A good dose of research will benefit doctors

As a physician, my primary responsibility is to improve outcomes for my patients. In addition to providing clinical services, conducting research is a very important aspect of improving patient outcomes. There are millions in India who suffer from diseases for which there is no cure, or have stopped responding medical treatment and need improved therapies.

The only way we can mitigate their suffering is to find better and more effective treatment options which clinical research makes possible. Yet, despite possessing the talent, resources and expertise, India lags behind in research.

Way behind India has 17 per cent of the global population and 20 per cent of the global disease burden, yet less than 1.4 percent of all global clinical trials are done in the country. According to a study on the research output of 579 institutions during 2005-2014, about 60 per cent of them had not published any research in over a decade. The study, published in Current Medicine Research and Practice ,revealed that only 25 of the 579 institutes (4.3 per cent) produced more than 100 papers a year, accounting for 40.3 per cent of the country’s total research output. AIIMS ranks third among the top ten global institutes that have published the most research between 2005 and 2014, behind Massachusetts General Hospital and Mayo Clinic in the US. AIIMS published 11,377 research papers in the last decade while Massachusetts General Hospital and Mayo Clinic published 46,311 and 37,633.

There are several reasons for the inadequate output, one being the high clinical workload as a result of shortage of doctors in proportion to disease burden. However, the institutes that produced the most research are also the ones that treat the largest number of patients. Which means other factors are responsible for the inadequate clinical research, such as lack of incentives to conduct research and lack of a culture that fosters research.

The first step is understanding what will serve as a driver for a doctor to undertake more research. For instance, a common misconception is that only financial incentives motivate doctors. However, according to a 2016 pilot study published in the International Journal of Health Policy and Management , a survey found that the three most frequent themes were mentorship in the research process (52 per cent), work-time allocated to research and away from clinical work (43 per cent) and financial reward (29 per cent). India also lacks a culture that encourages research and innovation in medicine. Leadership by example is most effective in setting standards. It is, therefore, important for senior doctors to be role models, guides and mentors.

Training, a lacuna Perhaps the biggest setback we face in clinical research is lack of training. While research is a core requirement in the medical school curriculum in the West, it’s not so in India. A recent news report on the clinical research infrastructure in India revealed that there are 21,738 postgraduate medical training positions in India that are required to submit a research thesis prior to graduation. However, in practice, only a few address questions of clinical relevance and only a handful are published in peer-reviewed medical journals.

The last five years have been a transformative phase for clinical research in India. Important regulatory changes have led to a more conducive environment for research. Many of the challenges in regulations and contentious principles have been addressed. For example, in March this year, the health ministry exempted clinical trials conducted at medical institutions or hospitals for academic research from mandatory permission from the Drug Controller General of India and allowed the ethics committees of these institutions to authorise research on approved drugs, thereby shortening the approval process. Overall, there has been a positive shift in people’s perceptions about clinical trials, thanks to increased advocacy efforts and greater engagement with stakeholders. I urge all doctors and medical students to commit to engage in more research.

The writer is a consultant pulmonologist at Sri Bala Medical Centre and Hospital, Coimbatore