THE JOURNAL OF LEADERSHIP APPLICATIONS
Vol. 8, No. 4
(626) 350-1500 Ext 102
“Extraordinary achievements demand extraordinary leaders.“
Primum Non Nocere: Above All Do No Harm
© 2010 William A. Cohen, PhD
Adapted from Drucker on Leadership (Jossey – Bass, 2010)
Peter Drucker summarized what he expected from the leader with what he said originated from the Hippocratic Oath: the Latin, primum non nocere. In plain English this is translated as “above all, do no harm.” However, as we will see, Drucker was only partially correct in his description of the origin of this cautionary instruction.
Hippocrates was a Greek physician born in 460 BC on the island of Cos, Greece. As Peter Drucker is known as “The Father of Modern Management,” Hippocrates is known as the “The Father of Medicine.” In the ancient world Hippocrates was regarded as the greatest physician of his day, or at least in the known civilization in the West. As Drucker looked at a business, Hippocrates looked at a patient and based his diagnoses on his observations. This was a breakthrough at the time. Hippocrates rejected the common views of his age that considered illness to be caused by evil spirits or the disfavor of the gods. He shared other commonalities with Drucker methods. Hippocrates believed that the body must be looked at as a whole and not just individual parts to be analyzed, diagnosed, and treated separately. He observed disease symptoms and consequently was the first to accurately describe and catalog indications of various illnesses. He developed the Oath of Medical Ethics, now known as the Hippocratic Oath for physicians to follow as their ethical and moral code. Its impact is confirmed by the fact that it is still affirmed by most physicians practicing western medicine today as they begin their medical practice. Hippocrates himself lived a long life, especially for ancient times, dying in 377 BC at the age of 83.
The Hippocratic Oath and Primum Non Nocere
The Hippocratic Oath is said to be one of the oldest binding documents in history. While some of its principles are considered inappropriate for modern medicine, the Oath is still held sacred by doctors and almost all U.S. medical schools administer it to its graduates. According to the American Medical Association, the Oath “has remained in Western civilization as an expression of ideal conduct for the physician.” However the statement “above all do no harm,” is not mentioned as such in The Hippocratic Oath. About the closest one comes to it are the words. “I will apply dietetic measures for the benefit of the sick according to my ability and judgment; I will keep them from harm and injustice.”
There is a great deal of controversy about the origins of the phrase, “above all do no harm,” but there is a significant connection to Hippocrates in that a closeapproximation to the phrase can be found in the Hippocratic Corpus: “to help, or at least to do no harm.” This comes from Epidemics. Epidemics, or Of the Epidemics which was also written by Hippocrates. Accordingly we can forgive Drucker this slight inaccuracy since it is the concept primum non nocere, and not the text from which it is drawn, that is important. Hippocrates was cautioning that the physician must consider the possible harm that any intervention might do. Drucker expands this to mean that the leader must consider the possible harm that any act he might do might cause the mission, the organization, its members, or society. Moreover, he considers this that should be the ultimate guide for the leader in ethical conduct . Although a simple reading of Drucker’s advice may give the impression that following it is easy, this is not so. Frequently the well-intentioned acts of leaders can do precisely what Hippocrates and Drucker cautioned against: that is, to do harm. And the harm done can be much greater than the good originally sought. So while seemingly a simple rule to follow, like other simple rules, it is not always easy.
Ensuring Primum Non Nocere
There are several ways that leaders can, with the best of intentions, cause harm to the organizations or others and thus fall into this ethical trap. Most start with the best of intentions: to make some situation better through a positive action. In many cases, the focus of the leader or leaders is so much on the one good intention that the system being altered is not considered as a whole. Another words, the focus is on a body part instead of the body and as a result while “the part” may be better, the solution may have the exact opposite result in tended on the body; that is the organization, its members, or society.
Moreover, Drucker taught that good intentions were of themselves not socially responsible. This of course is true of accepting social responsibilities which hurt the organization’s ability to accomplish its mission. However, it is more common, and even more serious, for organizations to take actions with the intent of improving a condition, frequently a social condition, only to result in tremendous and unintended negative impacts – all due to ignoring this basic concept.
