BMJ  2007;334:491 (10 March), doi:10.1136/bmj.39143.543611.FA

Letters

Academic medicine

Who should call the tune?

The first 150 words of the full text of this article appear below.

The BMJ of 27 January contains a remarkable convergence about why academic medicine is in trouble—notably, invisible leaders, ghost writers, and the influence of industry.¹²³

The invisible biopolitical leaders are too often preoccupied with their positions and powers. When things do not work out they try to disappear as academe and patients are left to flounder in a bureaucratic mess. The bottom line is that decision makers should be accountable to taxpayers for outcomes.

This problem is not confined to academic medicine. Consider that the Berlin Philharmonic Orchestra is state supported but governed independently. This freedom translates into high quality, without which the orchestra would lose public support. This triangular relation between freedom, performance, and accountability applies to any complex, creative human enterprise. When external controls, which are often financially manipulated by regulatory bodies, usurp freedom, the creative triangle is broken and yields neither performance nor accountability. Sound familiar?

University of Alabama

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Competing . . . [Full text of this article]

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