Dr Mohanan Nair's paper was an unpleasant but a more or less factual reminder of the state of affairs in the medical colleges of Kerala. It might benefit from a historical perspective and a comparative assessment with other medical institutions in India. The decay of medical colleges in Kerala reflects the general trend in this country where almost all public sector undertakings have failed in their mission. The few exceptions only prove the rule. I have seen once proud academic medical centres becoming centres of revolt, anarchy and political fiefdom. Research has taken a back seat. Many so-called missionary hospitals, which did a lot of charity work in the past, have now become profitable centers catering to the rich rather than the poor.