- Email: [email protected]
Academic health science systems
Correspondence
exploited if the vertical integration issue can be resolved. Such a system alliance could not only bring greater benefit to a larger proportion of the UK population but could lead the way internationally in showing the benefits of integrating academia and health care for the greater good. JT is Vice Provost (Health), UCL and academic lead for UCL Partners. IJ is Dean of the Faculty of Biomedical Sciences and Research Director for UCL Partners.
*John Tooke, Ian Jacobs [email protected] School of Life and Medical Sciences, University College London, London WC1E 6BT, UK 1
2
3
Dzau V, Ackerly C, Sutton-Wallace P, et al. The role of academic health science systems in the transformation of medicine. Lancet 2010; 375: 949–53. Department of Health. Report of the High Level Group (HLG) on Clinical Effectiveness. London: Stationery Office, 2007. http://www. dh.gov.uk/en/Publicationsandstatistics/ Publications/PublicationsPolicyAndGuidance/ DH_079799 (accessed April 30, 2010). Times Higher Education–QS. World university rankings 2009. http://www.timeshigher education.co.uk/hybrid.asp?typeCode=419 (accessed April 30, 2010).
Global health problems cannot be resolved by top-down approaches but need active and meaningful engagement of those affected and their local leaders. AHSCs have a role in the capacity-building that is required to achieve this. However, much global health funding does not originate from education budgets (but, for example, from international development budgets), and does not adequately allow for the one-on-one mentoring needed for capacity-building at the academic and leadership level. Furthermore, AHSC career paths often do not reward capacity-building that is not visible within the AHSC itself. As a result, many of us working in global health in AHSC settings are juggling the often contradictory demands of a traditional AHSC career path, meaningful international partnerships and mentoring, and different types of funding. I declare that I have no conflicts of interest.
Janneke van de Wijgert
Reuters
The printed journal includes an image merely for illustration
1782
Academic health science centres (AHSCs) can indeed have important roles in the discovery–care continuum and in global health.1,2 However, this move will not only require organisational transformation of AHSCs, but also reorganisation of AHSC career paths, educational systems, and funding mechanisms. The current trend in AHSC career paths is one of specialisation. However, in the paradigm presented by Victor Dzau and colleagues,1 AHSCs would need professionals who have sufficient understanding of different aspects of the discovery–care continuum to be able to facilitate the translation of discoveries into clinical applications, and clinical applications into public health programmes. Such knowledge requires skills-based educational systems that allow students to combine disciplines. But, equally importantly, career paths and funding mechanisms should reward translational skills and relevant work experience outside the AHSC.
[email protected] Academic Medical Center of the University of Amsterdam, Department of Internal Medicine, Center for Poverty-related Communicable Diseases, Amsterdam Institute for Global Health and Development, Center for Infection and Immunity Amsterdam, PO Box 22700, 1100 DE Amsterdam, Netherlands 1
2
Dzau VJ, Ackerly DC, Sutton-Wallace P, et al. The role of academic health science systems in the transformation of medicine. Lancet 2010; 375: 949–53. Wartman SA, Hillhouse EW, Gunning-Schepers L, Wong JEL. An international association of academic health centres. Lancet 2009; 374: 1402–03.
increased access to sterile syringes, prevention messages encouraging IDUs to use their own material, and wider access to methadone, buprenorphine, and antiretroviral treatments. Yet experts can do little when confronted with governmental inertia. In Russia, opiate substitution treatment is currently illegal. In south and southeast Asia, Latin America, and Africa, vast populations of IDUs are being infected and are infecting their sexual partners, promoting HIV spread and vertical transmission. However, unlike the modification of current sexual practices, which remains a difficult and often disappointing task, needle-sharing practices can be modified quickly and rapid results obtained. France is an excellent example of a country that lagged behind, but which rapidly caught up once effective harm-reduction measures were instigated. Syringe sales were forbidden until 1987 and opiate substitution was not developed until 1995. After rising to a very high level, the prevalence of HIV among IDUs has been in line with average European levels for several years. The latest French figures show a prevalence of 0·3% among IDUs younger than 30 years.2 Prejudices are indeed the primary enemy to public health and these prejudices are longstanding, but even delayed concerted actions can help to curb the HIV epidemic among IDUs. We declare that we have no conflicts of interest.
*Amine Benyamina, Lisa Blecha, Bertrand Lebeau, Michel Reynaud
Prevention of HIV transmission among intravenous drug users
[email protected]
Somehow the Article by Bradley Mathers and colleagues (March 20, p 1014)1 left us with a sense of despair. Strategically, preventing the spread of HIV among intravenous drug users (IDUs) through safe consumption and decreased viral load holds no mystery. Technically, effective and proven methods are clear:
1
INSERM, U669, Paris, France (AB, LB, BL, MR); AP-HP, Paul Brousse Hospital, Centre for Training, Research and Treatment in Addictions, Villejuif, France (AB, LB, MR); and Université Paris-Sud, UMR-S0669, Paris, France (AB, LB, MR)
2
Mathers BM, Degenhardt L, Ali H, et al. HIV prevention, treatment, and care services for people who inject drugs: a systematic review of global, regional, and national coverage. Lancet 2010; 375: 1014–28. Jauffret-Roustide M, Emmanuelli J, Quaglia M, et al. Impact of a harm-reduction policy on HIV and hepatitis C virus transmission among drug users: recent French data—the ANRS-Coquelicot Study. Subst Use Misuse 2006; 41: 1603–21.
www.thelancet.com May 22, 2010
exploited if the vertical integration issue can be resolved. Such a system alliance could not only bring greater benefit to a larger proportion of the UK population but could lead the way internationally in showing the benefits of integrating academia and health care for the greater good. JT is Vice Provost (Health), UCL and academic lead for UCL Partners. IJ is Dean of the Faculty of Biomedical Sciences and Research Director for UCL Partners.
