|Year : 2016 | Volume
| Issue : 2 | Page : 71-74
Medical Research in India: Time to Act
KK Talwar1, Samir Malhotra2
1 Department of Cardiology, Max Healthcare Institute Ltd., Saket, New Delhi, India
2 Department of Pharmacology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
|Date of Web Publication||7-Oct-2016|
K K Talwar
Department of Cardiology, Max Healthcare Institute Ltd., Saket, New Delhi
Source of Support: None, Conflict of Interest: None
The country has more than 400 medical colleges. In the area of patient care, India is recognized as a leading country. It is time that we have an objective look into our contribution in medical research. The state of medical research in the majority of medical colleges has been far below the desired level. We need to take measures to improve the quality of medical research in India: Training in Research methodology, Physician - Scientist Interaction and Public and Industrial Investment.
Keywords: Medical research, India, medical training
|How to cite this article:|
Talwar K K, Malhotra S. Medical Research in India: Time to Act. J Pract Cardiovasc Sci 2016;2:71-4
| Introduction|| |
The field of medical science has seen tremendous growth in India since independence. At present, the country has more than 400 medical colleges and a few institutes of national importance such as the All India Institute of Medical Sciences (AIIMS), New Delhi, and the Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, created by the act of parliament.
In the area of clinical work, i.e., patient care, India is recognized as a leading country, and at many places in the country, patient care being offered matches the best in the world, at a cost much lower than in the developed nations. This has led to a lot of emphasis on medical tourism with patients from all across the world, including the developing countries, coming to India for treatment. Further, the doctors who have migrated abroad have brought laurels to the country by virtue of their clinical expertise and service to the society of which the country can be justifiably proud.
Another area in which India can be proud of its achievements is the production of generic medicines, possible through a policy framework that encouraged companies to invest in this field. India is the world's largest exporter of generic medicines, especially in critical areas such as HIV/AIDS and vaccines, accounting for one-fifth of global exports in terms of volume. Most of the world's leading organizations such as UNITAID, UNICEF, and others depend on the high quality and cheap Indian generics. For example, the price of HIV treatment fell from US$ 10,000 a decade ago to less than US $80 due to Indian generics.
What about medical research? It is the time that we have an objective look into our contribution in medical research. The contribution of medical research can be assessed by studying how it has led to improvement or changes in our practice of medicine. It is also important to evaluate the reduction in the health care costs of delivering the health gains as well as any positive impact on a gross domestic product that occurred directly or indirectly from biomedical research. It would also be interesting to evaluate our contributions in the field of biomedical technology, which has tremendously contributed to the progress of medical care both with diagnostic and therapeutic applications.
A few years ago, one study examined Indian contribution in biomedical research evaluating more than 6000 research publications. A few institutes of the country such as AIIMS (New Delhi), PGIMER (Chandigarh), Christian Medical College (CMC) (Vellore), SGPGI (Lucknow), and Banaras University and Tata Memorial Cancer Centre (Mumbai) contributed to the majority of the publications. Another study showed that only about 10% of Indian medical colleges were active in research, and the majority of the medical colleges receiving research grants from the Indian Council of Medical Research (ICMR) did not produce any research paper, and only 10% of the projects ended up in publications in indexed journals.
A recent study has shown that 57% of our medical colleges did not publish a single paper between 2005 and 2014. This study showed that over this 10-year period, the AIIMS in New Delhi was at the top (11,377 publications) followed by the PGIMER in Chandigarh (8145 publications). The other institutions had fewer publications, the CMC in Vellore (3742), the Sanjay Gandhi Postgraduate Institute of Medical Sciences in Lucknow (3499), and the King George Medical College in Lucknow (2878). However, these numbers were not adjusted for the total number of faculty members in these institutions. The top ten institutions accounted for more than 40% of all publications. Such data show that the state of medical research in the majority of medical colleges has been far below the desired level.
The quality of these publications is also an important issue. What is the impact factor of the journal in which these publications have been published? How many times these have been cited? An analysis we did (unpublished) showed that >90% of the publications even in the leading medical institutes have less than 25 citations and <0.5% have more than 100 citations. We then looked at the quality of some of the individual research publications. Most of the research publications have been a follow-up of the ongoing research work in USA or Europe. Hardly, any new drug or medical equipment has been developed in India or any software of medical importance gained worldwide acceptance.
