The CEO-Chair Relationship Nobody Talks About Honestly

Picture this. A biotech CEO is days away from presenting a major strategy to the board. The Chairman calls. Trust is broken, he says. He's spoken to every other director. They back him. The CEO should step down.

The CEO hadn't seen it coming. The relationship had seemed functional. Disagreements on specifics, certainly, but nothing that felt terminal. What the CEO hadn't noticed was the pattern underneath: the direct calls to investors that didn't include them, the "context-setting" conversations with board members before meetings, the quiet construction of a consensus from which they were entirely excluded.

By the time the call came, the outcome was already decided. The board meeting was theatre. The relationship was over.

I am very familiar with this pattern. And it taught me more about biotech governance than anything I learned at McKinsey or Goldman Sachs. The lesson is simple: the CEO-Chairman relationship is the highest-leverage, highest-risk dynamic in early-stage biotech. When it works, it multiplies your effectiveness. When it fails, it can end your tenure and kill your company.

The failure mode in that story has a name. I call it the "go around." The Chairman builds relationships with investors, board members, and sometimes your own management team that bypass you. It begins innocuously. A direct call to an investor "just to check in." A coffee with your CFO to "understand the numbers." An email to a director sharing "context" before a meeting.

Each instance has a plausible explanation. "I'm just trying to help." "I want to ensure the board is informed." "I'm supporting you." But the cumulative effect is corrosive. Your authority diminishes. The board's confidence shifts. Opinions form in conversations you're not part of. By the time you present your strategy, the room has already decided.

I've seen the "go around" pattern destroy CEO effectiveness in months. The CEO walks into a board meeting thinking they're presenting options. The board walks in having already chosen. The meeting becomes a ratification exercise, and the CEO doesn't realise it until they're being asked to leave.

Here's what makes this pattern so dangerous: the dynamics you accept in the first six months become the dynamics you live with for years. Early interactions between CEOs and boards create feedback loops that self-reinforce. A Chairman who bypasses you once and faces no pushback will bypass you again. Each unchallenged boundary violation becomes the new baseline. By month nine, the pattern is structural. By month twelve, it's terminal.

After three decades in life sciences, working under Chairmen and now serving as one myself, I've observed three archetypes.

The Partner treats the CEO as a peer. They challenge assumptions constructively. They open their networks. They protect your authority with the board while holding you accountable for results. When disagreements arise, they address them directly and privately. You can always tell a Partner because after a difficult board conversation, you feel sharper, not smaller.

The Overseer treats you as an employee. They second-guess decisions. They build parallel relationships with investors and team members. Strategic discussions become approval processes. The tell is this: you start preparing for board meetings by anticipating what the Chairman will object to, rather than by thinking about what the company needs.

The Politician treats the role as a power base. They build coalitions. They manage information flow to maintain influence. They keep you slightly off-balance because your uncertainty is their leverage.

The Politician is the most dangerous archetype because their weapon is invisible: financial dependency. I've seen a board member, someone with genuine expertise and a deep personal connection to the patients the company existed to serve, fall silent during a governance crisis. Not because they agreed with what was happening, but because their board fees were a meaningful part of their household income. The Chairman knew this. The silence was purchased, not with a bribe, but with the unspoken threat of removal.

When your board includes directors whose financial security depends on keeping their seat, you don't have independent governance. You have a loyalty structure. And loyalty structures serve whoever controls the appointments.

This is why I'm sceptical of the standard early-stage board model. Two founders, two investors, one "independent." That independent director was often introduced by the lead investor, socially connected to the Chairman, and quietly aware that their continued position depends on not rocking the boat. That's not independence. It's architecture designed to look like independence.

Only the Partner model produces companies that fulfil their potential. The science is often the same across all three archetypes. The difference is governance.

After witnessing first hand dysfunctional governance, I made a deliberate choice about what kind of Chairman I wanted to be. When I took the Chairman role at AMPLY Discovery in 2023, I decided: not an Overseer, not a Politician. A Partner.

