- Email: [email protected]
An international association of academic health centres
Comment
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UN. The Millennium Development Goals Report 2009. 2009. http://www. un.org/millenniumgoals/pdf/MDG_Report_2009_ENG.pdf (accessed Sept 20, 2009). Granich RM, Gilks CF, Dye C, De Cock KM, Williams BG. Universal voluntary HIV testing with immediate antiretroviral therapy as a strategy for elimination of HIV transmission: a mathematical model. Lancet 2009; 373: 48–57. Ronsmans C, Graham WJ, on behalf of The Lancet Maternal Survival Series steering group. Maternal mortality: who, when, where, and why. Lancet 2006; 368: 1189–200. Campbell OMR, Graham WJ, on behalf of The Lancet Maternal Survival Series steering group. Strategies for reducing maternal mortality: getting on with what works. Lancet 2006; 368: 1284–99. Koblinsky M, Matthews Z, Hussein J, et al. Going to scale with professional skilled care. Lancet 2006; 368: 1377–86. Chowdhury ME, Botlero R, Koblinsky M, Saha SK, Dieltiens G, Ronsmans C. Determinants of reduction in maternal mortality in Matlab, Bangladesh: a 30-year cohort study. Lancet 2007: 370: 1320–28. Keber KJ, de Graft-Johnson JE, Bhutta ZA, Okong P, Starrs A, Lawn JE. Continuum of care for maternal, newborn, and child health: from slogan to service delivery. Lancet 2007; 340: 1358–69. UNICEF. Countdown to 2015: Maternal, Newborn, and Child Survival. 2008. http://www.countdown2015mnch.org/reports-publications/ 2008report/2008reportdownloads (accessed Sept 20, 2009).
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Bhutta ZA, Ali S, Cousens S, et al. Interventions to address maternal, newborn, and child survival: what difference can integrated primary health care strategies make? Lancet 2008; 372: 972–89. Costello A, Azad K, Barnett S. An alternative strategy to reduce maternal mortality. Lancet 2006; 368: 1477–79. Pagel C, Lewycka S, Colbourn T, et al. Estimation of potential effects of improved community-based drug provision, to augment health-facility strengthening, on maternal mortality due to post-partum haemorrhage and sepsis in sub-Saharan Africa: an equity-effectiveness model. Lancet 2009; published online Sept 23. DOI:10.1016/S01406736(09)61566-X. Greco G, Powell-Jackson T, Borghi J, Mills A. Countdown to 2015: assessment of donor assistance to maternal, newborn, and child health between 2003 and 2006. Lancet 2008; 371: 1268–75. Costello A, Osrin D. The case for a new Global Fund for maternal, neonatal, and child survival. Lancet 2005; 366: 603–05. WHO Maximising Positive Synergies Collaborative Group. An assessment of interactions between global health initiatives and country health systems. Lancet 2009; 373: 2137–69. Chopra M, Daviaud E, Pattinson R, Fonn S, Lawn JE. Saving the lives of South Africa’s mothers, babies, and children: can the health system deliver? Lancet 2009; 374: 835–46.
An international association of academic health centres Published Online October 1, 2009 DOI:10.1016/S01406736(09)61594-4 See Online/Viewpoint DOI:10.1016/S01406736(09)61082-5
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Governments around the world struggle with the challenges of providing good-quality health care, but knowledge on which to base sound rational decisions is in short supply. This lack of knowledge has presented a convincing case for a new organisational model that more closely links academic medicine and clinical practice. Academic medicine—along with its access to multiple disciplines, including the engineering, physical, and social sciences—holds a critical key to developing solutions to the challenges of effective health care. This alignment of academe and clinical care can realise what has become known as the virtuous cycle, whereby research, education, and clinical care are viewed as increasingly interdependent and as making each other better.1 This point is exemplified by the ability to bridge the discovery–care continuum, as discussed by Victor Dzau and colleagues in The Lancet today.2 This trend is occurring in many parts of the world at a time when academic health centres are being increasingly recognised as major drivers of the
