"James is a smart dud who just got through 150 patients with...

"James is a smart dud who just got through 150 patients with little cost.'

I think you meant dude not "dud" , guess that was a Freudian slip .
Obvious that James is "smart" no one gets to be a Doctor by being other than smart .
However takes more than being academically smart to make share price appreciation for shareholders , IMHO it takes correct analytical decisions , of risk versus reward .
This train wreck has been the result of a combination of poor risk to reward decisions ever since James took over from Kelley, not just his decision admittedly as it would have been signed off by the board but concentrating on one potential winner instead of a multiple quinella is analogous to having a portfolio consisting 99% of one stock .