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Physician, heal the sick, but after research.

The problems of medical research in Pakistan are twofold. One is the dearth of statistics and the other is the lack of research supervisors. The absence of the research professor in the health sector and medical institutions has contributed to this shortcoming. The main reason for the paucity of research professors is the absence of degrees in their specialised fields in our medical institutions.

Here it would be worthwhile to elaborate on the present concept of medical research. The cornerstone of all research is detailed surveys. This automatically provides not only the basis of all studies, but is also important in identifying the problems. To give an example, unless we know what common diseases are encountered in hospitals, how can a particular department be organized to deal with them? Only surveys can tell us about the exact number of beds to be earmarked for malnourished children or infectious disease cases. The second aspect of surveys touches on short term problem-oriented research programmes. Thus chest complications arising from measles when anti-infective therapy was administered or with-held, can be documented and will guide the paediatrician in handling measles cases.

The long-term or longitudinal method requires a more elaborate set-up. It leads to new discoveries. The change pattern of diet and the anti-smoking campaign in the US and UK for prevention of heart disease was a hypothesis tested by experimentation and confirmed by the results. Surveys established that the incidence of cardiac disorders dropped by one-third.

Surveys help give a better understanding of the history and evolution of medicine. They provide knowledge of various patterns of diseases, the factors responsible for them and the necessary treatment. For example, research shows that the increased incidence of heart disease today is a result of the quick tempo of life. Surveys also help in assessing any rise in viral infections and other unknown diseases.

The important point to remember is that the first step in the field of research is the survey. This is the easiest method if organised properly. Elementary statistical data have always been important. Today they are even more required because of increased travel and intermingling of people. There is a developing "international medical understanding" and the medical institutions around the world are cooperating with each other. The developing countries are like small laboratories where the human physiology is being observed. A generation ago even the affluent had to sweat through summer while today a number of labourers are working in air-conditioned factories. The changes in lifestyle and environment could have affected the human physiology which can now be recorded. The developments in medical research in the Third World today occurred in the West over the centuries. Even this limited data needs to be exchanged. In the developed countries bacterial infections are not much of a problem now. So their scientists have moved on to tackle unknown diseases resulting from viluses, autoimmune disorders and chronic degenerative diseases. The research which spanned centuries in the West will have to be done in a decade in the developing countries if epidemics of diseases like hepatitis, AIDS, cholera, or even a resurgence of tuberculosis following AIDS are to be avoided. The Third World has no time to waste as rapid communication and travel have made it essential that we conduct our own research tailored to indigenous needs.

The advantage in organising research from scratch is that it helps acquire an experience of methodology. Once research programmes get going they lead to a realisation that many observations which previously escaped documentation can easily be a part of the educative process in the future.

Research not only helps to identify and solve medical problems but creates an academic atmosphere. There are more meaningful discussions and a sense of achievement among those participating in the programme. Medical research surveys are also important for the administrative purposes as the government of the day has to be convinced that they would ultimately help in the formulation of appropriate health strategies. One approach would be to encourage research degrees like M.D. and M.S. which would automatically involve a large number of research projects. The results will also receive recognition in medical circles around the world. Their publication in international journals will act as an incentive for medical research workers. This is the way the Indians have approached the problem. They give preference to their own qualified doctors in manning the medical services.

They encourage their students to take an MD exam which requires research. This automatically motivates Indian medical students to get involved in research projects. All their professional appointments in medical collegess depend on the performance of their doctors in research fields. In fact a very important requirement for getting professional status is a patticular number of original articles published in research journals.

These are important factors in laying down traditions of medical research. It goes without saying that the community and the country as a whole gain from this. No wonder a great number of medical journals are published in India. They adorn the shelves of libraries around the world. Indeed medical research requires a motivated scientist and the beginning can be made by no more than a pencil and a piece of paper.
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Author:Omer, Zafar
Publication:Economic Review
Date:Sep 1, 1994
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