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 Table of Contents  
EDITORIAL
Year : 2022  |  Volume : 8  |  Issue : 1  |  Page : 1-3

What is new in academic international medicine? The importance of collaboration in postpandemic times


1 Associação Brasileira de Medicina de Emergência, ABRAMEDE; Department of Emergency, Hospital Universitário Pedro Ernesto, Universidade do Estado do Rio de Janeiro – UERJ; Department of Emergency, Hospital Estadual Getúlio Vargas – SES-RJ, Rio de Janeiro, São Paulo, Brazil
2 Associação Brasileira de Medicina de Emergência, ABRAMEDE; Department of Emergency, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo – FMUSP, São Paulo, Brazil
3 Associação Brasileira de Medicina de Emergência, ABRAMEDE; Department of Emergency, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul – UFRGS, Rio Grande do Sul, Brazil
4 Associação Brasileira de Medicina de Emergência, ABRAMEDE; Department of Emergency, Hospital Israelita Albert Einstein, São Paulo, Brazil

Date of Submission06-Mar-2022
Date of Acceptance10-Mar-2022
Date of Web Publication30-Mar-2022

Correspondence Address:
Dr. Daniel Ujakow Correa Schubert
Associação Brasileira de Medicina de Emergência, ABRAMEDE; Department of Emergency, Hospital Universitário Pedro Ernesto, Universidade do Estado do Rio de Janeiro – UERJ; Department of Emergency, Hospital Estadual Getúlio Vargas – SES-RJ, Rio de Janeiro, São Paulo
Brazil
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijam.ijam_25_22

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How to cite this article:
Schubert DU, Maia IW, Oliveira J. e Silva L, Guimarães HP. What is new in academic international medicine? The importance of collaboration in postpandemic times. Int J Acad Med 2022;8:1-3

How to cite this URL:
Schubert DU, Maia IW, Oliveira J. e Silva L, Guimarães HP. What is new in academic international medicine? The importance of collaboration in postpandemic times. Int J Acad Med [serial online] 2022 [cited 2022 Jul 4];8:1-3. Available from: https://www.ijam-web.org/text.asp?2022/8/1/1/341185



Despite the strong globalization of recent decades, differences in economic and social power between countries are still remarkable. This scenario is not different in academic medicine. More recently, the coronavirus disease 2019 (COVID-19) pandemic has exposed evident inequalities, especially in low-and middle-income countries (LMICs). This is seen, for example, with unequal distribution of vaccines and smaller proportions of vaccinated people in poor areas.[1],[2],[3]

Brazil is a LMIC and inequalities here go beyond social issues. The states are the size of European countries and social inequities are intense between regions. Such differences between states and regions reflect on medical care, so we can say that Brazil is almost “a laboratory of the world.” A study by Ranzani et al. analyzed the difference in mortality of intubated COVID-19 patients across different Brazilian regions and it showed that geographic location was associated with lower survival rates even after adjusting for age, social class, and comorbidities.[4] This alarming report within this national microcosm warrants a reflection that can be extrapolated to the globalized world. The dissemination of medical knowledge must be more homogeneous and it should respect regional particularities.

With this insight and even while living in the aftermath of a brutal and unexpected pandemic, it is important to think about future where reducing inequalities is imperative to mitigate possible future pandemics and their variants. The international medical academic community can and should foster a new level of knowledge sharing and collaboration with actions that can impact the quality of care provided by health professionals in countries with less resources. In this matter, here, we offer some reflections on how the international academic community can do better.

The first point that deserves reflection is the so-called international guidelines, which dictate the global “standard of care.” They often do not include different realities, being created only with the perspectives of developed countries.[5],[6] Collaboration for the construction of globalized international guidelines that address the needs of different regions and socioeconomic contexts must be a new rule, obviously without losing its methodological quality. Recommendations need to be based on the best evidence available, ideally synthesized through systematic reviews.[7] COVID-19 showed us how medicine works in LMICs, where even oxygen is sometimes a luxury.[8],[9] We should applaud studies that look into treating simple conditions in extreme environments such as the work done in African children with sepsis.[10] There is an evident need for creating scientific evidence in diverse settings that could be used by international guidelines.

