|Ahead of print publication
Does India need more medical scientists?
Director, Medical Affairs, Sciformix Technologies, Mumbai, Maharashtra, India
A-1404, Ankur, Link Road, Goregaon (West), Mumbai - 400 062, Maharashtra
Source of Support: None, Conflict of Interest: None
Research in any field builds new knowledge, brings about improvements in existing practices and new advances. Biomedical research is critical for advancing the health of a nation. Sadly, in India, medical research is woefully neglected. A study analyzing research output from 579 Indian medical institutions and hospitals between 2005 and 2014 reported that only 25 (4.3%) of the institutions produced more than 100 papers a year compared to the annual research output of 4600 papers from the Massachusetts General Hospital and 3700 from the Mayo Clinic.
Medicine is an applied science that is constantly evolving. Without the research done over the last century, medicine and healthcare would have remained primitive, and the improvements in therapeutics and life-expectancy that we see today would not have been possible! The importance of medical research and scientists to healthcare is evident by the list of Nobel Laureates which features many physician-scientists whose contributions have benefitted millions of patients the world over. Who hasn't heard of Sir Alexander Fleming, Edward Jenner, Robert Koch, and Frederick Banting!
India today is well known the world over for its excellent medical facilities and depth of clinical expertise. Every clinical specialty is well represented in most Indian hospitals. But can we say the same about the extent of biomedical research in the country? While Indian medical graduates excel in various research fields overseas, do we see a similar picture here at home? How many healthcare innovations or therapeutic advances have been based on research done in India? Even though every medical postgraduate in India is required to conduct “original research” for his/her thesis, and every position in public and private health-care setup requires publication of original research papers, the state of biomedical research in India, both basic and applied, is miserable.
Basic medical sciences such as physiology, pathology, biochemistry, and genetics enhance knowledge of the human body from the molecular level to the whole organism-its structure, functions, and alterations that happen in disease states. Medical scientists study diseases, their underlying causes, and how they can be prevented and treated. Pharmacologists and microbiologists try to find more specific therapy targets, develop newer drugs and improve existing treatments. Basic medical research provides knowledge to understand disease mechanisms and find appropriate targets and pathways for new drugs, diagnostic tools, or therapies to work. Considering our limited resources, it is understandable that we cannot spend our scarce resources on basic research in medicine. However, looking at our vast population, huge health-care needs and clinical expertise available in the country, we can certainly carry out outstanding clinical and public health research.
Take the case of public health research. Every nation must undertake research in public health to keep advances in healthcare locally relevant to benefit their own population. Certain diseases are specific to certain geographical regions or populations. It is well known that genetic, environmental, sociocultural, and dietary factors greatly influence manifestations and management of diseases; hence, health research done locally would have the greatest impact on the health of local populations. Multidrug-resistant tuberculosis, HIV/AIDS, malaria, and noncommunicable diseases (NCD) such as diabetes, heart diseases, chronic pulmonary obstructive diseases, and cancers are the biggest health-related challenges facing India today. Our research effort in these areas is not commensurate with our needs. Even though the quantum of public health research in India has gone up in the last few years, the proportion related to NCD which contribute significantly to the disease burden is still very small.
The reasons for such a sorry state of affairs are many. The often cited ones are lack of sophisticated research infrastructure, paucity of funds, and physicians “overburdened” with patient care. These certainly are there, but at a more basic level, the reasons may be hidden in our education system that promotes rote learning over a spirit of scientific inquiry and lateral thinking. We revel in our past glories in having given the world many sciences including Ayurveda, yet are unwilling to test ancient therapies using modern scientific methods or participate in modern medical research on local populations. We tend to view any form of medical research as “using Indian patients as guinea pigs,” or done “for the benefit of pharmaceutical industry.”
More importantly, our medical education and institutions lack training curriculum in conducting systematic research; neither is there any emphasis on recording and documenting observations systematically in medical practice. In addition, most medical graduates have a tendency to look on nonclinical branches of medicine such as physiology, biochemistry, and pathology as noncritical. This prejudice against basic medical sciences, and the glamour and pecuniary rewards of clinical practice lure many more budding physicians to take up clinical specialties over medical research as a professional career.
If we want more medical research to happen in India, we need to address these shortcomings systematically. We need to encourage scientific inquiry and rational thinking in our young population; our medical education needs overhaul to include training programs in systematic research methodologies, and our medical institutions must nurture and mentor budding scientists treating them on par with clinical specialists. We should invest in building proper research infrastructure, and make resources available for supporting medical research at the institutional level. In addition, perceptions of the stakeholders including the general public need to be addressed to create a more open environment for medical research.
Equally, we must remember that research need not happen only in advanced institutions under sophisticated settings, it can be done at patient bedside in clinical practice. An astute, observant, and reasoning clinician can seek answers to many clinical questions through simple yet well-designed clinical experiments in his day-to-day practice, as beautifully illustrated through many well-known examples by Nanivadekar in his thoughtful essay. To this effect, we must inculcate in our medical students and clinicians an attitude of scientific curiosity and reasoning, and a habit of systematically recording and documenting their observations.
We must firmly believe that while clinicians are the patient interface working to perfect the existing practice of medicine, medical scientists are needed to generate new knowledge and test new theories and therapies to bring about betterment and innovations in healthcare. Contributions by both are equally essential to medical science and patient care. A combination of both in a single professional is an ideal blend. We need both clinicians and medical scientists to make this world a better place!
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