It shall be worthwhile to review some major research contributions at the national level. It is not possible to include all the innovations that have occurred in India; however, an attempt is made to include many of the important ones here.
| Iodine Deficiency Disorders|| |
The studies conducted in Sikkim and Himalayan regions of India in the 1950s–60s proved that iodized salt significantly reduces the incidence of iodine deficiency disorders., This has proved a significant public health contribution.
| Cholera and Other Diarrheal Diseases|| |
One of the most important contributions from India is the discovery of cholera toxin by Dr. De, for which he was nominated for the Nobel prize a few times. This discovery formed the basis of treatment of diarrhea with rehydration therapy. The studies from the National Institute of Cholera and Enteric Diseases, Kolkata, showed that common household drinks (nimbu pani, coconut water, and rice water) are as good as oral rehydration solutions in preventing diarrhea-related mortality and are more palatable.
| Tuberculosis|| |
In 1956, the Tuberculosis (TB) Chemotherapy Centre, later renamed the TB Research Centre (TRC), was established in Chennai under ICMR, with the assistance of the British Medical Research Council, WHO, and the Government of India. The studies from the TRC, Chennai, showed that supervised administration of anti-TB drugs twice weekly is as efficacious as daily self-administered treatment,, now known as the directly observed treatment short-course, which is now accepted worldwide although some concerns have been raised recently.
| Poliomyelitis|| |
Polio has been almost eradicated from India - this was a result of the Pulse Polio Campaign. One of the landmark studies that showed, for the first time, that pulse polio immunization can be a useful strategy was done in Vellore, India.
| Leprosy|| |
The major Indian contribution in leprosy has been devising in therapeutic regimens. These include pulsed rifampicin, a new regimen, comprising conventional multidrug therapy (MDT) together with newer drugs such as ofloxacin and minocycline shown to be safe and well tolerated, and single dose of rifampicin, ofloxacin, and minocycline was shown to be as effective as 6 months of MDT for patients with monolesion leprosy. Besides these, we can also mention achievements in the eradication of smallpox and establishment of treatment regimens in leishmaniasis.
In the biomedical technology field, probably the only noteworthy contribution is the development of indigenous tilting disc heart valve (Chitra valve) by Prof. MS. Valiathan. A 10-year review of the valve in patients who underwent valve replacement showed that it has good hemodynamics with no structural failure, which is a huge advantage as it is cost-effective and user-friendly. Another important discovery was of reserpine from Rauwolfia serpentina (sarpagandha) as an anti-hypertensive by Rustom J. Vakil.
Some of the valuable contributions by Indians who excelled in research but mainly worked abroad, need mentioning. Dr. A S. Paintal is known for his original work as discovery of “J”receptor. His other major contribution includes the development of single fiber technique for recording afferent impulses from individual sensory receptors such as atrial B receptors, ventricular pressure receptors, and muscle pain receptors. Other distinguished names include Dr. Har Gobind Khorana, who received Nobel Prize for Medicine and Physiology in 1968 for cracking the genetic code. Dr. Venkatraman Ramakrishnan also shared Nobel prize in 2009 for his work on ribosomes. Other distinguished scientists who achieved recognition while working abroad include Dr. Yellapragada Subba Rao and Dr. Suren Sehgal.
These examples show that Indians have sufficient intellectual skills but are unable to attain the same heights while working in India. Some of the possible reasons are insufficient infrastructure, diminishing funding, lack of proper environment, and poor incentives for research. These need to be addressed if India has to be among the leaders in medical science.
| Way Forward|| |
We need to take measures to improve the quality of medical research in India if we have to compete with the global leaders in medicine. The following steps may help to improve the environment for research:
Training in research methodology
Training of research methodology in medical colleges is grossly inadequate as a result of which students are unable to plan research properly and are unable to critically analyze published work. Exposure to research in initial stages of their careers can stimulate some of them to undertake research as a main interest. At present, although every medical postgraduate has to write a thesis/dissertation, the quality of their work is often far below standards and hardly worth publishing. Training in ethics should also be formalized.
While encouraging research environment in medical colleges, it is important that mentors should encourage and promote original research ideas, there should be less stress on a number of publications and more on quality and impact. The faculty should be encouraged to get involved in research and incentives can be offered like out of turn promotion for excellence in research, financial incentives, and dual positions in different department/colleges on the patterns seen abroad.
