How far is the future?
http://www.100md.com
《英国医生杂志》
1 Epidemiological Research Centre, National Academy of Medicine, Pacheco de Melo 3081, Buenos Aires, Argentina cie@epidemiologia.anm.edu.ar
How far is the future? Not that far, really, since the present contains many of the elements featured in the five International Campaign to Revitalise Academic Medicine (ICRAM) scenarios.1 The problem is that we have the worst possible combination: market rules dictating where to go in a world where most people are not even part of the market; an academic environment in which everyone is torn between conflicting demands; and scientists who have second thoughts about mingling with other sciences and dread being in the public eye.
The good thing is that the seeds for change are also here. And while no single scenario will dominate over the next decades, much can be done to turn the tide. The international working party group has laid the foundations.2 3 We now have to roll up our sleeves. Research bugs as we are, we could start by probing into the apparently harmonious world of academic medicine. We might find out that we have been part of different worlds with colliding interests—scientific and political. The ICRAM initiative is a good occasion to recognise these conflicts and start working them out.
Achieving global equity
Looking from the developing world, we should clearly avoid the unbridled and truly global dominance of the private sector, which will not narrow the 10:90 gap and will certainly deepen the brain drain. But are scientists in the developing nations really willing to go against the grain of their governments and their markets, currently geared towards the commercially induced needs, anxieties, and expectations of their populations? We cannot take this for granted because we have increasingly become the task force of big corporations, and medical education flourishes in and for the private sector.
Global academic partnership
Rich countries will have to take the lead. It would be naive to expect leverage from poor countries with no budget for academic research and diminishing allocations for higher education. Most research in the developing world depends on external aid and agendas, and part of that money ends up being used for other purposes.
So what have we got to build on if we want to go in the direction of global health equity? We have landmarks such as the Global Forum for Health Research and the millennium development goals, which bind countries together in the fight against poverty, illiteracy, hunger, lack of education, sex inequality, child and maternal mortality, disease, and environmental degradation.4 But we also have colliding values and priorities that we should tackle if we want to move on. This will require leadership, though we should not mistake leadership for self reverence. This is the other great challenge in the academic world.
The good thing about most of the ICRAM scenarios is that they throw us into a messy reality of partnerships, alliances, negotiations, and, yes, other types of knowledge. Are we ready to embrace this world with all it entails? The time has come for us to grow, but we will never grow alone.
I thank Jorge Laucirica for ideas and help with writing this commentary.
Competing interests: None declared.
References
Clark J. International Campaign to Revitalise Academic Medicine. Five futures for academic medicine: the ICRAM scenarios. BMJ 2005;331: 101-4.
International Working Party to Promote and Revitalise Academic Medicine. Academic medicine: the evidence base. BMJ 2004;329: 789-92.
International Working Party to Promote and Revitalise Academic Medicine. ICRAM (the International Campaign to Revitalise Academic Medicine): agenda setting. BMJ 2004;329: 787-9.
United Nations. Millennium development goals. www.un.org/millenniumgoals/ (accessed 11 Jun 2005).(Zulma Ortiz, chief of training and resea)
How far is the future? Not that far, really, since the present contains many of the elements featured in the five International Campaign to Revitalise Academic Medicine (ICRAM) scenarios.1 The problem is that we have the worst possible combination: market rules dictating where to go in a world where most people are not even part of the market; an academic environment in which everyone is torn between conflicting demands; and scientists who have second thoughts about mingling with other sciences and dread being in the public eye.
The good thing is that the seeds for change are also here. And while no single scenario will dominate over the next decades, much can be done to turn the tide. The international working party group has laid the foundations.2 3 We now have to roll up our sleeves. Research bugs as we are, we could start by probing into the apparently harmonious world of academic medicine. We might find out that we have been part of different worlds with colliding interests—scientific and political. The ICRAM initiative is a good occasion to recognise these conflicts and start working them out.
Achieving global equity
Looking from the developing world, we should clearly avoid the unbridled and truly global dominance of the private sector, which will not narrow the 10:90 gap and will certainly deepen the brain drain. But are scientists in the developing nations really willing to go against the grain of their governments and their markets, currently geared towards the commercially induced needs, anxieties, and expectations of their populations? We cannot take this for granted because we have increasingly become the task force of big corporations, and medical education flourishes in and for the private sector.
Global academic partnership
Rich countries will have to take the lead. It would be naive to expect leverage from poor countries with no budget for academic research and diminishing allocations for higher education. Most research in the developing world depends on external aid and agendas, and part of that money ends up being used for other purposes.
So what have we got to build on if we want to go in the direction of global health equity? We have landmarks such as the Global Forum for Health Research and the millennium development goals, which bind countries together in the fight against poverty, illiteracy, hunger, lack of education, sex inequality, child and maternal mortality, disease, and environmental degradation.4 But we also have colliding values and priorities that we should tackle if we want to move on. This will require leadership, though we should not mistake leadership for self reverence. This is the other great challenge in the academic world.
The good thing about most of the ICRAM scenarios is that they throw us into a messy reality of partnerships, alliances, negotiations, and, yes, other types of knowledge. Are we ready to embrace this world with all it entails? The time has come for us to grow, but we will never grow alone.
I thank Jorge Laucirica for ideas and help with writing this commentary.
Competing interests: None declared.
References
Clark J. International Campaign to Revitalise Academic Medicine. Five futures for academic medicine: the ICRAM scenarios. BMJ 2005;331: 101-4.
International Working Party to Promote and Revitalise Academic Medicine. Academic medicine: the evidence base. BMJ 2004;329: 789-92.
International Working Party to Promote and Revitalise Academic Medicine. ICRAM (the International Campaign to Revitalise Academic Medicine): agenda setting. BMJ 2004;329: 787-9.
United Nations. Millennium development goals. www.un.org/millenniumgoals/ (accessed 11 Jun 2005).(Zulma Ortiz, chief of training and resea)