith could have just as well placed
photographs of Idi Amin, Radovan Kradzick or Slobadan Milosovic on the
cover of BMJ, the point being that nations sometimes do not just deserve
the leaders they get, but a cruel twist of fate can thrust tragedy upon
them through the acts of tyrants and bigots. In contrast, the vision and
courage of leaders like Gandhi and Mandela can offer hope where few can
imagine, and can lift the spirit and aspirations of mankind. Does the
above analogy offer any pointers to the way many national or global health
systems are structured and operate under dictators and despots? I believe
it does.
Despite a steady stream of scientific discoveries as well as progress
in genomics and biotechnology, global health is in disarray today. Not
only is inequity and increasing, but in many parts of the world HIV, multi
-drug resistant tuberculosis and malaria are wiping out a full generation.
To allow this to continue unabated is no different from willful genocide.
Apart from lack of resources, in many parts of the world morally bankrupt,
corrupt and inept leaders (both political and bureaucrats) underlie much
of the health problems of the developing world.
This crisis of leadership is by no means limited to developing
countries. It is also sobering to note that in the aftermath of 9/11, the
world has spent much more on arms and preparing for war than in supporting
development and promotion of global health. The yawning funding gap and
unfulfilled commitments made of the much touted Global Fund set up to
fight TB, HIV and malaria, is no secret. Today the sick and impoverished
of the world need a leadership in promoting global health and development
that blends the vision and courage of Gandhi and Mandela with the
pragmatism of Jimmy Carter. Thus if it takes a cover of the BMJ to make
the point and shock us into introspection ..... so be it!
Competing interests:
I work with all kinds of "leaders" in public health, and may be banned from their company following this note!
Competing interests: No competing interests
Dr Abhijit Chaudhuri writes: "No doubt,the BMJ will soon have Dr.
Harold Shipman on its cover…" He will perhaps be appalled to know this has
already happened-on the cover of our theme issue on what is a good doctor
and how can we make one. That cover evoked a similar response to the one
that included Hitler and Stalin. Our defence was that any such debate in
Britain in 2002 could not possibly ignore Shipman.
The broader question is "What are covers for?" Some readers would
seem to like them to be reserved for the good and the great. Being on the
cover of the BMJ would be akin to winning a prize. In my mind they are
there to attract attention and prompt people to read the particular
article and the whole journal. The ideal cover is visually striking,
relevant, and includes information that cannot easily be provided in
words. It would also prompt thought. It's very hard to create a cover that
scores highly on all measures.
The cover that included Gandhi, Mandela, Stalin, and Hitler scored, I
judge, 7/10 for visual impact, 5/10 for relevance, and 2/10 for including
extra information. It may, however, have scored 8/10 for prompting thought--even if many of those thoughts were unpleasant ones.
Richard Smith, editor, BMJ
Competing interests:
I am responsible for the cover that has caused such debate.
Competing interests: No competing interests
There is no difference between the commercial sector and the NHS
sector if looking at salary rises and bonuses of executives even when
performance and success is mediocre or performance poor. For example, in a
major teaching hospital in London a remuneration committee awarded its
chief executive a rise of 11.1% (£135,000 in 2000/01 to £150,000 in
20001/02) despite the trust sustaining a deficit of £1,303,000. This was
admittedly not considered material by the auditor and allowed the trust to
pass the breakeven duty as it was only a 0.42% deficit rather than
greater than the 0.5% that would have resulted in failure to hit the
statutory breakeven duty. The trust did have a support payment of
£6.7million to achieve the 0.42% deficit. The Department of Health's own
pay guidance for executives for the year was a 3.7% increase of the total
senior managerial pay bill with the ability for more than 3.7% for
individuals depending on performance. The question in this case is, was
the performance worth 200% more than the guidance limit?
Is there really a difference between the NHS and the commercial world
where Patricia Hewitt, the Trade and Industry secretary, is now looking at
possible legislation to limit the excessive rises awarded by remuneration
committees in the face of mediocre or poor performance? Should awards be
limited and more strictly monitored and controlled in the NHS to allow
more funds for frontline care and NHS modernisation as was indicated one
year in one of the Department's pay guidance letters? Auditors are only
obliged to note if executive pay is in a report not the size of awards or
that it complies with the government's guidance or even if the
remuneration committee decision making was valid. Are the actions of
remuneration committees, such as the one above, displaying good leadership
or do they simply encourage higher pay demands from other NHS staff groups
that could lead to inflationary pressures for the whole country? Good
leadership is partly about setting high standards of professional
behaviour and good examples for others to follow.It's also about using
common sense.
Competing interests:
None declared
Competing interests: No competing interests
Dr. Richard Smith's defence of his choice of the leaders only
reflects his very confused thinking on this issue. The pictures, I assume,
had some relevance to the published BMJ article on "values and
leadership". Dr. Smith ought to have known from his business school that
there is a subtle difference between self-proclaimed leaders who were
dictators and the true leaders who believed in freedom, equality,democracy
and justice for the people they led. The picture of Hitler on the book in
Dr. Smith's shelf depicted Hitler's monumental relevance to the modern
history and not his values as a "leader". Hitler and Stalin had campaigned
for sectarian hatred, death and destruction; not for the values of life
that medicine tries to preserve and protect. Surely, Dr. Smith would not
commend Hitler's medical "leadership" for his role in authorising the most
unethical human experiments ever conducted in the research laboratories.
Medicine is all about caring for people irrespective of their class
or creed. This was not what Hitler or Stalin ever did. They killed people
to show their power and to stay in power. Dr. Smith's logic that Hitler or
Stalin may have some form of a role model in the health care system
because of their power value is obscene and perverse.
Dr. Smith needs to educate himself more about Hitler and Gandhi
before he
realises why he should apologise. And the fact that no one has ever
objected to his selection of this picture is not an excuse (probably a sad
reflection of the intelligence of his audience).
No doubt,the BMJ will soon have Dr. Harold Shipman on its cover for
any debate on euthanasia.
Competing interests:
None declared
Competing interests: No competing interests
Re: Re: Judging editors by the friends they keep
Some quotations that might throw light on Joseph Watine’s request
[1]:
The man “who needs a master is an animal; as soon as he becomes
human, he no longer needs a master.” [2] Leaders are much like systems,
they “are mere prisons of the spirit…monstrous bureaucratic machines,
built in accordance with the rules that ignore the teeming variety of the
living world, the untidy and asymmetrical inner lives of men, and crush
them into conformity for the sake of some ideological chimera.” [3]
Sources
[1] Joseph Watine, Re: Judging editors by the friends they keep, BMJ
e-letter, 24 Dec 2002
http://bmj.com/cgi/eletters/325/7376/1352#28123
[2] Herder quoted by Sir Isaiah Berlin, in The Proper Study of
Mankind: An Anthology of Essays, ed. Henry Hardy and Roger Hausheer, with
a foreword by Noel Annan and an introduction by Roger Hausheer, London,
1998: Pimlico, page 378
[3] Isaiah Berlin, The Proper Study of Mankind, as above, 250-251
Competing interests:
None declared
Competing interests: No competing interests