Campaign to revitalise academic medicine

Editor—Rather than add my advice to the deluge that met the magnificent, international group of young people who came together last month to propose improvements for the academic medicine of tomorrow,¹ I pose a question to them: “Why, on earth, should you take any advice from any of us old farts who (through inattention, greed, or simple incompetence) got academic medicine into the simply awful mess in which you find it today?”

We have rejected the provision of continuous, comprehensive care and middling incomes in favour of huge waiting lists, unethical self referral for costly diagnostic tests, and industry-consultantships that pervert our science as profoundly as they line our pockets.

We continue to apply curriculums that value memory above thought, promote study by fear rather than reason, and sentence postgraduates to years of servitude in the educationally “lost generation.”

We value the study of adenine, thymine, cytosine, and guanine far above the study of childhood diarrhoea, Chagas' disease, community health, and patients' decision making. The issue is not the potential usefulness of basic research at some distant future date (although you might even dare question whether it is being oversold). The issue is that basic medical scientists have hijacked the granting bodies and have erected research policies that place greater value in serving their own personal curiosities than in serving sick people.

In deciding which of you will “succeed” in academic medicine, we not only reward your selfishness—for example, solo publication, lead authorship, the non-sharing and commercial exploitation of techniques or early results. We demand it. Educational contributions receive short shrift at promotion time, and exemplary clinical care close to none.

We who pontificate on how to improve academic medicine are responsible for its demise. Why, on earth, should you accept any of the advice we'll try to force down your throats?