Early in my tenure, we faced a strategic question that could have gone badly wrong under a different governance model. AMPLY had positioned around animal health applications for their AI/ML drug discovery platform. The science was sound. The commercial logic was weak. As Chair, I challenged the CEO with a simple question: "If this technology can identify novel targets in any disease, why are we limiting ourselves to the smallest addressable market?"

That question didn't come from me wanting control. It came from pattern recognition. I'd seen companies before anchor to their first commercial idea because nobody on the board had the standing or inclination to challenge it. The CEO didn't need to be told what to do. He needed a board member willing to ask the uncomfortable question and then get out of the way while the team worked through the answer. They concluded that pivoting to human health, specifically oncology, created a far more compelling proposition. The decision was entirely theirs. My role was to create the conditions for rigorous thinking.

I've also experienced the Partner model from the CEO side. At one company, I deliberately chose a Chairman I trusted for his integrity and genuine understanding of biotech. We disagreed frequently. We challenged each other. But we aligned on what mattered: the science, the strategy, the patient need. That alignment gave us the confidence to make hard calls together, including ones that cost us personally.

That's what a functional CEO-Chairman relationship looks like. Not agreement on everything. Alignment on what matters, and the trust to fight for it.

Here's why this relationship matters so much, particularly in biotech.

When a CEO-Chairman relationship fails, the consequences don't stop at the CEO's departure. I've seen the same cascade repeat. The new leadership abandons the outgoing CEO's strategy. The scientific founder gets sidelined, because the new regime views them as aligned with the old one. A platform approach gets narrowed to a single asset, because the people now in charge don't understand why the platform was the value. The asset fails, often because the expertise needed to develop it has been marginalised. The investors refuse further funding. The company dies.

The reason this cascade is so hard to stop is that everyone involved has rational reasons to let it continue. The new CEO needs to establish authority, which means distancing from the predecessor's strategy. The Chairman who engineered the change needs to justify it, which means the new direction must be "better." The investors who backed the Chairman need to believe their judgment was sound. And the scientific founder, having watched one CEO get removed, knows that challenging the new order means risking the same fate. So everyone stays quiet. The cascade proceeds. The company dies of governance, not of science.

I've seen this cascade destroy pipelines that could have produced medicines for patients with devastating diseases.

The governance failure didn't just end a CEO's tenure. It ended a company's mission. Nobody connects the dots publicly, because the CEOs who experienced it don't want to relive it and the Chairmen who caused it don't want to admit it.

If you're evaluating a Chairman or about to accept one as part of your funding terms, ask these questions. Not politely. Directly.

How do you see the division of responsibilities between us? A Partner will describe enabling your effectiveness. An Overseer will describe ensuring accountability. The words sound similar. The intent is not.

Tell me about a time you disagreed with a CEO you chaired, and how it was resolved. Listen for whether the resolution involved conversation or manoeuvre. If they can't give you a specific example, they've either never been tested or they're not willing to be honest about how they handle conflict.

Will you speak to my investors without me present? The answer is almost always "of course not." The question's value is creating a reference point. When they do it anyway, and some will, you can address it immediately because the expectation was explicit.

Then do your own due diligence. Talk to previous CEOs who worked with this person. Not the references they provide. Find others. Ask about behaviour under pressure. That's where the archetype reveals itself.

And if you notice the "go around" developing, address it immediately. Don't let small boundary violations normalise. The CEOs I've watched lose this battle waited too long. They hoped it would improve. Hope is not a governance strategy.

Every biotech exists to get medicines to patients. The science is hard enough. Don't compound it by accepting a governance structure where the most important relationship works against you. Get this relationship right at formation. Or be prepared to fight for your company's future.

This is the second article in a six-part series on biotech governance. Next: Protecting the scientific voice in governance.

I write Beards on Biotech because I've seen what happens when governance fails. If these patterns resonate with your experience, I'd like to hear from you.