Tom Mueller

High-trust work environments engender group harmony, stress-free cooperation and personal joy — not to mention yielding more productivity and profits. In fact, trust is a critical ingredient of successful group cooperation, one of homo sapiens’ key competitive advantages, and is hardwired in human brains. Yet organizations routinely undermine employee trust through glaring misalignments between words and actions. Trust-busting can manifest itself as institutional hypocrisy (the gulf between our mission statement and what we actually do), or as C-Suite impunity (the gap between our mission and how our CEO behaves). Many office cultures encourage employees to question their bosses or blow the whistle on wrongdoing, yet stigmatize or fire them when they do. Organizational red flags abound: “anonymous” whistleblower hotlines that funnel disclosures straight to human resources, and compliance departments which report to the firm’s general counsel rather than to the Board, are legion. Tom’s reporting in the intersecting fields of whistleblowing, institutional corruption, neuroscience and evolutionary psychology, together with his personal experience in investment banking, yield unique perspectives on how to build organizational trust through techniques like increased workplace autonomy, sharing of strategic information, celebrating excellence, and balancing group cohesion with collective conscience.

Whistleblowing is a vital act of free speech and of citizenship, in corporations, government offices, nonprofits, academia, religious institutions, and other realms. Blowing the whistle is protected by a growing number of US and EU laws, which encourage insiders to report misconduct within their organizations. Nevertheless, even whistleblowers who call out massive fraud and human harm routinely suffer savage workplace retaliation, and long-term blackballing within their industry. Corporate compliance departments, government offices and courts of law—all formally required to protect whistleblowers—are often strongly biased against them. Tom’s dramatic whistleblower sagas, some captured in his award-winning book Crisis of Conscience, illustrate how the ongoing war being waged over whistleblowing represents a fundamental struggle between free speech and corporate loyalty, between civic duty and organizational obedience.

A Grand Canyon-sized gulf has opened up between the ethical behavior expected among private individuals, and the ethical norms that govern public and professional life: between what is considered acceptable among individuals, and what is customary—even obligatory—in large organizations. Recent research in behavioral economics, cognitive bias, social psychology, agency theory and other fields reveal how organizations normalize financial conflicts of interest, institutional corruption, and socially harmful behavior. High-pressure work environments, both public and private, that are guided by “transcendent” mission statements and “visionary” CEOs often induce basically good individuals to perform evil acts. Some compliance and risk management departments are little more than government-sanctioned shields to protect individual executives from the negative legal consequences of their collective wrongdoing. Realigning corporate and personal ethics, corporate personhood, and the individual conscience, will be essential for the future wellbeing of democracies and societies.

AI is not, as many argue, a medical panacea, but a double-edged sword. To be sure, powerful computers crunching huge data sets are opening exciting new frontiers. Whole-genome sequencing is enabling radically individualized diagnoses and cures; neural-network-driven pattern recognition is beginning to spot skin cancers and read scans better than humans. The “deep phenotype,” an expansive digital composite of an individual’s DNA and RNA sequences, epigenetics, immunological record and more, is on the horizon. Yet serious questions remain about how widely such methods will be applied, given that the creation of solid data sets will be complicated by privacy concerns and intellectual property barriers. At the same time, AI is already being used by insurance companies to deny medical care for certain conditions, and personal data is vulnerable to hackers and other malicious actors. More fundamentally, the advent of AI threatens to accentuate one of the central problems of medicine since the advent of high-tech medicine: the degradation of the all-important human bond between patient and healer. Indiscriminate use of AI will reinforce the almost robotic response to patients on the part of many MDs, which has arisen since the advent of diagnostic machines, electronic health records and other digital wizardry — a process of alienation that not only disempowers and demoralizes patients but has led to unprecedented levels of physician burnout and exodus from the medical profession. Making AI not the replacement but the trusted servant of skilled medical professionals, freeing them to become compassionate caregivers for their fellow humans rather than distracted screen-watchers, is one of the great challenges of 21st-century medicine.

In his explosive new book How to Make a Killing, Tom unveils the dialysis industry as a graphic microcosm of America’s healthcare system as a whole — a system in financial, social and moral crisis. Back in 1980, America spent around 9% of its GDP on healthcare, in line with other OECD nations, and enjoyed strong medical outcomes. Today America spends over 18% of GDP, yet its medical outcomes have fallen to the bottom of the OECD. Private equity buyouts of entire swaths of American medicine, currently under intense congressional scrutiny, are just the latest phase of a finance-driven takeover of the medical profession that began in the late 1960s, and that routinely places profits before patient care. Tom’s work highlights the tensions between acute care and preventative medicine (the latter vastly less profitable); between financialization and medical ethics; between corporate power and the overall wellbeing of the body politic. All issues that revolve around a central question: should healthcare in America remain the privilege of a wealthy few, or should it become a basic right of citizenship, as it is in every other developed nation? The UK and other countries that are actively questioning the viability of their national health schemes should consider America’s cautionary tale.