Pollution from motor vehicles has received a lot of attention over the last thirty years. Despite this, you will see some quiet modification of the strict policies in coming years despite the outcry for even more strict control. To eliminate, or at least reduce pollution, both states and the U.S. government passed laws limiting the emissions that an automobile can emit and be allowed on American roadways. Even the Sierra Club, perhaps the most vocal environmental advocate in the United States, admits that today’s American automobiles emit 90% less pollution than those cars manufactured in the 1960’s. Yet today, we have more pollution in American air from automobiles than ever before, even though many foreign cars not manufactured for the American market or extensively modified, can’t meet U.S. standards for pollution emission. The Sierra Club states that the reason for these results is that technological improvements to reduce emissions have mostly been offset by the increases in number of cars on the road, the number of inefficient light trucks and sport utility vehicles in use, and the number of miles driven each day. This is partly true. However, this explanation ignores another important factor in the system. The use of pollution emission reduction devices on automobiles has a negative effect on fuel economy. So even if a car drives the same number of miles, it burns additional fuel in order to do so. Therefore, for a given number of miles, more fuel must be produced. This requires more oil to be refined for this car to drive the same number of miles. Oil refining is a much greater potential source of pollution than automobiles. So more refining must be accomplished, and thus more pollution will result for the car to drive the same number of miles, unless refining pollution is also reduced. It’s all part of the body or system. Unintended consequences due to good ethical intentions are frequently negative and counterproductive if not thought through using a primum non nocere criterion.
Look Before Leaping
In the 1990’s, the country was in the midst of the quality revolution, which had some good results, and unfortunately quite a few bad ones too. In the enthusiasm for the new “revolutionary” focus in which the emphasis was to be on the process and not on the outcome, some leaders violated every principle of management and leadership learned over the past seven thousand years and eagerly followed consultants who certainly knew less than they did.
One division of a major corporation surprised several thousand employees when they came to work in the morning. Without prior warning the employees were greeted by waiting busses and instructed to climb aboard. The buses took them several miles away to a large aircraft hangar. The movement bore all the signs of a mass kidnapping and no one except those behind this action had any idea of what was going on. On arrival the employees were disembarked, gathered together, and told that they were all fired. However, if they wished (I repeat these words tongue in cheek) they could apply for rehiring if they could justify their work position or restructure it such that it was justified to upper management. With consultants and human resource people advising, the company shut down for the day while the entire organization went through this rather bizarre exercise. I think the idea was to raise the productivity, the understanding of each member’s contribution, and where everyone fit in, get rid of useless jobs, and maybe even unproductive people. However, I was told by participants that it was a madhouse and little other than chaos and insecurity resulted.
Of course, the consultants had a preconceived template of how things should be, and the newly design jobs were structured into the template. Fortunately, the workers were less gullible and more practical than the company’s leaders and managed to work around the crazy quilt organization that resulted after this day of spirited, but confusing activities. Eventually things drifted back to normal, although the shutdown, affect on morale, and working around the Frankenstein monster created probably cost the company a bundle in productivity.
Did the company’s CEO intend to create such a mess? Of course not. To the contrary, he was an intelligent leader who wanted to establish his organization in the forefront of the new total quality movement. However in failing to look closely at what the so called “experts” were advising, he didn’t follow Drucker or Hippocrates. Though he sought to do good, he definitely caused harm. He probably forgot, or didn’t know about another of Drucker’s insights: reorganization is always major surgery and generally should only be attempted as a last resort.
Change for the Good without Looking Into the Future
Any leader, taking any action, assumes the responsibility for the outcome into the future. Such good intentions may be either from government, individuals, or corporations. Thus no leader in any organization is exempt. Drucker’s favorite example of this was the sad history of a Union Carbide plant, built by the company with the very best of intentions. But these leaders didn’t consider primum non nocere either.
Union Carbide is one of the oldest chemical and polymers companies in the United States which since 2001 has been a wholly owned subsidiary of The Dow Chemical Company. The company came out of World War II with a strong reputation for developing raw materials for the chemical and metals industries which help win the war. Expanding its capabilities and concerned with its social responsibilities, in 1951 Union Carbide decided to locate one its new plants in a depressed area where unemployment was a major social problem. After a search for a suitable geographical area that really needed Union Carbide’s help, the president’s staff thought they found exactly the right place. For various reasons, the area selected was uneconomical for manufacturing, and probably always will be. Nevertheless Union Carbide opened one of its most state of the art plants in a small isolated town and instantly, as if by magic, created 2000-2500 new jobs. It even installed the latest anti-pollution equipment which trapped 75% of the ash from its smokestacks, at a time when trapping 50% was the best anyone else could achieve. Union Carbide got a lot of publicity and was considered a corporate hero when the plant opened. However, its accomplishment was not appreciated for very long. Ten years later the country had become much more aware of the dangers of pollution. A new city mayor was elected on the platform, “Fight Pollution.” There was only one company in the area, and that was Union Carbide, and thus the only pollution came from the Union Carbide plant.
