Strategy thinkpiece: an open letter on the future of the Academy

The Academy is developing a new ten year strategy for 2022–2032. To start the conversation we are publishing a series of thinkpieces on what needs to change in the next decade for better research and better health.

Here, we share an open letter to the new President of the Academy of Medical Sciences, Professor Dame Anne Johnson PMedSci, from Academy Fellow Dr Richard Smith CBE FMedSci. This piece is also published in the British Medical Journal here.

Dear Anne,

I’m delighted that you have become the president of the Academy of Medical Sciences, and I applaud you for conducting a series of meetings with fellows across the UK to explore the ideas laid out in your blog on your priorities as President. I was pleased to be invited to an early meeting focused on international strategy,  and I am glad to be invited to share my thoughts from that meeting to encourage a broader debate on the future of the Academy as part of the development of its ten year strategy..

One of the messages that came through clearly in meeting I attended, and in your blog, was the need for greater diversity in the Academy. We have strong evidence that diversity makes for better decisions. This presents a challenge to the Academy, which is designed to be an elitist organisation but exists in a society that places increasing value on diversity and is sceptical of elites.

I remember how George Godber, probably England’s most distinguished chief medical officer, argued for decades that Britain lacked a single, widely-respected voice for medicine and should have an equivalent of the US Institute of Medicine which was created in 1970 – see my previous writing here on what the UK and US  health systems can learn from each other. The US Institute of Medicine, now renamed the National Academy of Medicine, has achieved a global influence – on, for example, safety and quality of health care – that the UK Academy has yet to manage. This is partly because the US Academy is better resourced but also because it is a broader church. The UK Academy opted to be the voice of academic health sciences rather than the voice of medicine, but could it be more? And could it become a broader church, perhaps introducing associate members, which would provide a route for the Academy to become more diverse.

Perhaps even better than being a voice for medicine the Academy might be a voice for health. You will know that medicine and health care account for only a small part of health, but for most people, including politicians, health and health care are synonymous with the implicit assumption that health is a product of health care. We need to move away from such thinking and put greater emphasis on health. The Academy could take the lead, although it might need to change its name.

Another message that came through strongly in the meeting was a call for a new way of doing science. One participant said how we have moved from the Holocene to Anthropocene, necessitating change in everything, including how we do science.

A new way of doing science will be much more interdisciplinary and global with more involvement of citizens. A broader range of methods will be needed together with a greater willingness to bring together different kinds of studies and data to reach conclusions. Without curiosity-driven research being neglected, there might be more emphasis on research that brings social benefit. Implementation of research findings will become as important as discovery, and the hierarchy of science that ranks genetics above social science will disappear.

Secondary aspects of the new science might be universal data sharing, greater transparency throughout the research process, immediate open access to all research, and the final abandoning of publications and the place of publication as the main way to measure success. In addition, scientific integrity (and its dark twin, misconduct) will be take much more seriously as will the commitment to explaining science and how it works to the public.

Perhaps such developments in the way of doing science might increase the confidence of the public in science, countering the disturbing finding by the Academy in 2016 that “only about a third (37%) of the public trust evidence from medical research, compared to approximately two-thirds (65%) who trust the experiences of their friends and family.” (see more on the Academy's work on evidence here). I agree whole heartedly with your emphasis on the need for the Academy to lead the way in giving status to public and patient voices.  

The Academy has a crucial role to play in the relationship between health sciences and government. That relationship has been scrutinised during the pandemic and has in many ways been found wanting: with scientists working within government having to comply with poor decisions, and politicians being able to pick the “science” that suits them best from feuding scientists. The Academy needs to be in the lead of explaining the nature of science – with its huge uncertainties and debate and argument at the heart of it – to the public; and while Fellows of the Academy must work within government the Academy itself should be fiercely independent, not only of government but of all stakeholders. Yet at the same time it must work with all of them.

Despite us being in the middle of the pandemic, person after person on the international strategy call emphasised the need to put responding to climate change as the top priority for the Academy. The kind of medicine and health care we have now is not sustainable, and a major intellectual effort is needed to describe what has been called “post-growth health care” (www.bmj.com/content/371/bmj.m4168) The NHS in England has led the world by being the first health system to device a detailed plan (available here) for how to reach carbon net-zero. Most health systems have rising carbon consumption. But much more work is needed on the detail of the NHS plan and its implementation. The Academy should play a leading role here and I am glad you mention this in your blog.

Another priority must be addressing national and global inequality. Science has done a good job in measuring and defining the problem but a much less good job at responding to it. Perhaps the new broader, interdisciplinary, more inclusive science with a greater concentration on implementation and social benefit can do better.

How much the Academy should work within Britain and how much internationally is a difficult question. People on the call talked of the need for decolonialisation, and you rightly answered that it would be a paradox for the Academy to lead on such an issue. But Britain, including British science, has benefited hugely from slavery and exploitation of its empire. At the same time Britain, the birthplace of the industrial revolution, has contributed far more than its share of greenhouse gases to the atmosphere. Justice dictates that the Academy should do all it can to share its competencies, build capacity, and promote science globally.

The pandemic has illustrated how we are part of nature not its master and how inequalities and injustice mean that the disadvantaged suffer most. The Academy should be diversifying, promoting health not just health care, designing the new science, and tackling the related challenges of climate change and injustice. As the Intergovernmental Panel on Climate Change has told us, the next decade will determine the future for our planet and its people and all their activities, including science, health, and health care. You will be the president of the Academy for the first five years of that decade, presenting you with a formidable challenge but also a great opportunity for leadership.

Best wishes

Richard

Competing interests: Dr Richard Smith was one of the Founder Fellows of the Academy admitted when it was formed in 1998. As editor of the British Medical Journal at the time he was elected for his contribution to leadership in the communication and understanding of biomedical and health research.

This perspective is from an Academy Fellow and former editor of the British Medical Journal, focusing on diversity, the voice of the Academy, inequalities and climate change.

This is only one piece of the puzzle. Explore previous thinkpieces from researchers who have lived in multiple countries and formerly been supported through the Academy's grants and careers work here. In future thinkpieces, we’ll be exploring further areas and opinions from our Fellowship and beyond. If you’d like to get involved in our ongoing strategy development, find out more here.

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