From the Editor
Jul 2002

Pay It Forward

Audiey Kao, MD, PhD
Virtual Mentor. 2002;4(7): doi: 10.1001/virtualmentor.2002.4.7.fred1-0207.


"Think of an idea for world change, and put it into action."

In response to the above homework assignment, Trevor, the 12-year-old hero in the book-turned-movie entitled, Pay It Forward, comes up with an intriguing idea. He describes it to his mother and teacher this way: "You see, I do something real good for three people. And then when they ask how they can pay it back, I say they have to pay it forward to three more people each. So nine people get helped. Then those people have to do 27. Then it sort of spreads out, see. To 81. Then 243. Then 729. Then 2,187. See how big it gets?"

Trevor puts his idea into action by providing a homeless man with a place to sleep in his garage. This act ultimately leads to the first scene in the movie where a stranger, a high-powered litigation lawyer, hands over the keys of his new Jaguar to a reporter whose car was just demolished. Questioning the stranger's motivations, as many of us probably would have, the reporter is determined to get the story behind this seemingly irrational act. In the end, the reporter gets his story. But the film's ending is bittersweet—Trevor dies, although his idea lives on.

While Trevor's tale is fictional, the notion that 1 person or act can make a difference appeals and resonates with our better selves even in a time when hopelessness and destruction are not in short supply around the world. In fact, a Pay It Forward Foundation has been established to "educate and inspire young students to realize that they can change the world and provide them with opportunities to do so."

At its recent Annual Meeting in Chicago, the American Medical Association (AMA) officially launched WorldScopes, the first in a series of Caring for Humanity projects intended to bring the ideals of the Declaration of Professional Responsibility to life. Over the next 2 years, the AMA intends to collect 100,000 stethoscopes and then distribute them, with the help of humanitarian organizations, to health care professionals in communities where medical resources are scarce. We recognize that no single project can solve the underlying inequities and disparities in health and health care around the world, but we hope this project, with all its simplicity, will serve as a springboard for future actions from individuals and institutions of medicine.


Virtual Mentor. 2002;4(7):



The viewpoints expressed in this article are those of the author(s) and do not necessarily reflect the views and policies of the AMA.