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 …