The literate and effective dissection of the problems of the modern Academic Health Sciences Centre (AHSC) represents a significant contribution by Lozon and Fox. However, the fundamental issues may be both simpler and more intractable than they describe. The hospitals, medical schools and research institutes that compose the AHSC have individually and collectively drifted away from an ethos of service with the patient at its centre. Systems theory teaches us that "emergent behaviour" wherein the AHSC becomes more than the sum of its parts will only be achieved when there is commitment to a common purpose aided by mutual respect and the generalist perspective necessary for its full expression.

As social and health trends underscore and support the need for aggregative and problem focused education and research, it is not clear that AHSCs are reacting in an effective way - increased isolation from community and generalist care leaves highly specialized institutions vulnerable to criticism of both irrelevance and sub-optional care. A re-affirmation of unambiguous commitment to both study (research and educate) as well as serve those who suffer provides the most likely avenue to make the 21st century "the best of times" for the AHSC.

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