Union Carbide was hurt and amazed when attacked by the very people they had sought to help. So the company fought back. What was the matter with these guys, anyway? Didn’t they know that the only reason that Union Carbide came to the area was to do a good deed and to create 2500 jobs in a totally depressed area? Union Carbide defended itself vigorously with the area’s citizens. However, pollution had become a popular cause and the company soon found itself at war with the state government, the federal government, the environmentalists, and the media. All this, and the plant was barely economical! Union Carbide had only established the plant as a part of its social responsibilities. Its good intentions were done at considerable cost to the company. It certainly never set out to be a polluter and had even used the very latest anti-pollution equipment when it built the plant. It made little difference. The federal government made threats, and Union Carbide received little support from anyone, including those in the town who had previously benefited. The fight dragged on. Even the usually friendly business media did not support Union Carbide. Business Week published an article in February 1971 under the title, “A Corporate Polluter Learns the Hard Way.”
In frustration and probably some feelings of retaliation Union Carbide announced that the plant would have to be closed as it could not be brought up to environmental standards and remain economically feasible. Union Carbide couldn’t win that way either. Union Carbide was heavily criticized for this decision. Not only was Union Carbide a polluter, but the company didn’t care anything about its employees! Public opinion forced Union Carbide to keep the plant open at great cost to the company. Drucker’s conclusions were that Union Carbide could have avoided a lot of its problems by simply accepting responsibility when pollution became an important factor, but primarily that the plant should never have been built in the first place. Its location insured that any kind of plant built in the area would be uneconomical. The leaders forgot the basic rule of ethics which has no time limit: above all, do no harm.
The Great Housing Depression
As the housing problems of 2007 deepened into crisis in 2008, fingers of guilt pointed in all directions. The roots went back to the mid-1990’s and the very good and noble intentions of making ownership of homes open to all Americans, even those who could not get loans to buy housing in the past. So the laws were changed and the government, in the name of this good intention encouraged the mortgage industry to lower lending standards. As a part of this effort, The U.S. Department of Housing and Urban Development (HUD) formulated policies which fueled the trends toward issuing increasingly risky loans and directed Government Sponsored Enterprises that that at least 42% of the mortgages they purchased should have been issued to borrowers whose household income was below the median in their area.
Meanwhile, the economy and housing prices continued to expand. Laws were further loosened which permitted and even encouraged borrowers to borrow homes for not so much as what they could afford, but how much they could borrow. These practices also encouraged investors to borrow and to whenever and wherever possible to purchase in order to make money in a market that appeared to a certainty. In nine years, subprime loans rose by 1000%.
It was always assumed that a bank cares about whether the loans it makes are repaid, and that therefore it would carefully screen the potential borrowers. In the 1970s and 1980s, this was in fact the case. The bank that originated a mortgage usually held it long term and derived income from interest and from repayment of the principal. As a result, banks would create only those mortgages that were likely to be repaid. However, once the goal was established of permitting a greater percentage of the American population to become home owners, various financial innovations were developed and permitted which changed this. For example, mortgages could be broken into component parts so that the principal could be separated from the interest, and then the components packaged into securities by common characteristics such as maturity or perceived risk that could be sold separately in financial markets.
These various factors caused a number of results which should have been foreseen as potentially harmful, but were not. High yields in a time of low interest rates were very attractive to Wall Street and these mortgage-backed securities developed quickly into a large market. Nothing wrong with that except that many banks and specialized mortgage companies no longer held the mortgages they originated. The main source of revenue was the origination fee, not the repayment of mortgage principal or interest as had been true in the past. As a result, they were no longer concerned about repayment, but rather to make as many of these loans possible under the much more lenient laws.
So these very good intentions created a toxic mix of incentives which sooner or later would lead to real harm when “the bubble burst.” And if one interjects human greed which easily clouds judgment when “everybody’s doing it,” a major disaster was simply waiting to occur. On one side borrowers were encouraged to borrow and to purchase far more than they could afford. It seemed that they would even make money on these deals as housing prices went higher and higher. The lenders were encouraged to approve as many mortgages as possible since the market was so heated that they would be able to sell the mortgages in these packages before any repayment problems arose, even for clearly risky borrowers. At the same increasingly less regulated and easy financial controls, made it easy for borrowers, lenders, and financial investment institutions to profit — at least on paper — until everything came crashing down. Above all, do no harm! 
