Bharat Krishna Discusses Ethics in Medical Research on The Balancing Act Podcast

Andy Temte: Welcome back to the Balancing Act Podcast. I’m Andy Temte. On the Balancing Act, we talk to business leaders and industry experts to explore the balancing acts we play in our professional lives and learn about the events that put rocket boosters behind their career success. Today, we have Bharat Krishna joining us. Bharat is the managing director at CITI Program, a global leader in online education with a focus on research ethics and compliance at over 2,500 institutions worldwide. He’s also served as general manager of Kaplan Test Prep International. So, as you know, we have worked together in the past. Welcome to the show, Bharat.

Bharat Krishna: Thank you, Andy. It is such a pleasure to see you again after a few years and I’m delighted to be on your show.

Andy Temte: Yeah, thank you. It is wonderful to see you again. Before we get started, we do this with all of our guests, please tell our listeners your story.

Bharat Krishna: Well, Andy, I think we met about 10 years ago, maybe a little bit longer, and I think we were doing the digital transformation at Kaplan Test Prep. If I remember correctly, you had just finished your transformation in the sense that the Kaplan professional division had gone almost fully online or really adopted online in those days. So, really, I was reflecting when I got this invite from you, the history and how much has changed in the last 14, 15 years and what a journey it’s been. I think Kaplan was a great place to interact with you.

Thank you for the invite to the show and I appreciate the book. I read it cover to cover eagerly and learned a lot from it. Actually, when I was reading it and we’ll talk about it as the show goes on, but I actually discovered that I’ve made some of those mistakes and found my way around the balancing act. So, I love the title of the book, and I’m really, really happy to be here.

Andy Temte: Thanks.

Bharat Krishna: So to answer your question on my story, I’ll try to keep it brief, maybe nature or nurture type quick intro. So, my X chromosome from my mom, a very, very businesslike, scientific, analytical, left-brained, super organized leader, manager type, and my Y chromosome from my dad’s side, creative, right-brained, emotional, a great writer, a very accomplished artist in his own right. My mom was a very accomplished scientist. So, for the first 10 or 12 years of my adult life, I think I had an internal conflict on seriously which side was going to pull for me. So, it was real interesting rollercoaster in retrospect.

So, I did an undergraduate degree in economics, so I went more my X chromosome side at the beginning as I was an economics major. Then I started a computer science degree and I did not complete that. So, I decided as I was starting that computer science program that that was not for me. So, I ended up leaving India in the early to mid-90s and coming to the US for grad school to media and a film school. So, I really swung from the X to the Y and I spent a couple of years doing that. I didn’t finish that either, Andy, but this was the early to mid-1990s and I must’ve been sitting in a library somewhere. I opened up Netscape Navigator for the first time. You know what I mean?

So really by story, it starts with the internet with a wide adoption of the internet. I was here in the US during the .com boom days, this very starting point of the .com boom days as this intersection between this science technical person and potentially creative person and really struggling with figuring out what I wanted to be. I ended up working in a lot of the .com early days with online transformation of businesses and online business models. I found my way somehow to PricewaterhouseCoopers, their e-business consulting group. I’d done a couple of things and I found myself there. I got introduced to someone and I was working for them.

So, I was doing online consulting, online business consulting, technology transformation consulting, and I did retail theme parks, very interesting work in my early days with PWC. PWC’s e-business consulting was acquired by IBM. So, I became part of IBM and worked with IBM for a few years and at some point decided that I wanted to go back and do an MBA. So, actually fourth attempt at school thing. Thankfully, I finished my economics degree and so I said, “I want to go back and do my MBA.” So I went back to MIT and did my MBA at MIT in my early 30s. So, really lifelong learner, different path, and a very motivated student going back when I was 30 to do my MBA.

I finished my MBA at MIT, went to work at McKinsey, finishing MBA school, executive communication skills, building strategy, working with C-suite. That was very interesting for me, worked with media, publishing, education companies. Then after a few years at McKinsey, I ended up at Kaplan, because I really wanted to be really running a business and seeing all aspects of a business. So, Kaplan was a great place also, because education was going more online a little later than other industries and Kaplan was at the forefront of online learning in those days. It was the place to be. Kaplan Test Prep had a great reputation.

