The dawn of revolutionary medicine

Abstract

Medicine requires revolutionaries. Are you ready to erect the barricades? Might you be so willing if I amended this rallying cry to ‘academic medicine’ requires revolutionaries? Unfortunately any mention of ‘academic’ in relation to healthcare awakens an ancient instinct in professionals, an urge to hunt for something less boring instead. The first question you might ask is what is academic medicine? And it would be a good one. A simple definition might allude to the triad of clinical care, research and teaching. But when the BMJ and partners decided that academic medicine was in crisis and launched the International Campaign to Revitalise Academic Medicine in 2003, the international working party of 20 medical academics had difficulty agreeing on the definition of academic medicine, whether or not there was a problem in the first place, and if there was a problem what was it? Little wonder, some might say, ask an academic a simple question and you will receive several complex or indecipherable answers. The deadlock achieved by ICRAM, however, helped underline the depth of the crisis within academic medicine. If medical academics had a poor understanding of their own plight, what hope for the rest of us or indeed for academic medicine? Jeffrey Aronson attempts to guide us to the true path in this issue of JRSM (JRSM 2011;104:6–14). Academic medicine has been in crisis for at least 15 years. The number of academic clinicians in the UK is falling steadily. The problems have been identified and include: the research assessment exercise, bureaucratic research governance, working for two masters (university and NHS), and the difficulties of animal experimentation. There are others, of course, but the one that stands out is that the consultant contract in 2003 ended the parity between some clinical academic and NHS salaries. An important issue for journals, continues Aronson, is their increasingly international outlook, which gives UK researchers fewer opportunities to share their expertise with national and international audiences. Here at least the JRSM can make a tiny contribution. The focus of the JRSM is to publish articles of interest to UK clinicians, and while the larger journals might be eyeing global bounty, the JRSM has moved to address the needs of UK clinicians, of whom medical academics are an important subgroup. A new UK Centre for Medical Research and Innovation (UKCMRI), which will open in 2015, hopes to attract scientists in their mid-30s, make academic careers more attractive, and enable trainees to practise their discipline more efficiently. This is an opportunity to motivate young scientists, believes Aronson, and he turns to Nobel Prize winners Peter Medawar and James Watson for inspiration. He also draws on the thinking of physicist Thomas S Kuhn, who distinguished ‘normal’ science from ‘revolutionary’ science. Normal science is research firmly based on one or more past scientific achievements. Revolutionary science is transformational and involved in ‘paradigm shifts’ that open up new approaches to science never considered before. It is revolutionary science and revolutionary scientists that Aronson urges us to consider, study and follow. Perhaps step one is to abandon the miserable connotations of ‘academic’ medicine? Revolutionary medicine has a far more thrilling ring to it. Do you hear the people sing, singing the song of angry academics?