Open letter to the leader of academic medicine

BMJ. 2007 Jan 27; 334(7586): 191–193.

doi:  10.1136/bmj.39043.676898.94

PMCID: PMC1782025

John P A Ioannidis, professor,¹ Tahmeed Ahmed, scientist,² Shally Awasthi, professor,³ A Mark Clarfield, Sidonie Hecht professor of geriatrics,⁴ Jocalyn Clark, director of knowledge translation,⁵ Lalit Dandona, chair, health studies area,⁶ Amanda Howe, professor of primary care,⁷ Juan M Lozano, professor of clinical epidemiology and paediatrics,⁸ Youping Li, director,⁹ Hardi Madani, medical student,¹⁰ Ana Marusic, professor,¹¹ Idris Mohammed, professor,¹² Gretchen P Purcell, assistant professor of surgery and biomedical informatics,¹³ Margaret Rhoads, final year medical student,¹⁴ Karen Sliwa-Hähnle, associate professor,¹⁵ Sharon E Straus, associate professor,¹⁶ Tessa Tan-Torres Edejer, scientist,¹⁷ Peter Tugwell, director,¹⁸ Robyn Ward, professor (conjoint),¹⁹ Michael S Wilkes, vice dean,²⁰ and Richard Smith, chief executive²¹

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As their campaign comes to a close, ICRAM presents a challenge to academic medicine's invisible leaders

We are not sure who you are. Unsubstantiated rumours suggest that you may not exist at all. We wonder where academic medicine is getting its lead from. Is it some of the many serious scientists, clinicians, and educators? Is it people with illnesses, those who wish to remain healthy, or society at large? Is it political leaders of uncompromising principles and vision? Is it selfless benefactors and visionary entrepreneurs? Or is it self interested compromisers carrying embellished titles acquired through anything but merit? Maybe it's corporate industry escorting academic medicine to the dance tonight?

You might ask who we are. We are participants in the International Campaign to Revitalise Academic Medicine, a group of mostly young academics from around the world who feel that academic medicine needs reinvention (box). We have gathered evidence systematically, consulted and debated globally, and given thought to how the future might look. Here is what we think.

What is ICRAM?

The International Campaign to Revitalise Academic Medicine (ICRAM) was launched in 2003 by BMJ and 40 other partners concerned about a decline of academic medicine globally. A working party of 20 mostly young academics was created under the leadership of Peter Tugwell in the summer of 2004 to foster a debate on the future of academic medicine worldwide. Readers will find additional information about ICRAM's efforts in our collected resource at bmj.com/academicmedicine.

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An academic dys-ease

Academic medicine entails critical thinking, research, innovation, teaching, learning, and leadership in improving health care. If this really is the job description, then few human activities are more essential for the future of humankind. So why does the mere term “academic medicine” bring to many people a feeling of long standing malaise? This malaise reflects an absence of a compelling vision for the future, difficulties in both recruiting and retaining the best and the brightest, debasement of values, disconnection from stakeholders, and lack of a global outlook.

The pursuit of health is a global priority. Health care consumes an ever increasing proportion of gross national products. However, even in the countries that devote the largest resources to health, provision is beset with the serious problems of poor quality, danger, limited access, poor usability and responsiveness, low productivity, and lack of affordability.

While life expectancy continues to increase in the rich world, it is shrinking in much of the poor world. Furthermore, most of what we would like to know we don't know—for example, how to cure advanced cancers, the common cold, and many degenerative diseases or how to deal with emerging diseases. Challenges to academic medicine are momentous, coming at a time when science—particularly genomics and information technology—is taking great leaps forward. Are we meeting these challenges?