Various parts of Kaplan had such great promise and potential that I found myself at Kaplan first in a corporate strategy role and then followed by operating roles as part of Kaplan Test Prep. We suddenly interacted quite a bit in those days. So, I spent almost a decade at Kaplan, transforming from strategy consulting to operating business. Then about five years ago, I got this great opportunity to work for the C-I-T-I Program or CITI Program. It’s actually an acronym. It stands for Collaborative Institutional Training Initiative. It was founded as part of the University of Miami. I’m sure we’ll talk a little bit more about it. I could talk forever about CITI Program. It’s a great place. So, I’ve been here for about five years and it’s just been a great journey. So, again, not a straight path, but certainly a very interesting one.

Andy Temte: Yeah. So, I love your story about the creative versus the technical. Isn’t education wonderful? I suffer from the same internal conflict of I’ve got a very creative side and a very technical side, and education is just a wonderful place to be when you’ve got both of those things going on at the same time.

Bharat Krishna: Absolutely. I mean, it is a great industry and a great place as you say for that mix. Absolutely.

Andy Temte: So, Bharat, one event in your life that just really accelerated your career, what is that?

Bharat Krishna: I try to say this to my kids and other people I meet as well because I am someone who finished one degree and then started two and didn’t quite think that was right. Then I went back much later to a third program. I had lots of very interesting people and people mentors who really helped me along my way. I don’t want to miss not mentioning some of those people, but there was Kelly Chambers who’s a very senior person at IBM now. She picked me up at PWC and really gave me a whole bunch of opportunities. She was a great mentor and great leader and she’s grown very successfully at IBM and she’s a big leader.

There was Lisa Tondreau who’s also a partner at IBM. She’s retired now. She was just a fantastic manager. John Polstein, I cannot not mention John Polstein at Kaplan.

Andy Temte: We cannot not mention John Polstein.

Bharat Krishna: John Polstein, for me, was just a fantastic mentor. Of course, I met other mentors like yourself as part of my Kaplan experience. That was great. McKinsey was a fantastic place. My engagement or interaction with people was more in shorter, shorter durations there, but I met so many leaders there as well that it’s hard to even count or recollect. I obviously have to also mention my current boss and CEO of Biomedical Research Alliance of New York, Paddy Mullen, who is just a spectacular leader and coach. So, CITI Program rolls into her portfolio, which then ultimately rolls into New York based institutions, NYU, Mount Sinai, Montefiore Einstein, and Northwell Health, which are the institutions that ultimately own the CITI Program.

So, all these people and leaders have had an impact on me, but if I had to pick one major thing that changed my life trajectory, I think it was going back to school at MIT for my MBA. I think that also really taught me what’s the difference between a motivated student and a semi-motivated student, because I myself was I think semi-motivated in my earlier educational journeys where I might’ve been checking some boxes based on other people’s expectations of what I might become or want to be. I think when I found myself at 30, going back to do my MBA, I wanted to be there and I think that made all the difference.

Andy Temte: Yeah, our educational journeys, it doesn’t have to be in a collegiate setting, but our educational journeys, they do help define us. Before we dive into research ethics and a bunch of balancing acts there, let’s dive into the CITI Program just a little bit more. Give us a short primer on the CITI Program and who the company serves.

Bharat Krishna: Sure. So, CITI Program is mainly an online education platform, founded about 20+ years ago at the University of Miami. It’s originally started as a group of institutions that got together to solve a common problem. They had to train their researchers on a whole bunch of new content and courses that were required to standardize their research, regulations, compliance, safety training, mostly around human subjects research. So, the CITI Program has grown a lot from there. We primarily catered to the research industry around content of research, how to conduct research ethically, compliance, safety regulations.

The industries we serve are higher ed hospitals, research labs, pharma, biotech, increasingly a lot of technology companies, and also a whole smattering of other industries like nutrition science, pharmacy, et cetera. So, we are really a specialist niche training provider at the intersection of this content and these types of industries. We serve, as you said, thousands of institutions. We serve a vast array of all the major research institutions in the US and beyond, and we’ve trained millions of learners. We train almost two million learners a year these days on various topics and courses. It is a great program, fantastic team, very mission oriented, and it’s just a great place to work.

Andy Temte: Two million a year, that’s an impressive number. Let’s focus on research ethics. Last year in 2022, we had a guest, a friend of mine named Lee Rasch, and we talked about political ethics. This time, we’re going to focus on research ethics. What’s the most important balancing act that you and your team have to play as it relates to research ethics compliance in the medical field?