economy3 and as international patient-referral centres.4 The rapid globalisation of health care has accelerated this trend and offers a unique opportunity for such centres to work together to improve global health. At this important juncture of need and opportunity, these centres can position themselves as agents of change that personify the ideal that health care is crucial for a nation’s welfare, as they work for both economic and societal progress. In 2008, the Association of Academic Health Centers International (AAHC International) was created with such a mission.5 The association seeks to promote best practices, foster international relations, and enhance the missions of education, patients’ care, and research. By bringing together leading international institutions and forging strong global partnerships with governmental agencies, industry, WHO, funding bodies, national academies, and philanthropists, the association will build a collaborative global community in academic health to seek solutions to pressing international health issues. AAHC International will also offer a platform as a thought leader to provide advice and guidance to leaders of academic health centres and their constituencies in areas such as: the organisation and management of academic health centres; collaborative research, education, and scholarship; policy development, including issues surrounding the global health workforce; health-systems sharing for crucial issues (eg, ageing of the population, environmental health, ethnopharmawww.thelancet.com Vol 374 October 24, 2009
Comment
cology and disease management, health-services research, surveillance, and public health); and development of exchange programmes for leaders and administrators. This bringing together of academic health centres worldwide provides unprecedented opportunities for constructive collaboration. In research, for example, large clinical trials across academic health centres will be possible, with the sharing of research materials and expertise, the generation of large databases, and evaluation of important areas such as outcomes, patients’ safety, and cost–efficacy. Clinically, the new organisation could mobilise the international academic community to combat the threat of, for example, an H1N1 pandemic.6 AAHC International could help facilitate threatmodelling to advise on issues such as school closures and clinical trials, search for important biomarkers, examine cytokine profiles and organ dysfunction in diverse populations, and study societal and bioethical issues to advise governments and international health organisations. The association will also enable the academic community to explore the potential for harmonisation of education and training programmes to prepare students and trainees for work in a global society. A key challenge for the new organisation will be to address the problem of health inequality, particularly in countries with underdeveloped health-care systems.7 This new international organisation of academic health centres will serve to mobilise and speak on
behalf of their enormous collective strengths and resources, while helping to ensure that they can effectively contribute in international matters that affect health, research, and the economy. In so doing, AAHC International will help to foster an international community of academic health centres, a community driven by the ideal of improving the public good. Steven A Wartman, *Edward W Hillhouse, Louise Gunning-Schepers, John E L Wong Association of Academic Health Centers, Washington, DC, USA (SAW); School of Medicine, University of Leeds, Leeds LS2 9JT, UK (EWH); Academic Medical Centre, University of Amsterdam, Amsterdam, Netherlands (LG-S); and Yong Loo Lin School of Medicine and National University Health System, Singapore (JELW) [email protected] We have attended several meetings about the establishment of AAHC International and are part of an informal steering group. 1 2
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Wartman SA. Towards a virtuous cycle: the changing face of academic health centers. Acad Med 2008; 83: 797–99. Dzau VJ, Ackerly DC, Sutton-Wallace P, et al. The role of academic health science systems in the transformation of medicine. Lancet 2009; published online Oct 1. DOI:10.1016/S0140-6736(09)61082-5. Davies SM, Bennett A. Understanding the economic and social benefits of academic clinical partnerships. Acad Med 2008; 83: 535–40. Martin DR. Challenges and opportunities in the care of international patients: clinical and health services issues for academic medical centers. Acad Med 2006; 81: 189–92. AAHC International. http://www.aahcdc.org/international.php (accessed Aug 24, 2009). Neumann G, Noda T, Kawaoka Y. Emergence and pandemic potential of swine-origin H1N1 influenza virus. Nature 2009; 459: 931–39. Gracey M, King M. Indigenous health part 1: determinants and disease patterns. Lancet 2009: 374: 65–75.
