Scientific research that positively affects humankind is imperative to national development. Research can be directed to innovate and evolve new concepts; or solve existing societal problems. Research, basic or applied undoubtedly requires resources, of human, financial and material kind. Developing medical research has been a challenge for India. As factors affecting health differ with region, genetic diversity and socio-economic conditions, research from across borders may not always help. In India, with infections, rising metabolic disorders and rural-urban socio-economic gap, health care concerns are compounding. To address problems, indigenous to India or any of her districts, organized medical research with evidence based health policies are crucial. Apart from sporadic achievements, research to augment clinical care, public health and policy have been insufficient. Human resources, infrastructure, bridging basic and applied biomedical research are vital issues demanding immediate attention.
Medical research is considered in 3 broad categories. The first forms basic science research (bench research) conducted in laboratories. It encompasses genetics, proteomics, drug development, cellular and molecular research. Scientists are from pure science background; though few doctors opt for bench research. It is largely funded by the union Govt, and its agencies. Private sector laboratories exist, but sub serves industry. In the last decade, quantum of bench research has increased, particularly due to increase in Govt. funding. In the 90s, chemistry, bio-chemistry and pharmacology were highly researched fields. This decade has research in applied frontiers like Oncology, cellular metabolism, genetics, drug development and molecular Biology. Some contributions from Indian bench researchers are indeed noteworthy.
The second category comprises of translational research; which is testing knowledge earned in bench research and translating the same to practice. Focus on translational medical research has gained momentum. Indigenous heart valve and ocular stem cell transplantation are examples of successful translational research in India. However we are far behind the national requirements. The third category encompasses clinical and community (public health) research to augment clinical practice knowledge. Researchers are clinicians and such research is best carried out in a medical college or a tertiary hospital.
For research to translate into development, all categories of medical research require cohesion and should be complementary to each other. Such an arrangement is grossly deficient in India. Often, subjects of bench research are out of tune with clinical requirements. On the other hand, quality bench research is often not translated into practice. Absence of a policy, man power and resource deficiencies in clinical (& public health) research are major reasons for lack of productive medical research.
Humans living in different communities show significant differences in responding to a disease. Even normal values of certain clinical parameters differ geographically. This is due to genetic diversity amongst communities and different environments. Further, health care delivery and preventive policies are interwoven with regional social, economic and religious practices. With vast populations living in poor socio economic conditions, treatment affordability is a major concern. Hence, for effective diagnosis and treatment strategies, indigenous medical researches of various kinds are essential. However, in India, normative health data, clinical presentation, treatment response data and vital epidemiology research are largely insufficient for clinical treatment and public health planning. Significant part of medical practice in India is based on western research and data.
Wholesomely, translational, clinical and public health researches are infantile in India. This is reflected by the fact that Indians contribute only around 1% to global biomedical research, out of which only 40% are studies in clinical medicine. Several surveys have shown that only 25% of medical colleges apply for research grants. Further, 20% of medical colleges have not published a single paper. Lack of faculty exposure, infrastructure and outdated teaching curriculum are top reasons for this dismal state of affairs. The lack of quality and quantity in medical research reflects upon our health policies, for evidence based policies are pivotal to inclusive development.
Bench research is relatively well funded compared to clinical and public health research. A lack of state policy in developing physician scientists has ensued in a human resource crunch. In independent India, policy of medical education has been to create ‘basic community oriented doctors’. The system neither sensitizes nor provides a platform for graduates to groom as a physician scientist. This apart, until 2008, none of the advisory bodies set up to formulate National Health Policies have addressed poor state of medical research. (NIHFW 2009).
India is at cross roads of development. In an era of rising ill-health, developing India requires bridging the gap between bench and clinical researchers. In Parallel, we need to nurture a community of physician scientists. Updating medical curriculum and introducing research for undergraduates is one such strategy. Organizing current system of bio-medical research to meet national demands requires major policy interventions. Currently, biomedical research is largely fostered by the Union Govt. State Govts. and regional agencies have to play a larger role in boosting the same Failing this, clinical approaches and public health policies are bound to remain primitive.
