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Darwin's Medicine blog

Professor Brian D Smith is an authority on the pharmaceutical industry and works at SDA Bocconi University and Hertfordshire Business School.

C-Suite keystones

By Brian D Smith


Both business and biology are complex, right? I don’t mean complicated. (Let’s just take that for granted, shall we?) I mean complex, in the sense of complexity theory.

In other words, there are just so many different things going on and interacting with each other that it’s naïve to say, ‘x causes y’. In genetics, for example, we’ve learned that there’s rarely ‘a gene for x’. Similarly, my research shows that business success is usually attributable to many things. But are there exceptions? Might there be business equivalents of genes that are disproportionately significant? Two recent experiences have got me thinking that there might be.

Two kinds of CEOs
While researching my book Leadership in the Life Sciences, I interviewed a whole series of CEOs from pharma, medtech and other life sciences companies. All the interviews were fascinating but one stuck in my mind. The CEO of a family-run, medium-large firm was passionate – perhaps angry would be more accurate – when he told me that there were two types of CEOs. In his view, there are those whose mission was human health and well-being and managed return on investment as a means to that end. Then there are their mirror images; those for whom financial returns were the goal and for whom human well- being was a means to that end. My informant saw himself as the former type of CEO and his disdain for the latter was barely disguised. Now, I’ve no doubt that this impassioned characterisation was a simplification, but it was borne out by subsequent research. I’ve interviewed CEOs who see their position as a ‘force multiplier’ that allows them to help more people than if they had stayed a scientist or doctor. And I’ve met others whose focus on financial metrics dominated how they viewed everything else. To be clear, I’m not making a value judgement here. Academics try not to do that. But the ‘two types of CEOs’ observation seems a reasonable approximation to the truth and, ever since those interviews, I’ve wondered how to understand it better.

Keystone genes
If you trained as a scientist, you would know what I mean when I say that theory frames your thinking. You can’t get a microbiologist to not think about germ theory and you can’t get a cell biologist to not think in terms of cells. My own understanding is framed by Generalised Darwinism and the idea that there are the business equivalents of genes. If you’ve read my work, you will know that these are called ‘organisational routines’, little sub-processes for getting things done. In Darwinist thinking, both genes and routines are ‘replicators’ because they store information about how to do things and they can be copied. So when I think about the two kinds of CEOs, I naturally think about how their routines differ, just as a biologist would look for genetic differences between organisms.

This was on my mind as I listened to the always excellent ‘Big Biology’ podcast, which featured Professor Matt Barbour’s work on keystone genes. Without getting into the weeds, these are simple genetic variants that have a disproportionate impact on a phenotype and its ecosystem. Professor Barbour’s work found keystone genes that shape plant defences and therefore the surrounding insect food web. If you’re into the science, it’s fascinating but it focused my mind on what keystone routines I might see in the C-suite of life sciences companies.

Financialisation alleles
I’ve kept both Barbour’s work and my passionate CEO’s ‘two types’ model in my head as I have continued to study life sciences business models. It’s early days, but I do think that it’s possible to differentiate between two different routines – alleles if you like – in the C-suite. They can be seen in the way that big investment decisions are made and, especially, the way that evidence is framed, weighed and acted on. Both alleles consider financial and patient outcomes of course and both filter out choices that would be clear clinical or economic failures. The difference comes in borderline cases. One allele weights patient outcome higher, the other favours economic returns. What’s interesting to observe is how even rigorous and objective analyses can be shaped by the CEO’s cognitive biases and habits. These seem to be associated, to some degree, with the CEO’s business and scientific background.

CEO compatibility
So what might this mean in practice? When asked about the practical implications of keystone genes, Barbour points to possible applications in agricultural science. I think there may be analogous implications for the life sciences industry. Investors who want to have an impact on patient well-being might recruit CEOs who exhibit the patient- centric routines. Conversely, those focused on returns should focus on CEOs with the other, financialised, decision routines. Equally, senior executives joining a company might consider their compatibility with the CEO. The CEO’s ‘routineome’ may not be the only thing you consider but you probably shouldn’t ignore it.

Professor Brian D Smith works at SDA Bocconi and the University of Hertfordshire. He is a world-recognised authority on the evolution of the life sciences industry and welcomes questions at

Professor Brian D Smith works at SDA Bocconi and the University of Hertfordshire. He is a world-recognised authority on the evolution of the life sciences industry and welcomes questions at

21st November 2022

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