Agreement: I Agree Body: Dear Editor The tragic situation with healthcare in Russia is well highlighted in the BMJ piece by Gerden [1]. As the article states, a contributing factor to this crisis is Russia’s invasion of Ukraine and the associated high military expenditure. But further underlying these problems is Russia being an autocracy led by a personalist autocrat [2]. Such personalist autocrats “tend to be selected for personal characteristics that make them more likely to use military forc