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What is wrong with Pakistani doctors? - How medical researchers skimp.

Byline: Dr Amjad Mehmood

In Pakistan, research is a word reviled in society and the same is its relevance in scientific fields including the field of medical research.

A few days ago, Saudi Arabia, Qatar, Bahrain and the United Arab Emirates showed the mirror to Pakistan's medical community by sacking hundreds of Pakistani doctors who had secured jobs on account of their Master of Surgery (MS) or Doctor of Medicine (MD) degrees. Holders of these degrees had been working in the Arab countries since 2016. These doctors have also been issued deportation orders.

Pakistani doctors working in clinics (i.e. patient treatment and care) are excellent but not those who are working in clinical research. It is the latter who have brought ignominy for Pakistan. In the past, Saudi Arabia was more concerned about the clinical aspect of medicine, but recently Saudi Arabia has invested heavily in conducting clinical research, especially that related to causes of a disease and the application of drugs in patients. In responsive, some medical universities in Pakistan developed certain MS and MD programmes to get the skilled force consumed in Saudi Arabia and other Gulf countries, but the strategy seems to have backfired. Saudi Arabia has taken the initiative and the rest of the Gulf countries have followed suit, alleging that Pakistan's postgraduate degrees are short of structured training programmes. In Pakistan, there are four main reasons for the consequent opprobrium.

The news of expulsion of Pakistani clinical researchers from the Middle Eastern countries might have taken many Pakistanis by surprise, but to many Pakistanis working in the field of clinical research the odious episode was an eventuality supposed to see daylight one day

First, the concept of research, even clinical research, is still alien to Pakistan's medical universities. Professors themselves violate research rules with impunity and the same malpractice trickles down to student researchers. Garbage in, garbage out. For instance, a former VC of a government medical university in Lahore, after assuming charge, circulated his curriculum vitae claiming 120 research articles published in the field of reproductive endocrinology and high-altitude physiology during his research experience spanning 35 years. If one research article has at least 2000 words, the total words published were about 240,000. With such a number, a whole book could have been published. Similarly, with such an extended research experience and number of publications, there could have been inventions and discoveries (patent rights) against his name. Unfortunately, there were none. Even related to his field of research, no standard book had included his name as a contributor.

Second, in Pakistan, medical researchers are not careful about the validity of research. They overlook the fact that the steps taken to conduct research are more important than the conclusion. Every step has to be recorded in a logbook. A common reason to drawing a conclusion not flowing from the research conducted is that there is a tendency in Pakistani researchers to steal the objectives and conclusion of research performed elsewhere in the world and replicate the same in the context of Pakistan to claim a scientific credit. For instance, in 1991, P Laurberg et al published the result of their study at Aalborg Regional Hospital (Denmark) on high incidence of multinodular toxic goitre in the elderly population in a low iodine intake area in East-Jutland Denmark. In 2013, from the government medical universities in Rawalpindi, a team of researchers replicated the same study in the northern region's elderly population, and without following the requisite steps. drew the same conclusion.

Steps of conducting research were not followed because before conducting research, the team of researchers knew of the conclusion it would be reaching. Similarly, in 2005, at the Osaka University in Japan, A Fukukara et al conducted a study on human beings to examine the effect of a secreted protein (Visfatin) on testosterone levels in insulin-resistant diabetic males. Interestingly, in 2013, a team of Pakistani clinical researchers based in Rawalpindi reinforced the same findings by conducting a study on male rats. In the world, experiments are conducted first on animals and then, after their success, human beings are engaged in clinical trials. In Pakistan, just to earn a scientific credit, the reverse is done. A Fukukara et al did not need any reinforcement, but researchers in Pakistan were in need of a scientific credit. News of such virtuosity has reached foreign countries that view the achievement of Pakistani researchers with doubt.

Third, in Pakistan, medical researchers are incautious about the reliability of research. Any research whose results are not replicable is unreliable research. There are several examples where unreliable data have been produced to serve the purpose of the researcher only. For instance, a head of department in a government-sector medical university in Lahore declared a couple of years ago that he had discovered a Pakistani type II diabetes. The professor published four research articles (from 2013 to 2015) in four different research journals of Pakistan. The articles indicated that each time he got the approval of the Ethical Committee of the university. Interestingly, the blood samples of 212 patients he used were the samples he reportedly collected from November 2009 to January 2012 during his PhD studies. It is still not known how he cryopreserved the samples to keep on using them for more than three years after the date of sample collection and it is also not known why the Ethical Committee of the university permitted him to declare in each research article that the cohorts of the patients were fresh each time. Neither any independent nor a third party researcher has been successful in repeating the experiments.

Fourth, Pakistani researchers practice a culture of condoning. That is, you overlook my faults and I will overlook your mistakes. They do not challenge each other because they mutually conduct research malpractices. There are other silent participants in this malicious activity of research quackery. Each medical university has hired the services of media managers who secure hefty salaries from the university and penetrate the media to forestall the publication of any news prejudicial to the interests of the university. These media managers also offer the reporters covering the health beat a direct access to medical facilities of attached hospitals as a sop to stay tight-lipped. Above all, medical universities especially those in the government sector are supervised by the Chancellor, who happens to be Governor of the province. For instance, there are several complaints against research malpractices lying pending with the office of the Governor of Punjab. Governors, mostly from non-science areas, do not involve themselves in the universities' research issues. Registrars of medical universities also propitiate the governors with different favours and keep the issues suppressed. Consequently, the complaints remained unanswered and unaddressed.

The news of expulsion of Pakistani clinical researchers from the Middle Eastern countries might have taken many Pakistanis by surprise, but to many Pakistanis working in the field of clinical research the odious episode was an eventuality supposed to see daylight one day. When teachers (or trainers) are involved, students (or trainees) cannot escape research malpractices. A thorough inquiry into the matter is required to root out the malpractices of research quackery and research misconduct rampant in Pakistan's medical universities and hospitals spoiling the future of young clinical researchers and bringing disgrace upon Pakistan.
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Publication:Pakistan Today (Lahore, Pakistan)
Geographic Code:7SAUD
Date:Aug 16, 2019
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