Academic medicine: who is it for?

Editor—The big problem for academic medicine is irrelevance. Sewankambo and others rightly call for relevant research—for irrelevance creeps in at every stage of research and teaching, from identifying health problems, conceptualising them, designing ethical research projects, securing funding, and interpreting findings.¹,²

When the outcome filters back to clinicians and would-be clinicians it is stamped with the hallmarks of ambitious politicians and academics, the avarice of shareholders and corporations, the tired ideas of bastioned, venerable institutions, the bureaucratic dead hand of committees, and the blindness of science. Then comes the righteous indignation that Luddite clinicians ignore these expensive, erudite fruits and that students fall asleep.

The brutal fact is that academic medicine's understanding will always lag behind the doing of good clinical practice, just as literary scholarship follows good creative writing and natural science follows nature. Even transformative technical innovations betray a mechanistic view of humanity that often misses the point of being alive. Nevertheless, it suits the games of politicians and corporations to keep academia alive to supply credibility and commodities.

What is to be done?

• Devolve more clinical research and teaching away from institutions towards the coalface at home and abroad

• Encourage more jobbing practitioners to do research and teaching

• Revive responsive research funding, and put research commissioning in the hands of a mix of patients, clinicians (including public health clinicians), and global thinkers (not politicians or medical academics)

• Limit publicly funded institutions to an agreed percentage of industry initiated research

• Use more conceptual approaches based on values and systems such as creative arts, complexity and philosophy. The art of medicine and the human predicament will not be understood by science alone.