Medical Research in India – Are we doing enough?

-Sadiya Khan, Intern, Bangalore.

All over the world there have been tremendous advances in medicine and technology leading to the early diagnosis and advanced treatment of various diseases. This is responsible for increased life expectancy of the human race and we owe all this to years of quality medical research and innovation. India too has come a long way in terms of its healthcare services. We are known for the depth of our clinical expertise, but can we say the same about medical research in our country? Are we producing quality research and why are Indian students excelling in research abroad but not in their home country?

Unfortunately, we aren’t doing enough.  A study showed that in a span of ten years , only 25 medical Institutions in India have published more than 100 papers a year compared to an annual output of 4600 from Massachusetts General Hospital and 3500 from Mayo clinic. Alarmingly, 57.3 % of the medical colleges did not have a single publication in a decade. In the last 75 years, we have not even been nominated for a Nobel prize in Medicine. Even the quality of research publications is dismal with 90 percent of the publications from leading Institutes having less than 25 citations. We continue to rely on data generated in other countries with very different genetic and physiological backgrounds which can impact diagnosis and prognosis. 

With the enormous human resource in our country, we can definitely do a better job but what are the roadblocks?

The lack of a research friendly environment, infrastructure and incentives for quality research are some of the reasons for the present scenario. There are minimal to no incentives for publishing good quality research. Clinicians need to take time out of their busy schedules in order to conduct studies and they would rather spend their time and energy treating patients and earning a livelihood. Research contribution of a doctor should be an important criterion for faculty jobs and promotions in medical colleges. Providing incentives to faculty for not only conducting but also guiding good quality research can be a game changer. 

Another factor is the inadequate emphasis on research in the undergraduate teaching program. Indian system of education focuses on rote learning and there is no room for critical thinking and analysis. Most of the students are interested in clearing entrance exams and find it daunting to take up research projects. Policy makers need to ensure that there is more focus on understanding the various research methodologies and their application among undergraduate medical students. Professors with a good research track record should be approachable, foster the student’s interest and encourage them to learn from their mistakes. Though it is mandatory for the post graduate students to publish at least one research paper during their training, most of them consider it a formality in order to be eligible for the examinations. Residents work long hours and need to be allotted protected time for research so that they don’t consider it an additional burden. We need more people taking up research by choice and with the right intentions. The introduction of MD-PhD dual degree programmes is one step in this direction. 

 Unfortunately, there has also been a rise in the number of predatory journals publishing large number of poor quality papers without peer reviews. This defeats the whole purpose of research and needs to be regulated. Medical records are a treasure trove for research by serving as a database. Most medical colleges have a poorly maintained record section. Medical record systems need to be digitalized for faster and easier retrieval of accurate data. 

Further, there is a lack of collaboration between clinical and paraclinical departments which is imperative to producing meaningful research. Medical colleges should also recognize the need to foster collaboration with various biomedical and technological institutes in order to solve a wider spectrum of problems and produce translational research. 

Lastly and most importantly, are we spending enough? According to a study, research output in a country is positively correlated with its expenditure on research and development. India’s health research budget is only 0.02% of the GDP compared to 2.2% in the US and 1.7 % in the UK. The Government needs to realize the importance of investing in medical research. They must support the researchers with adequate funding and ensure effective utilization of the same. We have a long road ahead of us, but with small efforts at all levels of administration; we can definitely make great strides of progress in the field.

References:

1. Ray S, Shah I, Nundy S. The research output from Indian medical institutions between 2005 and 2014. Curr Med Res Pract. 2016;6:49–58.
2. Phadnis, A. (2022, April 3). India’s health budget still in need of improvement, shows data. Business Standard. https://www.business-standard.com/article/economy-policy/india-s-health-budget-still-in-need-of-improvement-shows-data-122040300926_1.html
3. Sharma S. Does India need more medical scientists? Perspect Clin Res. 2019 Jul-Sep;10(3):106-107. doi: 10.4103/picr.PICR_114_18. PMID: 31403027; PMCID: PMC6647902.
4. K.K. Talwar (2022, September 20). It’s time we aimed for a Nobel in medicine. The Tribune India. https://www.tribuneindia.com/news/comment/its-time-we-aimed-for-a-nobel-in-medicine-433340