Sweeping changes are needed to boost research in India, say researchersBMJ 2014; 349 doi: https://doi.org/10.1136/bmj.g6473 (Published 28 October 2014) Cite this as: BMJ 2014;349:g6473
Indian biomedical researchers have echoed Prime Minister Narendra Modi’s recent admission that India is lagging behind in medical research. Modi made his comments in an address at the All India Institute of Medical Sciences, New Delhi, on 20 October.
Researchers told The BMJ that acknowledgment of the problem by the prime minister is a good sign, but widespread structural changes are needed for the problem to be addressed effectively.
Satyajit Mayor, a biologist and the director of the National Centre for Biological Sciences in Bangalore, said, “That clinical and biomedical research is at a very low ebb in the country is absolutely true, even though there is a huge opportunity because of the genetic diversity among our people. It is a major matter of concern in terms of the policies the government should put in place.”
One reason for the lack of progress in medical research, the researchers said, is that clinicians in India are overburdened with large numbers of patients, leaving them with very little time for research. India currently has only one doctor for every 1800 patients,1 and the career track defined by the Medical Council of India, the statutory body that sets standards for medical education, does not leave any room for research.
“If a clinician is inclined to do research within their trajectory of moving from being an MBBS to an MD to a specialist in a hospital, there is no time to even look sideways. If they do that, they get shoved off the rails. The fact that some clinicians in India still carry out research at great odds with the time and resources they have is extraordinary,” said Mayor.
As well as the sheer workload on doctors, there is no system in place to help practising clinicians communicate with basic science researchers who can answer their research questions. Rajesh Gokhale, director of the Delhi based Institute of Genomics and Integrative Biology, said, “There are some medical research problems that will take 15-20 years to solve, but there are some which we can solve in 2-3 years and which can really change people’s lives. But to be able to understand these problems we need to communicate.”
One way to solve this problem would be to create partnerships between hospitals, medical colleges, and basic research institutions. But it is hard to foster such partnerships in India because of regulatory hurdles, said Gokhale.
B N Gangadhar, the dean of behavioural sciences at the National Institute of Mental Health and Neurosciences in Bangalore, said that the process of applying for research grants, which are essential for carrying out high quality research, is a barrier for most doctors. If the process of obtaining research grants was streamlined and made less time intensive, it could make a difference to the state of medical research in India.
The study of rare genetic disorders, such as leucoderma, is a victim of the chasm between basic research and clinical practice, said Gokhale. Although leucoderma occurs in <1% of the population, in a country of one billion people the burden is significant. Yet clinicians typically do not collect data or carry out research on this disease, even though they meet a significant number of patients with leucoderma.
The recent tightening of clinical trial regulations in India has also been a problem for medical research.2 Even though organisations such as the Institute of Genomics and Integrative Biology do not carry out clinical research, doctors need drugs to be tested on the Indian population because it is genetically unique and diverse, said Gokhale. Furthermore, the ban on clinical trials has had a spillover effect on research culture, said Kiran Mazumdar Shaw, the managing director of Biocon, a drug company based in Bangalore. Most medical colleges in India, Shaw said, do not carry out medical research, so collaborating with drug companies on clinical trials is the only time they are involved in any sort of research. “By creating a moratorium on clinical trials, you have killed this opportunity as well,” she said.
On 22 October the Indian Department of Science and Technology announced a 50% rise in stipends for research scholars in India.3 Many scientists lauded the move, saying it will encourage more research, but Gokhale believes there is only so much it can do in the face of the brain drain faced by India. “We continue to lose our best people abroad. And then we are expected to do equivalent research. That isn’t feasible,” he said.
Cite this as: BMJ 2014;349:g6473