Second, the use of social media as a tool for scientific dissemination and a platform for international horizontal discussion should be encouraged. The beginning of the pandemic demonstrated how social media was important in spreading the impressions of health-care professionals on the ground before the waves hit other parts of the world. This fact was embraced by major scientific journals and societies with the dissemination of live podcasts/webinars where international academic medicine could effectively take place.[11],[12]

Third, more journals need a truly open-access format. The price to publish in open-access journals is abusive, not to mention to buy an article. This makes the process to access the most relevant scientific research elitist. The benefit of opening up data and scientific research related to COVID-19 during the pandemic has been immeasurable and felt around the world.[13],[14],[15] LMIC researchers, when they manage to publish their work, are often unable to disseminate them in this format, often not benefiting their own community.

It comes down to money. Using Brazil as an example, the Brazilian currency (Brazilian Reals - BRL) has gone into sharp devaluation due to political and economic issues in recent years. A medical school professor in Brazil, for example, earns around 15,000 BRL per month,[16] which, at current rates, would be around 34,000 US dollars per year.[17] Since university-based financial support is practically nonexistent due to federal funding cuts[18] and professors often run research studies with their own salary, it is not a financially easy decision to pay scientific journal subscriptions, publish in open access, or participate in an international congress. But what if?

What if, in a multiverse, there was a monetary correction initiative according to your monthly income and financial parity related to the dollar? Many international conferences have distinguished subscription prices according to the country of origin, but everything ends up being very expensive since not all professors are paid in dollars and not all have academic funds to participate in conferences to present their own paper. The money almost always comes out of the researcher's or student's own pocket.

What if we could effectively reduce distances and borders by sharing different realities? What if the exchange between international doctors was something more frequent? What if we could share realities by allowing an American doctor to visit the emergency department of a public hospital near a “favela” in Rio de Janeiro and in return we could go to their teaching hospitals and exchange experiences? What if we could all sit down together and do science, tackling common problems, proposing projects, and funding strategies? The segregation of knowledge of different realities is also relevant and we should aim to reduce that.

In summary, the first step when thinking about a new postpandemic world is to look at the past and the present. It is to assume that there is inequality within academic medicine, a scientific segregation of access and production, of minorities and genders, but above all, an economic segregation. This is all, in aggregate, a barrier to not only scientific, academic, or medical development but also to the growth of humanity as a whole. We suggest to look at others and dare not only to think but also to do differently. Perhaps this editorial will help to open doors to a future with more accessible knowledge and less inequalities.

Conflicts of interest

There are no conflicts of interest.

Ethical conduct of research

The authors declare that this editorial does not require Institutional Review Board/Ethics review or approval.



 
  References Top

1.
Sánchez-Páramo C, Hill R, Mahler DG, Narayan A, Yonzan N. COVID-19 Leaves a Legacy of Rising Poverty and Widening Inequality. World Bank Blogs. Available from: https://blogs.worldbank.org/developmenttalk/covid-19-leaves-legacy-rising-poverty-and-widening-inequality. [Last accessed on 2022 Feb 23].  Back to cited text no. 1
    
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Yonzan N, Cojocaru A, Lakner C, Mahler DG, Narayan A. The Impact of COVID-19 on Poverty and Inequality: Evidence from Phone Surveys. World Bank Blogs. Available from: https://blogs.worldbank.org/opendata/impact-covid-19-poverty-and-inequality-evidence-phone-surveys. [Last accessed on 2022 Feb 23].  Back to cited text no. 2
    
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Burki T. Global COVID-19 vaccine inequity. Lancet Infect Dis 2021;21:922-3.  Back to cited text no. 3
    
