The Nightingale Project

         

             

             Clay Johnston is a businessman and physician and was the first dean of the Dell Medical School at the University of Texas, the position from which he retired a few weeks ago. The custom of heaping praise on a departing high-ranking academic can be skipped entirely in Dr. Johnston’s case, if you’re a member of a minority group in Texas—because outcomes have not been good. 

            When Dean Johnston started out he made no promises in that regard, actually. In an interview as he took the position of Dell dean five years ago, Dr. Johnston refused to be held to any firm numbers regarding diversity in the student body. And a good thing too, because he did a poor job on this crucial front of minority access to health care, on both ends, as patients and as practitioners. He and his right hand Vice Dean Mini Kahlon have been absolutely M.I.A. on race during their tenure in Austin. At the conclusion of last semester the Dell website announced that the proportion of minorities in class was 17 percent. In a state that is more than half black and brown. Shame, and shame again.

Interestingly, however, at the time of the interview when Dr. Johnston refused to commit, so to speak, lo those five years ago, he criticized the diversity profile of the institution he had just left, the University of California San Francisco, the most prominent health-related public university in the world. “I’m certainly not going to defend UCSF and its track record,” he said, rather huffily, at the time of is hiring at UT. “We both know it needs to be better.” It is better, actually—better than Dell’s. 

Dean Johnston promised to create in Austin a new and fairer way of choosing students—through greater emphasis on interviews and on non-traditional backgrounds. That hasn’t happened. Upper middle-class white male has long been the norm in American medical schools, previously it was white guys but now at Dell it’s a lot of white girls. As incoming dean, Dr. Johnston also promised to evaluate potential students’ problem-solving skills instead of relying merely on test scores and grades. But the faculty members who judge the students for admission are still white, as is two-thirds of Dell faculty (black and brown faculty membership is 12 percent), including a key administrator who is a white South African physician, an odd choice to assure increased diversity for blacks and Latinos in health care in the Lone Star State. That means the same old outcomes are achieved as previously, or worse. 

Of Dell Medical School’s 14 department chairs, under the good Dr. Johnston, 11 are white and three are Asian, again in a state that is more than half black and Latino and, the U.S. Census just reported, is getting blacker and browner every day. The context of Dr. Johnston’s time at Dell has to be considered as well, if one is interested in these poor outcomes for minorities in admissions. He came on board (as dean and as UT vice president of medical affairs, at a salary of $750,000 a year) at a time when the university was reeling from an admissions scandal, an issue that may be particularly pertinent here. The then-university president was found to have offered places to unworthy undergraduates who were politically-connected to Texas elites.

A second admissions scandal erupted three years into Dean Johnston’s tenure—code-named “Operation Varsity Blues” by the FBI—involving eight major higher education institutions, across the country, including UT but not the medical school. A corollary question arises therefore, given this history, and given what should be higher numbers of minorities at Dell Medical School. What are the chances that these very prestigious and very sought-after places, at Dell Med, have been awarded in some cases to the well-connected, as has happened in the past at UT and at UCSF also, btw, whence Dean Johnston came? It’s not beyond the realm of possibility. Considering the university’s non-diverse past, you might say. 

Although former Dean Johnston criticized his ex-employer the University of California, a lot of faculty at Dell are actually ex-UCSF, including the above mentioned Associate Dean Kahlon. Before and during the pandemic there’s been an exodus from San Francisco to Austin and also from UCSF to Dell. The danger here is that while people flow from the University of California, so does the culture in Baghdad by the Bay, which is not good. An NPR report recently quoted a former UCSF medical student saying that he was still hearing black patients referred to as niggers on rounds there just a few years ago. There’s also a lot of UC propaganda in cyberspace, which is a sign that administrators know there’s a problem but are trying to hide it. For example the University of California’s common practice is to show photos of happy-looking isolated black students on its website, to make the student body appear more diverse than it really is—a practice that has been adopted wholeheartedly by Dell. Bad behavior has flowed from Texas to the Bay Area also. UC System’s Executive Vice President for Medical Affairs, Dr. John Stobo was fired for sexual harassment of an assistant just last year. He arrived at UC from UT Medical Branch on Galveston Island where he was president (John Stobo’s signature is on my nursing diploma from Medical Branch, btw, for the record.) And then there’s Dr. Johnston himself, who has shown a particular talent for ethical not sexual compromise.

While still at UCSF, the Dell ex-dean authored a paper arguing the novel position that prices for medicines are not high enough and he co-authored another in which he bemoaned conflict of interest accusations against medical researchers. 

That is Dr. Johnston's legacy, you could call it, at the University of California San Francisco. His favorite business case, btw, when he's presenting papers or giving talks, is the growth of the American railroad industry, back in the day, during the Industrial Revolution or whenever, and he likens that history to American medicine today. Here in the Live Music Capital of the World, among his first efforts was the unsuccessful attempt to lure pharmaceutical giant Pfizer to the city in order to harvest healthcare data from minorities.

Traditionally one of the biggest holes in Big Pharma’s data resources involves blacks, Latinos and Asians, while whites are overrepresented. To design treatments and meds, companies like Pfizer need as much representative data as possible, and that means minorities need to be in the mix. And it is there that Dean Johnston’s reputation and his legacy at Dell Medical School may have just been rescued by history. Pfizer took a lot of heat and eventually dropped plans for a hub here but was soon replaced in the enterprise by Google Health and its Nightingale Project. With an assist by Dell Medical School and the good Dr. Johnston, who has done what he was brought in to do, basically, to create a Big Medicine-UT axis, which may help to save all of our lives one day, actually, whether Dean Johnston is a good guy or not. 

He was brought in to do a job—to establish the university’s business ties with Big Pharma or Google, or whoever, as the case may be, like back in the day with the railroads and the Robber Barons and all that—and let’s all hope he got it right. 

Specifically, Dell Medical School and its partner Ascension Seton, which is a Catholic non-profit and operates a dozen hospitals in the Austin area, have teamed up with Google to transfer information on patients. Everything from zip code to hemoglobin level, for Big Data analysis. Before the pandemic this agreement was made public—revealed by the Wall Street Journal just before Covid broke out, to widespread horror on the part of privacy activists. This Big Data agreement was considered yet another Big Tech invasion and an attempt to profit from patient information. Which it was, in another era. But since the pandemic the ground has shifted under everyone’s feet. As we enter the second wave of Covid-19, one can only hope that data is flowing like the Mississippi, from hospitals and labs. The danger of the dreaded Big Tech-Big Medicine hookup, facilitated by academics like Clay Johnston—the Nightingale Project, as the endeavor is called by Google, or by any other name—pales in comparison to the danger of the next virus, which could feature a more virulent strain or a faster-moving outbreak. Big Pharma (Pfizer, Moderna, Johnson & Johnson and others, companies synonymous with the vaccine makers) have actually performed well in the COVID-19 crisis. You have to give the devil his or her due.

A lecture delivered last semester at UT by a Big Pharma scientist revealed that the Moderna vaccine was designed in a day-and-a-half—with the succeeding months, before rollout, spent on testing, production, and regulatory approval. The Nightingale Project preceded the pandemic, and was a bad idea then, but it’s a great one now, hopefully Dr. Johnston took care of business, like the professional he is. There is a risk that Google or whoever will become even more powerful, through access to raw patient data, much of it from minorities—who are being denied access to seats in the Dell Medical School, by the way, not that there's anything wrong with that. But that risk can be lessened by de-identifying healthcare data and making it a public good, free to everyone. The fear of medical data release—like the fear of masking and of vaccination—is real and may be just as deadly.