Japan approves brain death to increase donors: will it work? On July 13, 2009, Japan’s legislature passed a bill to revise the Organ Transplant Law to discard the law’s unique double standard on brain death, in which brain death constitutes death only when the patient has given previous written consent to be an organ donor and the family does not oppose the donation. The revised law, which does not stipulate that brain death constitutes death but is designed for uniform recognition of people who are brain dead as legally dead, will take effect in a year. The legal revision seems to have finally made Japan like many other countries on this issue. However, the time lag has clarified that the majority understanding of brain death is not appropriate. With the advancement of intensive medical technology in the past few decades, www.thelancet.com Vol 374 October 24, 2009
inconsistencies inherent in the concept of whole-brain death, which has been adopted by the USA and many other countries including Japan, have become evident.1–4 Even James Bernat, the world’s leading defender of the idea of whole-brain death, has admitted that it is a social construct rather than a scientific concept.5 In December, 2008, the US President’s Council on Bioethics issued a White Paper titled Controversies in the determination of death6 that examined many questions about the clinical and ethical validity of the whole-brain concept of death. Although the Council concluded that the neurological standard is defensible, they say that the term brain death is highly problematic and should be replaced by total brain failure. The report also emphasises that to maintain a distinction between naming the 1403
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UN. The Millennium Development Goals Report 2009. 2009. http://www. un.org/millenniumgoals/pdf/MDG_Report_2009_ENG.pdf (accessed Sept 20, 2009). Granich RM, Gilks CF, Dye C, De Cock KM, Williams BG. Universal voluntary HIV testing with immediate antiretroviral therapy as a strategy for elimination of HIV transmission: a mathematical model. Lancet 2009; 373: 48–57. Ronsmans C, Graham WJ, on behalf of The Lancet Maternal Survival Series steering group. Maternal mortality: who, when, where, and why. Lancet 2006; 368: 1189–200. Campbell OMR, Graham WJ, on behalf of The Lancet Maternal Survival Series steering group. Strategies for reducing maternal mortality: getting on with what works. Lancet 2006; 368: 1284–99. Koblinsky M, Matthews Z, Hussein J, et al. Going to scale with professional skilled care. Lancet 2006; 368: 1377–86. Chowdhury ME, Botlero R, Koblinsky M, Saha SK, Dieltiens G, Ronsmans C. Determinants of reduction in maternal mortality in Matlab, Bangladesh: a 30-year cohort study. Lancet 2007: 370: 1320–28. Keber KJ, de Graft-Johnson JE, Bhutta ZA, Okong P, Starrs A, Lawn JE. Continuum of care for maternal, newborn, and child health: from slogan to service delivery. Lancet 2007; 340: 1358–69. UNICEF. Countdown to 2015: Maternal, Newborn, and Child Survival. 2008. http://www.countdown2015mnch.org/reports-publications/ 2008report/2008reportdownloads (accessed Sept 20, 2009).
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Bhutta ZA, Ali S, Cousens S, et al. Interventions to address maternal, newborn, and child survival: what difference can integrated primary health care strategies make? Lancet 2008; 372: 972–89. Costello A, Azad K, Barnett S. An alternative strategy to reduce maternal mortality. Lancet 2006; 368: 1477–79. Pagel C, Lewycka S, Colbourn T, et al. Estimation of potential effects of improved community-based drug provision, to augment health-facility strengthening, on maternal mortality due to post-partum haemorrhage and sepsis in sub-Saharan Africa: an equity-effectiveness model. Lancet 2009; published online Sept 23. DOI:10.1016/S01406736(09)61566-X. Greco G, Powell-Jackson T, Borghi J, Mills A. Countdown to 2015: assessment of donor assistance to maternal, newborn, and child health between 2003 and 2006. Lancet 2008; 371: 1268–75. Costello A, Osrin D. The case for a new Global Fund for maternal, neonatal, and child survival. Lancet 2005; 366: 603–05. WHO Maximising Positive Synergies Collaborative Group. An assessment of interactions between global health initiatives and country health systems. Lancet 2009; 373: 2137–69. Chopra M, Daviaud E, Pattinson R, Fonn S, Lawn JE. Saving the lives of South Africa’s mothers, babies, and children: can the health system deliver? Lancet 2009; 374: 835–46.
An international association of academic health centres Published Online October 1, 2009 DOI:10.1016/S01406736(09)61594-4 See Online/Viewpoint DOI:10.1016/S01406736(09)61082-5
1402
Governments around the world struggle with the challenges of providing good-quality health care, but knowledge on which to base sound rational decisions is in short supply. This lack of knowledge has presented a convincing case for a new organisational model that more closely links academic medicine and clinical practice. Academic medicine—along with its access to multiple disciplines, including the engineering, physical, and social sciences—holds a critical key to developing solutions to the challenges of effective health care. This alignment of academe and clinical care can realise what has become known as the virtuous cycle, whereby research, education, and clinical care are viewed as increasingly interdependent and as making each other better.1 This point is exemplified by the ability to bridge the discovery–care continuum, as discussed by Victor Dzau and colleagues in The Lancet today.2 This trend is occurring in many parts of the world at a time when academic health centres are being increasingly recognised as major drivers of the