Bharat Krishna: A really good question, just one small modification there, the medical ethics. So, we train social behavioral research ethics, even care ethics. So, we do span more than medical practice ethics. But to go back to the question, so research ethics really has a source during World War II with all the Nazi experiment, especially medical ethics. The Nazi experimentation on prisoners of war and conducting medical experiments, that’s where those whole field really started. Then US Public Health Service has a whole bunch of cases of where… The Tuskegee syphilis study is a classic example where there was a study that went on for 30 or 40 years where a minority population was treated unethically in a study around syphilis.

So, those were the genesis of where this whole area or field has evolved. So, now there’s a lot more guardrails and the US is really a leader in the space on how to conduct ethical research when it involves human beings. So, we train and we train a lot more than just the human subjects research audience today, but for the most part, we train ethics bodies like the institutional review boards who have to study a protocol for a research if it involves human subjects and approves them. Animal studies go through their own review board. Hospitals have ethics committees. So, if there’s a very complex decision to make between life and death or procedure for a patient, there are hospital ethics committees that makes certain decisions.

So, thankfully, we have very qualified people and very concerned people that volunteer for these roles. Now, we train these ethics boards, but we also train the people conducting the research and we train everybody in the ecosystem around these research and the related activities. But the major decisions and balancing acts are really done by people in those shoes. So, we are training those people. So, I think for us, the balancing act is really from a content standpoint, putting ourselves in the shoes of people who are making some pretty significant and difficult choices.

So, how do you construct courses and content that you can’t cover all scenarios, you can’t really communicate every single thing that might come their way, but we are talking about discussing frameworks and case studies. How do we train a whole body of individuals and related but not necessarily the same job role as well? How do you train all of them so that the end product is better research for everybody and for society?? So that’s a big balancing act. I think there’s one other balancing act I think the team plays, which is critical is taking a CITI Program course is not the primary goal of the people conducting research. We try not to be a sheep dipping exercise or a check the box exercise.

We take our role very seriously and we have to balance and understand that these are busy people. Some of them are medical doctors and they’re conducting research. They’re conducting lifesaving research and they don’t want to be spending hours taking CITI Program training. So, we really have to balance the efficiency and the efficacy of our training as well. That’s a big balancing act that my team plays.

Andy Temte: Everybody wants the easy button for the training.

Bharat Krishna: That’s right.

Andy Temte: But it has to be meaningful and make an impact. While I was listening to you talk about the field of research ethics and some of the early drivers of research ethics, Malcolm Gladwell’s Revisionist History popped into my mind. So, if any of our listeners want to do a deep dive into some of those specific stories of some of the pretty very interesting but horrific early research stories, maybe a season five or six of Revisionist History, I think that’s a place where you’ll be able to get some of that. Bharat, let’s focus on you. What’s the most important balancing act that you’ve played as it’s contributed to your career success?

Bharat Krishna: It’s an interesting question. First of all, I want to also note that I’ve loved Revisionist History. It’s one of my favorite podcasts. It’s just great. Malcolm Gladwell is just so entertaining. So, balancing act for me professionally, personally, I think, has evolved certainly over time. I’m trying to start to think of an analogy here. I think early in my career like a lot of people, I view my career as a P&L. How much money am I going to make? What’s my expense and what kind of quality of life do I want? Is it of making me happy and I’m checking the boxes and moving on? I think thankfully, I’ve evolved really into thinking of my career and my choices as more of really a balance sheet. Is there sufficient work-life balance? Am I leaving impact?

Personally, do I feel like I’m doing something with my skills and my professional life? Is my spouse having a good balance with her career? Are my kids’ health and welfare also a factor in that? So I think some people really much earlier in their life are able to find that balance and really move between viewing their life as a P&L versus a balance sheet. Not that the P&L is not important. I think we still need to make sure that you have the right financial focus and goals and have responsible spending, et cetera. But I think life really, in my view, for me personally, has evolved into being more of a balance sheet.

I view it not in terms of, “Am I running the highest revenue company out there?”, but I really view it as, “Are my staff happy? Are they growing? Am I training more people in the industry? Are my feedback on my courses better? Are the stakeholders that own the entity happy with the reputation that the CITI Program is growing with?” All those things really start to become a factor. I think really it’s a balancing act of trying to juggle a lot of those things.

Andy Temte: Yeah. Well, I love your analogy of the balancing act that you’re playing as a balance sheet. So, thank you for the plug for financial and business acumen.

