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Private
sector must prioritise research
Soumya
Viswanathan - Mumbai
In
the medical circles, as far as research goes, the popular
joke is -- publish or perish. Papers are therefore published,
generally "inspired" by articles in foreign
journals. But prospective medical research, which is pre-planned
research, takes a back seat over clinical work in India.
The
numbers may have attracted multi-national contract research
organisations but Indian healthcare institutions are not
impressed. While government has the numbers and no money,
private has low numbers and the drive to make money and
therefore neglects research, feel experts.
Those
voicing their dissatisfaction over existing medical research
scenario say whatever little that is coming is from the
government side and private sector, inspite of being the
more dominating one with 80 per cent market, is hardly
contributing towards it. Even in Mumbai there is hardly
any research being conducted since most hospitals here
employ part-time consultants.
Medical
research in private hospitals today is mostly retrospective
analysis of established facts. Large proportion of the
research that is published is retrospective research where
patient records are analyzed and data collected. Dr Harish
Nadkarni, Mumbai-based ISO expert agrees. "Medical
research today is only statistical analysis of cases.
The studies are done only conform to established international
outcomes," he says.
And
there are reasons why experts stress that hospitals prioritise
prospective research. Says Dr Murad Lala, consultant surgical
oncologist, Hinduja Hospital, "Only 5 per cent of
world’s population suffers from oral cancer as compared
to 30 per cent of Indians. Research therefore must come
from here." Agrees Dr Subbiah Arunachalam, distinguished
fellow, M S Swaminathan Research Foundation, Chennai,
"The 90/10 issue in medicine is known to all. Ninety
per cent of what the US spends accounts for 10 per cent
of the world’s diseases. But 90 per cent of diseases
that India suffers from attracts less than ten per cent
of funds. Spending in medicine and agriculture must therefore
be local."
Dr
Girish Nair, project director, Cardiac Research Academy
(CRA), Bangalore says, "Cardiovascular research in
the developed countries has built a scientific base for
defining risk and recognising when to intervene. Such
data has also been useful for developing constructive
public health policies and programmes. With the CVD epidemic
in India becoming apparent, local research is required
to build a scientific base for defining the CVD risk and
recognising when to intervene." The CRA in association
with Heart Centre which funded Rs 3 lakh studied the heart
status of 182 policemen. The result submitted to the state
government has evoked an assurance of immediate release
of funds for police personnel in case of contingency.
But such initiatives are few and far between.
While
experts insist that the industry must work towards this,
there are some hurdles in making it happen. "A problem
about good quality prospective research is balancing the
responsibility of patient care and research. In almost
all hospitals in India, the work load on the consultants
in terms of patient care is very heavy and they are not
able to dedicate adequate time to research," says
Dr Arun Goel, sr surgical oncologist, Dharamshila Cancer
Hospital.
Private
hospitals may have the advantage of fewer patients and
therefore enough time to carry out research but the disadvantage
of low numbers. Experts feel one solution is to have multi-centric
studies. Dr Nandini Mundkur, chief executive, Bangalore
Children’s Hospital and Research Centre is in favour
of encouraging multi-centric studies to make it meaningful
rather than accept those funded by the pharma industry
as the outcome is generally biased. The hospital has signed
a MoU with Sir Dorabji Tata Centre for Research in Tropical
Diseases and the Center for Human Genetics to conduct
multi-centric studies in childhood autusim.
The
Indian Cooperative Oncologists’ Network is one such
initiative made by oncologists across the country to conduct
muti-centric trials. ’’In India, such bodies
don’t work because of bloated egos and the insecurity
of "losing a patient," says an oncologist.
Then
there comes the hospital’s responsibility to provide
infrastructure, one of the reasons for absence of adequate
research, feel some. Says Dr Naresh Trehan, Escorts Heart
Institute, "Most of the hospitals in India neither
have that kind of money nor the physical resources. So
their work is restricted."
V
R Joshi, director, medical research, Hinduja Hospital
says quality research needs resources both in terms of
manpower, laboratory facilities and related infrastructure.
"Not all hospitals can boast of this," he says.
Even
after everything is made available to the researchers,
it is the mind-set which must change feel some. "If
medical curriculum gives importance to training in research
then a handful of doctors may show interest. Recently
the Dept of Science and Technology offered research scholarships
for 30 students but only enrolled 3 or 4 because they
got only so many candidates," says Dr V Mohan of
M V Diabetes Research Centre, Chennai.
Says
Dr Arunachalam, "It is for a doctor to carry out
research if he wants to perform well. At a senior level
especially, it is very important to do so."
Finally,
the advantage. Cutting edge research generates intellectual
property that may add to the country’s prosperity.
The last word -- Attempts to reduce clinical work load
and promote research are required to improve the quality
of research.
A
rough indicator of research:
Publications
as listed on Pubmed:
Multi-speciality
Hospitals:
Hinduja
Hospital 1985-200285
Jaslok1988-200282
Amrita
Institute of Medical Sciences1994-200219
New
Eye Hospitals:
Aditya
Jyottill 20022
LVPEItill
20022
Speciality
Hospitals:
Wockhardt
Hospital1989-20026
Escorts
Hospital1993-200214
SankaraNetralaya1987-2002104
John
Hopkins200259
(With
inputs from Vijaya K in Bangalore and Nidhi Srivastava
in Delhi) |
