The letter was mainly about the leadership of academic medicine, or lack thereof. Although written with considerable humor, the effect was scathing:
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?
The letter then noted the problems that afflict health care world-wide.
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.
It then pleaded for leadership with a vision that would end the current complacency, and worse.
Assuming that you do exist and that you have the ethos and, yes, the power to change things, we ask with respect and curiosity what is your vision? We've repeatedly heard the standard promotions for academic centres: 'We do the best research, we offer the best care, we are the best teachers, our discoveries shake the world, we save lives, we create medical superstars ....' Please, can we send the public relations people for a break and try to agree. How much can be achieved? What are our priorities?
Provided that you have a vision and that you are not some kleptocratic rogue appointed by a dictator at the Ministry of Health, you need to decide what you want.
A compelling vision requires the right people to materialise it. We don't want to see academic medicine replete with stagnation, compromise, pettiness, opportunism, selfishness, monolithic dogma, and intellectual narcolepsy. We don't want academia to provide authenticity to rotten societies with debased, non-humane values.
Finally, the letter suggests that we have reached our current state because of the failure of the leaders of academic medicine to uphold the core values of their institutions.
The smallest gap between rhetoric and reality rapidly undermines any institution. Too many institutions have damaged themselves by becoming strangled by business. It is by no means wrong to interact with the private sector (and some institutions might make this their primary focus), but a successful institution should be clear about its values, live by them, and never debase them in the pursuit of short term gain. Not every institution will have the same values, but some values seem fundamental to all. Perhaps the most basic might be the pursuit of truth, wherever it might lead, and the genuine interest to help people and our communities.
Political, religious, and corporate dogmas cumulatively undermine both academic and community freedom around the world. The malaise that affects academic medicine has much to do with losing healthy contact with stakeholders.
In some languages academic has become synonymous with something so remote that most people would not have any interest in it. Enhanced interaction is likely to benefit all, especially when guided by transparency, meritocracy, respect for both individual talents and teamwork, and pursuit of the common good.
It ends with a plea,
Dear potential leader of academic medicine, we don't know whether you exist, but we sincerely hope you do.
You can be a true leader regardless of your formal title or lack thereof. We have no doubt that you will succeed if you invest in an uncompromising yet positive vision.
The ideas in this cleverly written letter should be familiar to readers of Health Care Renewal. (We have posted about ICRAM before.) We have certainly written about how leaders of health care organizations may fail to uphold their organizations' values, and how such failures may lead to the ongoing problems in health care, including rising costs, declining access, stagnant quality, and demoralized health care professionals.
What is striking to see such a vigorous, albeit humorous exposition of them in one of the world's leading medical journals, and an exposition that underlines that the crisis in health care leadership is global, not just confined to the US, or to English speaking developed countries.
So let's see who is paying attention.