Bharat Krishna: Of course.

Andy Temte: That is awesome. We’re going to take a really short commercial break and we’ll be right back with Bharat Krishna. I’m Andy Tempe. My new book, The Balanced Business, is scheduled for release on October 3rd. This book blends everything I’ve learned over the last 35 years and details the management operating system I would deploy if I could go back and do it all over again. The Balanced Business is a practical real world guide to help businesses achieve long-term success that’s built on a culture of trust, balanced with accountability.

The Balanced Business is available for pre-order on amazon.com today. We’re back with Bharat Krishna talking about training in the field of research ethics. Bharat, I want to ask a fairly obvious question. How is the deluge of medical mis or disinformation, the acceleration of science denialism, has that impacted your business? I have to imagine that your programs are more valuable than ever. How do we rebuild trust in medical science?

Bharat Krishna: Wow. I mean, we could devote a whole series of podcasts to this conversation. I think that’s one of probably the most critical societal challenges ahead for really the world. I think there’s two sides to this. First of all, science is a human process. So, human beings conduct science. I mean there’s a reason programs like ours exist. There is fraud in science. There is misrepresentation that is bad data. I don’t want to necessarily call out individual cases, but it hit the headlines recently. The President of Stanford just resigned a couple of days ago, because three of his co-authored papers were found to have data that was compromised and wasn’t corrected in time.

Now, he wasn’t explicitly charged with committing any fraud, et cetera, but for the reputation of his institution, he stepped down. So, these kinds of things happen and we just as public and even people closer to the industry hear less about these cases than about maybe some of the other loudly spoken issues. So, science does have issues in terms of output. I think the other thing is the pharma and medical device and industries have over time lost a little bit of public trust. I’ve just recently read a book, An American Sickness by Elisabeth Rosenthal. I mean it’s fascinating.

One of the opening analogies in the book, Andy, was something like imagine, Andy, you’re taking a flight from La Crosse to New York and you don’t know what the price of your flight is. You’ll land in New York, and then you get a bill from the airline. Then a month later, you get a bill for the fuel surcharge and then for the catering and then the pilot sends you a bill three months later. I mean, this is our healthcare system. I think pharmaceutical companies, healthcare, and research science institutions have lost a little bit of faith, I think, of the public. They do need to work to rebuild that. On the flip side of that, I think it’s very easy for public to jump to conclusions that all of science is bad because of a few bad apples.

Life expectancy in the 1900s was 47 in the US, and life expectancy now is almost 80. That’s thanks to science and medicine and to everybody who participates in all those wonderful understanding of how medicine works. We send people to the moon and we’re sending rockets to Mars and we have a supercomputer in our pocket. I mean, all that is science. I think it’s amazing that we take these bad apple examples and as a society, we’re able to disregard science very quickly. But I wouldn’t blame the people for it. I think there’s a little bit of blame both sides, but I think the scientific community, pharmaceuticals, healthcare have a little bit of regaining trust to do, I think, with the public based on all the misunderstandings of the past.

I think what the public sometimes doesn’t see is there are federal regulatory bodies, especially with federal research. There’s the Office of Research Integrity as part of the HHS, Health and Human Services. The FDA has a whole bunch of policies and procedures. There are large repercussions. There are destroyed careers and reputations. There are large fines. A few years ago, I think the largest fine for research misconduct for institution was handed out to Duke University for almost $112 million for falsified research data. So, there are checks and balances, but I do think the public and the scientific and the research community has to come together and really work very hard. I think a lot of that’s going to boil down to better communication.

Andy Temte: Well, I appreciate you addressing this question. This is one of several reasons why I wanted to have you on the show is to show the general public that there are institutes like yours who are working all day every day to ensure that ethics underlies medical science. So, thank you for the work that you and your team are doing. Now, this next question is one that I also frequently ask, and it is the balancing act between technical skill and behavioral skill, human skill, the old derogatory term is soft skill in the modern world of work. Let’s run a thought experiment. Suppose you have somebody sitting right in front of you right now, one of your colleagues or institutions, how do you get that balancing act between technical and human skill right?

Bharat Krishna: This is a great question, Andy, and they’re not easy to answer. So, I’m going to try and build on the previous conversation, which was around science and medical and scientific miscommunication, misinformation that’s out there. I think for institutions that are training their scientists, physicians, pharmacists, whatever they might be, even engineers for that matter, I think training on communication skills and communicating with others and communicating with the public is a much more important facet of their careers and lives than probably has ever been in the past. So, one example I can think of is I did a case study. I remember a case study at MIT Sloan where we studied the importance of communication skills as managers.