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Ranzani OT, Bastos LS, Gelli JG, Marchesi JF, Baião F, Hamacher S, et al. Characterisation of the first 250,000 hospital admissions for COVID-19 in Brazil: A retrospective analysis of nationwide data. Lancet Respir Med 2021;9:407-18.  Back to cited text no. 4
    
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Singer M, Deutschman CS, Seymour CW, Shankar-Hari M, Annane D, Bauer M, et al. The third international consensus definitions for sepsis and septic shock (Sepsis-3). JAMA 2016;315:801-10.  Back to cited text no. 5
    
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Machado FR, Salomão R, De Azevedo LC, Lisboa T, Filho RC. Why LASI did not Endorse the New Definitions of Sepsis Published Today in JAMA. São Paulo, Brazil, Latin America Sepsis Institute; 2016. Available from: https://ilas.org.br/assets/arquivos/upload/statement-en.pdf. [Last accessed on 2022 Feb 23].  Back to cited text no. 6
    
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Zhang Y, Akl EA, Schünemann HJ. Using systematic reviews in guideline development: the GRADE approach [published online ahead of print, 2018 Jul 14]. Res Synth Methods. 2018;10.1002/jrsm. 1313. doi: 10.1002/jrsm. 1313.  Back to cited text no. 7
    
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World Health Organization Joint News Release. COVID-19 Oxygen Emergency Impacting more than Half a Million People in Low- and Middle-Income Countries Every Day, as Demand Surges. World Health Organization. Available from: https://www.who.int/news/item/25-02-2021-covid-19-oxygen-emergency-impacting-more-than-half-a-million-people-in-low--and-middle-income-countries-every-day-as-demand-surges. [Last accessed on 2022 Feb 24].  Back to cited text no. 8
    
9.
Covid-19: Brazil Hospitals 'Run out Of Oxygen' for Virus Patients. BBC; January, 2021. Available from: https://www.bbc.com/news/world-latin-america-55670318. [Last accessed on 2022 Feb 22].  Back to cited text no. 9
    
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Maitland K, Kiguli S, Opoka RO, Engoru C, Olupot-Olupot P, Akech SO, et al. Mortality after fluid bolus in African children with severe infection. N Engl J Med 2011;364:2483-95.  Back to cited text no. 10
    
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JAMA Network. Coronavirus in Italy – Report From The Front Lines. YouTube. Available from: https://www.youtube.com/watch?v=TKS1pahoPRU. Published March 13, 2020. [Last accessed on 2022 Feb 22].  Back to cited text no. 11
    
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European Society of Intensive Care Medicine. WEBINAR: Management of Critically Ill Patients with the Virus. ESICM Website; March 10, 2020. Available from: https://www.esicm.org/news-coronavirus/. [Last accessed on 2022 Feb 23].  Back to cited text no. 12
    
13.
Tavernier W. COVID-19 demonstrates the value of open access: What happens next?. Coll Res Libr News Vol 81, No 5 (2020) 81:226. [doi: 10.5860/crln. 81.5.226].  Back to cited text no. 13
    
14.
United Nations Educational, Scientific and Cultural Organization. Open Access to Facilitate Research and Information on COVID-19. Available from: https://en.unesco.org/covid19/communicationinformationresponse/opensolutions. [Last accessed on 2022 Feb 25].  Back to cited text no. 14
    
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Wellcome. Sharing Research Data and Findings Relevant to the Novel Coronavirus (COVID-19) Outbreak; January, 2020. Available from: https://wellcome.org/press-release/sharing-research-data-and-findings-relevant-novel-coronavirus-ncov-outbreak. [Last accessed on 2022 Feb 25].  Back to cited text no. 15
    
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*Based on Exchange Rates as of March 2022. Available from: https://www.bloomberg.com/quote/USDBRL: CUR. [Last accessed on 2022 March 6]  Back to cited text no. 17
    
18.
Galvão-Castro B, Cordeiro RS, Goldenberg S. Brazilian science under continuous attack. Lancet 2022;399:23-4.  Back to cited text no. 18
    




 

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