economy3 and as international patient-referral centres.4 The rapid globalisation of health care has accelerated this trend and offers a unique opportunity for such centres to work together to improve global health. At this important juncture of need and opportunity, these centres can position themselves as agents of change that personify the ideal that health care is crucial for a nation’s welfare, as they work for both economic and societal progress. In 2008, the Association of Academic Health Centers International (AAHC International) was created with such a mission.5 The association seeks to promote best practices, foster international relations, and enhance the missions of education, patients’ care, and research. By bringing together leading international institutions and forging strong global partnerships with governmental agencies, industry, WHO, funding bodies, national academies, and philanthropists, the association will build a collaborative global community in academic health to seek solutions to pressing international health issues. AAHC International will also offer a platform as a thought leader to provide advice and guidance to leaders of academic health centres and their constituencies in areas such as: the organisation and management of academic health centres; collaborative research, education, and scholarship; policy development, including issues surrounding the global health workforce; health-systems sharing for crucial issues (eg, ageing of the population, environmental health, ethnopharmawww.thelancet.com Vol 374 October 24, 2009
Comment
cology and disease management, health-services research, surveillance, and public health); and development of exchange programmes for leaders and administrators. This bringing together of academic health centres worldwide provides unprecedented opportunities for constructive collaboration. In research, for example, large clinical trials across academic health centres will be possible, with the sharing of research materials and expertise, the generation of large databases, and evaluation of important areas such as outcomes, patients’ safety, and cost–efficacy. Clinically, the new organisation could mobilise the international academic community to combat the threat of, for example, an H1N1 pandemic.6 AAHC International could help facilitate threatmodelling to advise on issues such as school closures and clinical trials, search for important biomarkers, examine cytokine profiles and organ dysfunction in diverse populations, and study societal and bioethical issues to advise governments and international health organisations. The association will also enable the academic community to explore the potential for harmonisation of education and training programmes to prepare students and trainees for work in a global society. A key challenge for the new organisation will be to address the problem of health inequality, particularly in countries with underdeveloped health-care systems.7 This new international organisation of academic health centres will serve to mobilise and speak on
behalf of their enormous collective strengths and resources, while helping to ensure that they can effectively contribute in international matters that affect health, research, and the economy. In so doing, AAHC International will help to foster an international community of academic health centres, a community driven by the ideal of improving the public good. Steven A Wartman, *Edward W Hillhouse, Louise Gunning-Schepers, John E L Wong Association of Academic Health Centers, Washington, DC, USA (SAW); School of Medicine, University of Leeds, Leeds LS2 9JT, UK (EWH); Academic Medical Centre, University of Amsterdam, Amsterdam, Netherlands (LG-S); and Yong Loo Lin School of Medicine and National University Health System, Singapore (JELW) [email protected] We have attended several meetings about the establishment of AAHC International and are part of an informal steering group. 1 2
3 4
5 6 7
Wartman SA. Towards a virtuous cycle: the changing face of academic health centers. Acad Med 2008; 83: 797–99. Dzau VJ, Ackerly DC, Sutton-Wallace P, et al. The role of academic health science systems in the transformation of medicine. Lancet 2009; published online Oct 1. DOI:10.1016/S0140-6736(09)61082-5. Davies SM, Bennett A. Understanding the economic and social benefits of academic clinical partnerships. Acad Med 2008; 83: 535–40. Martin DR. Challenges and opportunities in the care of international patients: clinical and health services issues for academic medical centers. Acad Med 2006; 81: 189–92. AAHC International. http://www.aahcdc.org/international.php (accessed Aug 24, 2009). Neumann G, Noda T, Kawaoka Y. Emergence and pandemic potential of swine-origin H1N1 influenza virus. Nature 2009; 459: 931–39. Gracey M, King M. Indigenous health part 1: determinants and disease patterns. Lancet 2009: 374: 65–75.
Japan approves brain death to increase donors: will it work? On July 13, 2009, Japan’s legislature passed a bill to revise the Organ Transplant Law to discard the law’s unique double standard on brain death, in which brain death constitutes death only when the patient has given previous written consent to be an organ donor and the family does not oppose the donation. The revised law, which does not stipulate that brain death constitutes death but is designed for uniform recognition of people who are brain dead as legally dead, will take effect in a year. The legal revision seems to have finally made Japan like many other countries on this issue. However, the time lag has clarified that the majority understanding of brain death is not appropriate. With the advancement of intensive medical technology in the past few decades, www.thelancet.com Vol 374 October 24, 2009
inconsistencies inherent in the concept of whole-brain death, which has been adopted by the USA and many other countries including Japan, have become evident.1–4 Even James Bernat, the world’s leading defender of the idea of whole-brain death, has admitted that it is a social construct rather than a scientific concept.5 In December, 2008, the US President’s Council on Bioethics issued a White Paper titled Controversies in the determination of death6 that examined many questions about the clinical and ethical validity of the whole-brain concept of death. Although the Council concluded that the neurological standard is defensible, they say that the term brain death is highly problematic and should be replaced by total brain failure. The report also emphasises that to maintain a distinction between naming the 1403