*John Tooke, Ian Jacobs [email protected] School of Life and Medical Sciences, University College London, London WC1E 6BT, UK 1
2
3
Dzau V, Ackerly C, Sutton-Wallace P, et al. The role of academic health science systems in the transformation of medicine. Lancet 2010; 375: 949–53. Department of Health. Report of the High Level Group (HLG) on Clinical Effectiveness. London: Stationery Office, 2007. http://www. dh.gov.uk/en/Publicationsandstatistics/ Publications/PublicationsPolicyAndGuidance/ DH_079799 (accessed April 30, 2010). Times Higher Education–QS. World university rankings 2009. http://www.timeshigher education.co.uk/hybrid.asp?typeCode=419 (accessed April 30, 2010).
Global health problems cannot be resolved by top-down approaches but need active and meaningful engagement of those affected and their local leaders. AHSCs have a role in the capacity-building that is required to achieve this. However, much global health funding does not originate from education budgets (but, for example, from international development budgets), and does not adequately allow for the one-on-one mentoring needed for capacity-building at the academic and leadership level. Furthermore, AHSC career paths often do not reward capacity-building that is not visible within the AHSC itself. As a result, many of us working in global health in AHSC settings are juggling the often contradictory demands of a traditional AHSC career path, meaningful international partnerships and mentoring, and different types of funding. I declare that I have no conflicts of interest.
Janneke van de Wijgert
Reuters
The printed journal includes an image merely for illustration
1782
Academic health science centres (AHSCs) can indeed have important roles in the discovery–care continuum and in global health.1,2 However, this move will not only require organisational transformation of AHSCs, but also reorganisation of AHSC career paths, educational systems, and funding mechanisms. The current trend in AHSC career paths is one of specialisation. However, in the paradigm presented by Victor Dzau and colleagues,1 AHSCs would need professionals who have sufficient understanding of different aspects of the discovery–care continuum to be able to facilitate the translation of discoveries into clinical applications, and clinical applications into public health programmes. Such knowledge requires skills-based educational systems that allow students to combine disciplines. But, equally importantly, career paths and funding mechanisms should reward translational skills and relevant work experience outside the AHSC.
[email protected] Academic Medical Center of the University of Amsterdam, Department of Internal Medicine, Center for Poverty-related Communicable Diseases, Amsterdam Institute for Global Health and Development, Center for Infection and Immunity Amsterdam, PO Box 22700, 1100 DE Amsterdam, Netherlands 1
2
Dzau VJ, Ackerly DC, Sutton-Wallace P, et al. The role of academic health science systems in the transformation of medicine. Lancet 2010; 375: 949–53. Wartman SA, Hillhouse EW, Gunning-Schepers L, Wong JEL. An international association of academic health centres. Lancet 2009; 374: 1402–03.
increased access to sterile syringes, prevention messages encouraging IDUs to use their own material, and wider access to methadone, buprenorphine, and antiretroviral treatments. Yet experts can do little when confronted with governmental inertia. In Russia, opiate substitution treatment is currently illegal. In south and southeast Asia, Latin America, and Africa, vast populations of IDUs are being infected and are infecting their sexual partners, promoting HIV spread and vertical transmission. However, unlike the modification of current sexual practices, which remains a difficult and often disappointing task, needle-sharing practices can be modified quickly and rapid results obtained. France is an excellent example of a country that lagged behind, but which rapidly caught up once effective harm-reduction measures were instigated. Syringe sales were forbidden until 1987 and opiate substitution was not developed until 1995. After rising to a very high level, the prevalence of HIV among IDUs has been in line with average European levels for several years. The latest French figures show a prevalence of 0·3% among IDUs younger than 30 years.2 Prejudices are indeed the primary enemy to public health and these prejudices are longstanding, but even delayed concerted actions can help to curb the HIV epidemic among IDUs. We declare that we have no conflicts of interest.
*Amine Benyamina, Lisa Blecha, Bertrand Lebeau, Michel Reynaud
Prevention of HIV transmission among intravenous drug users
[email protected]
Somehow the Article by Bradley Mathers and colleagues (March 20, p 1014)1 left us with a sense of despair. Strategically, preventing the spread of HIV among intravenous drug users (IDUs) through safe consumption and decreased viral load holds no mystery. Technically, effective and proven methods are clear:
1
INSERM, U669, Paris, France (AB, LB, BL, MR); AP-HP, Paul Brousse Hospital, Centre for Training, Research and Treatment in Addictions, Villejuif, France (AB, LB, MR); and Université Paris-Sud, UMR-S0669, Paris, France (AB, LB, MR)
2
Mathers BM, Degenhardt L, Ali H, et al. HIV prevention, treatment, and care services for people who inject drugs: a systematic review of global, regional, and national coverage. Lancet 2010; 375: 1014–28. Jauffret-Roustide M, Emmanuelli J, Quaglia M, et al. Impact of a harm-reduction policy on HIV and hepatitis C virus transmission among drug users: recent French data—the ANRS-Coquelicot Study. Subst Use Misuse 2006; 41: 1603–21.
www.thelancet.com May 22, 2010