Competition and rivalries may lead to the Tall Poppy Syndrome in Medicine

The Tall Poppy Syndrome (TPS) is recognized conceptually in accounts by Herodotus’ Histories and Aristotle’s Politics. The specific reference to poppies occurred in Livy’s History of Rome.

I was able to identify an example of TPS as far back as Philip II, King of Macedonia and father of Alexander the Great. (It should be noted that Aristotle tutored Alexander for three years until the age of 16.) Philip was assassinated (cut down) in the spring of 336 BC by a young Macedonian noble, Pausanias, who was captain of his body guards. Pausanias was killed while attempting his escape. Was Pausanias purposefully killed while attempting escape to prevent a trial and identification of a motive, plot and other possible perpetrators?

In 338 BC, the plot thickened when Philip divorced Alexander’s mother Olympias, who was the princess of neighboring Epirus, and married Cleopatra Eurydice, a Macedonian lady of nobility. At the wedding feast, Cleopatra’s uncle, general Attalus, pronounced that Philip should father a “legitimate” (pure blood) heir for the Kingdom. Alexander threw his cup at the Attalus prompting Philip, sword drawn, to charge Alexander before he fell in drunken stupor. Olympias and Alexander fled to Epirus only to eventually return in isolation and insecurity.

One assassination theory involved Pausanias’ revenge on Philip for not obtaining retribution of Attalus’ mistreatment of Pausanias. Others theories implicated both Olympias and Alexander. Be that as it may, Alexander immediately ascended the Macedonian throne and engineered what many contemporary leaders performed; he executed (cut down) all domestic enemies (poppies). This included a cousin as well as Attalus (revenge). Olympias had Cleopatra Eurydice and her daughter with Philip, Europa, burned at the stake. Philip then embarked on his father’s dream of conquering the Persian Empire and becoming one of history’s most successful military commanders.

TPS is commonplace in Australia compared to other Anglophile nations, especially the United States. Australian victims of TPS are frequently business people, media, sports and entertainment stars and especially politicians. These are high profile people who are afforded the opportunity to become conspicuous which increases the likelihood of being cut down. The medical and scientific communities are low profile which may mitigate their prospect of being cut down.

American medicine is very competitive and often involves a winner. This milieu is a breading ground for TPS since the emotion envy, especially the negative variety, may surface which may elicit an action to negate (cut down) the competitor’s strengths. Competition is involved in applications to medical school, internships, residencies, fellowships and clinical positions in desirable locations or universities. Once established in clinical practice, friendly competition ensues for patients which may even escalate into rivalries. Of course, universities with their “publish or perish” mantra face similar perils.

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