To encourage research in medical colleges, a few years back, the MCI made publications as one of the criteria for promotion. The MCI did not mention that these publications should be indexed in a standard database like the PubMed to ensure the quality of publication. Since then, there has been mushrooming of local journals to publish articles without any merit. This helps the faculty to fulfill the required criteria for necessary promotion, but the very purpose of stimulating quality research has been defeated. The Medical Council of India should define that the articles be indexed in a standard database, namely, PubMed.
Many physicians turn into active researchers by virtue of their aptitude or simply due to an overpowering spirit of enquiry. Robert Koch was initially a Physician but went on to discover the TB bacillus; Louis Pasteur originally was a Chemist and became the father of vaccinology. In modern times, the concept of bench-to-bedside, i.e., translational science has brought the integration of laboratory experience to medical practice in a more organized way. Thus, a close physician–scientist interaction is very important to promote translational medical research. There is a considerable communication gap between clinicians and scientists which hampers the quality and utility of research resulting in a lot of meaningless researches being conducted. A better collaboration between MDs/DMs and PhDs shall promote a good quality and meaningful research.
The medical colleges should be encouraged to foster relationships with various research institutes of Indian Council of Medical Research (ICMR), Department of Science and Technology (DST), Council for Scientific and Industrial Research (CSIR), and Department of Biotechnology (DBT). and universities and vice versa. This will help to collaborate basic and clinical research-learning from each other's expertise and thus enhance opportunities for translational research.
Public and industrial investment
The industry should devote resources for research, particularly in the field of biomedical sciences. There should be efforts in indigenizing various biomedical materials/devices and encouraging innovation. Today, in the medical field, nearly 80% of the biomedical materials/devices are imported driving upward the cost of health care.
India's tremendous strength in patient numbers, availability of most disease categories, and availability of trained physicians are some of the strengths for research. The right environment and encouragement will help to promote the quality of medical research. With our intellectual strength, it is time for us to be a global player in contributing to the field of medical research.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Satyanarayana K. Final report of the project on national mapping of science: Biomedical sciences. Inf Today Tomorrow 2000;19:17-21.
Reddy KS, Sahni P, Pande GK, Nundy S. Research in Indian medical institutes. Natl Med J India 1991;4:90-2.
Arora M, Banerjee JK, Sahni P, Pande GK, Nundy S. Which are the best undergraduate medical colleges in India? Natl Med J India 1996;9:135-40.
Ray S, Shah I, Nundy S. The Research Output from Indian Medical Institutions Between 2005 and 2014, Current Medicine Research and Practice; 18 April, 2016. Available from: . [Last accessed on 2016 Apr 26].
Sooch SS, Ramalingaswami V. Preliminary report of an experiment in the Kangra valley for the prevention of Himalayan endemic goitre with iodized salt. Bull World Health Organ 1965;32:299-315.
Ramalingaswami V, Subramanian TA, Deo MG. The aetiology of Himalayan endemic goitre. Lancet 1961;1:791-4.
De SN. Enterotoxicity of bacteria-free culture-filtrate of Vibrio cholerae
. Nature 1959;183:1533-4.
Tuberculosis Chemotherapy Centre. A concurrent comparison of home and sanatorium treatment of pulmonary tuberculosis in South India. Bull World Health Organ 1959;21:51-144.
Tuberculosis Chemotherapy Centre. TRC Chennai. Intermittent treatment of pulmonary tuberculosis – A concurrent comparison of twice-weekly isoniazid plus streptomycin and daily isoniazid plus p-aminosalicylic acid in domiciliary treatment. Lancet 1963;281:1078-80.
John TJ, Pandian R, Gadomski A, Steinhoff M, John M, Ray M. Control of poliomyelitis by pulse immunisation in Vellore, India. Br Med J (Clin Res Ed) 1983;286:31-2.
Girdhar BK, Desikan KV. 'Pulsed' rifampicin therapy in leprosy. A clinical study. Lepr India 1979;51:475-80.
Katoch K, Katoch VM, Natarajan M, Gupta UD, Sharma VD, Singh HB. Long term follow-up results of 1 year MDT in MB leprosy patients treated with standard MDT + once a month minocycline and ofloxacin. Indian J Lepr 2008;80:331-44.
Efficacy of single dose multidrug therapy for the treatment of single-lesion paucibacillary leprosy. Single-lesion Multicentre Trial Group. Indian J Lepr 1997;69:121-9.
Muralidharan S, Muthubaskeran V, Chandrasekar P. Ten years outcome of Chitra heart valves. Indian J Thorac Cardiovasc Surg 2011;27:24-7.