The case study was really the Challenger Space Shuttle disaster, which I don’t know if you remember, but unfortunately, people died and Space Shuttle took off and fell apart before it really went out of the atmosphere. But I think the engineers actually flagged that the O-rings, which was a technical term, I don’t remember the exact details, but they were faulty or they weren’t give way because the weather conditions weren’t perfect. We saw these case simulations and this was a filmed case with showing how these scenarios of how the engineers communicated, recreated scenes of how these engineers communicated with all the decision makers involved at NASA and how the decision was made to still go ahead with the launch.

The point of that whole exercise and case I think was to teach everybody watching, saying, “Oh, my God. This could have been stopped only if folks listened and folks who were actually in possession of the knowledge knew how to communicate and influence better.” That’s all. That was the gap here. I think that’s the kind of situational education and training and we really need to not only make this part of MBA students and business students, but I think we need to have that… I’m just giving that as an example from my experience. That opened my eyes. That kind of situational training, learning, I think we need to give to anybody in the technical field because I think it’s very important.

Andy Temte: Yeah, thank you for that. What I heard and I’m going to just parrot it back, communication and active listening skills, you got to have both sides. You can’t just have a megaphone and be communicating out. The recipient has to have open ears and open mind and be able to receive and process the information. So, when folks answer this question, typically, we’re talking about emotional intelligence. I really appreciated your answer bringing us back to the fundamentals of communication and active listening.

So, kudos to you. Bharat, we’re out of time, but one more question. If you had access to a time machine and could send a message to an earlier version of Bharat Krishna, what would that message be and what previous version of yourself would you choose to send it to?

Bharat Krishna: Oh, boy. So, this sounds like my conversation sometimes with my daughter, we watch these multiverse, Marvel movies. She’s into that phase and I think of Back to the Future. You want to go back and change something. I’d say one thing I wouldn’t want to change is I think any of the mistakes that I made. Thankfully, I didn’t make any terrible, terrible mistakes, but I made several mistakes. In fact, I made some of the mistakes as a businessperson that I’ve read in your book. These are common things you do as you grow up. But I think people learn better from mistakes and you don’t necessarily learn from success as much as you do from mistakes.

So, I wouldn’t want to go back and change any of those because I think those are all valuable lessons that I take and it’s part of what I’m today. But I think one thing to connect back to XY chromosome and science and life sciences and medicine, in all the winding journey that I described at the beginning, one of the areas that I never paid attention for the longest time was life sciences. I was never a biology person. I reflect back and think on why. I was into computer science or art and science, but never biology. I remember this time when I was in 9th grade or 10th grade, I was in a classroom and we were dissecting things for the first time. The entire place smelt of chloroform and we were taking a cockroach apart.

A couple of days later, we were taking a frog apart. A couple of weeks later, my teacher was taking a chameleon apart. The chloroform was insufficient. This creature started running around the lab, half its guts out. I just lost it. I just lost it. I think subconsciously, I said, “I will never be a life sciences biology person.” So I think if I go back in time, given that I’m enjoying myself so much for the last decade learning about life sciences, I married a microbiologist and a public health person, she’s a professor. So, certainly, I’ve been reintroduced to the area of life sciences and biology and medicine, a lot of which I have read with great intellectual curiosity on my own much later in life. But if I had to go back and say, “Hey, wait a minute, don’t discount it,” it would probably be that moment and say, “Don’t discount bad experiences from learning about an area or subject.”

Andy Temte: Yeah, that’s a great message and told with great levity. Most of us can remember dissecting the frog for the first time in the eighth grade and how that was more entertainment value than it was any kind of learning experience.

Bharat Krishna: That’s right.

Andy Temte: Bharat, it’s been a pleasure to have you on the show. Thank you so much for being here and shining a bright light on the field that you are a leader of, research ethics. Really appreciate again the work that you’re doing there, and thank you for being on the show.

Bharat Krishna: Well, thank you so much for having me, Andy. It’s been a pleasure speaking with you and great to see you again.

Andy Temte: All right. Well, my name is Andy Temte. This is the Balancing Act Podcast. You can find us on all the major podcast streaming services as well as YouTube. Please like, subscribe, rate, and share this public good with all your friends and colleagues. Have a great day.