Applying Drucker’s Thoughts On Primum Non Nocere
· Good intentions don’t count for anything
· Beware of unintentional results
· Look before you leap, especially with new concepts and untested ideas
· Not doing harm counts in the future, too
· Keep doing what you’ve been doing successfully and eventually you are going to fail
 No author listed, “The Hippocratic Oath – Classical Version,” PBS- Survivor MD Accessed at http://www.pbs.org/wgbh/nova/doctors/oath_classical.html , June 5, 2008
 No author listed, “Automobiles: Mobile Pollution,” Sierra Club website, Accessed at http://www.sierraclub.org/field/southernplains/issues/air.asp .
 Drucker, Peter F., Management: Tasks, Responsibilities, Practices (New York: Harper & Row, Publishers, 1973) pp. 320-322.
 Vlasenko, Polina, “How Did We Get Into This Mess? The Origins of the Housing Crisis,” The American Institute for Economic Research, September 21, 2008, Accessed athttp://www.aier.org/research/commentaries/554-how-did-we-get-into-this-mess-the-origins-of-the-housing-crisis , January 1, 2009
 No author listed, “Subprime Mortgage Crisis,” Wikipedia, Accessed at http://en.wikipedia.org/wiki/Subprime_mortgage_crisis , December 1, 2009
THIS IS WHAT THEY’RE SAYING ABOUT THE BOOK
Bill Cohen’s Drucker on Leadership is the best collection of Peter Drucker’s unique insights, deep wisdom, and practical advice I have ever read. Cohen channels Drucker as only a three decades-long colleague and student can. You will find the lessons highly accessible, immensely enjoyable, and wonderfully fresh. – Jim Kouzes, Award-winning co-author of the bestselling, The Leadership Challenge
Cohen has written with clarity and authority about the major challenges facing leaders today. And Cohen, like Drucker, emphasizes responsibility and integrity in leadership, qualities so desperately needed today. I strongly recommend this book to you. – Joseph A. Maciariello, Horton Professor of Management, Peter F. Drucker and Masatoshi Ito Graduate School of Management and Co-Author of The Daily Drucker by Peter F. Drucker and Management by Peter F. Drucker
Cohen’s unique relationship with Peter Drucker, as student and friend, allows him to extract valuable leadership lessons from Drucker’s writings and teachings on management. Bill Cohen’s “labor of love” provides the essential lessons for leaders straight from the Father of Modern Management. – Ronald E. Riggio, Henry R. Kravis Professor of Leadership and Organizational Psychology, and director of the Kravis Leadership Institute at Claremont McKenna College
For those who aspire to lead – and we need a new generation of Drucker— like leaders in organizations in every country around the world — Bill Cohen distills the essential leadership lessons from the world’s greatest management thinker. – Ira A. Jackson, Dean and Professor of Management, Peter F. Drucker and Masatoshi Ito Graduate School of Management
Through a blend of anecdote and analysis, Bill Cohen has given us great insight into Peter Drucker’s thinking on leadership—an aspect of Drucker’s work that many have misconstrued or overlooked altogether. This is a new prism through which to view Drucker and, as such, a valuable contribution to the field. – Rick Wartzman, Executive Director, The Drucker Institute
What Cohen learned as Peter Drucker’s student, and their personal relationship afterwards, changed Bill’s life. Reading Drucker on Leadership will change the way you look at and apply leadership forever. – Bruce Rosenstein, author of Living in More Than One World: How Peter Drucker’s Wisdom Can Inspire and Transform Your Life
I read Dr. Cohen’s books in Chinese, and with the help of a translator, reviewed a draft of Drucker on Leadership in English. Peter F. Drucker helped me found the Peter F. Drucker Academy in China. It was a pleasure to see his concepts and what he instructed me brought together in one place and explained so that they could be applied by any executive. This is a valuable and useful book. – Minglo Shao, Chairman and CEO of the Bright China Group, Founder of the Peter F. Drucker Academy
For more information, contact me directly by e-mail at firstname.lastname@example.org or telephone (626) 794-5998. Yes we do give international seminars — The U.S. country code is 01.
THIS MONTH’S THOUGHT FOR LEADERS
To know what is right and not do it is the worst cowardice.