Five Future Scenarios for Academic Medicine

Simultaneously published this month in PLOS Medicine in a longer version, and the British Medical Journal in a shorter version is an article by the International Campaign to Revitalise Academic Medicine (ICRAM) presenting five possible scenarios for the future of academic medicine. In the longer version are a list of "current instabilities in academic medicine," which includes some items that many will find familiar, and "drivers of change in academic medicine," most of which are pretty telegraphic.
The five scenarios are fairly extreme, and seem to be products of some fairly severe disagreement among the widely geographically dispersed members of ICRAM (see the BMJ version, "The members of the group often couldn't agree. They disagreed, ofr example, over the importance of business, particularly pharmaceutical companies, in academic medicine. Would business interests destroy or enhance academic medicine?") The scenarios include:

• "Academic Inc" - academic medicine becomes entirely a private, predominantly for-profit enterprise
• "Reformation" - academic medical centers disappear, and all "academic" activities take place in the community
• "In the Public Eye" - academic medicine as celebrity culture
• "Global Academic Partnership" - academic medicine focusses almost completely on the plight of global health
• "Fully Engaged" - academic medicine became fully engaged with stakeholders

The ideas are interesting, and the future may hold some elements of some of them. It wasn't clear whether some of the scenarios were meant as dsytopias or utopias. Surely, this article ought to generate some discussion, but my concern is that this worthwhile movement has not yet clearly defined the problems in academic medicine that it seeks to address.
The lists of "current instabilities" and "drivers of change" contain many poorly defined items. For example, the latter includes "'big hungry buyers' demanding more from health care," "managerialism," and "expanding gap between what could be done and can be afforded in health care." All these touch on issues explored in Health Care Renewal, but don't seem to quite get at the core of the problems. It may be that the problems afflicting academic medicine in countries throughout the world are so varied that it really is hard to define a set of universal issues. On the other hand, international gatherings often end of speaking "international-speak," in which crucial distinctions are blurred in order to avoid offending one party or the other.
Maybe the group will be able to get beyond "international-speak," and engage more directly with the nitty gritty issues that are afflicting academic medicine in individual countries, even if that means coming up with solutions customized to each countries' needs. Let's wish them luck.