Implementing research findings in developing countries

The excellent article by P. Garner et al.1 has been commented on by T. Gibbs 2, who explained the educational roots of difficulties in implementing research evidence in medical practice, using the example of Ukraine.

Problems described by Garner et al. are relevant to all countries with old fashioned medicine. For example, in Russia in medical practice and in medical education the importance of scientific understanding of pathology is indisputable. It is the foundation for the prized 'individualization' of treatment of the patient.

Another 'educational' barrier for the implementation of the research findings in practice in Russia is the old fashioned state of epidemiology. Russian epidemiology is still the science of the spread of infectious diseases. It is the point defended by the powerful Dr. V. Pokrovskiy, head of the Academy of Medical Sciences and the head of the major Moscow research institute of epidemiology. He insists that 'epidemiology is a Russian science' and is a science of the spread of infectious diseases 3. As a result no medical school teaches students epidemiological methods and modern biostatistics, and there was no textbook on epidemiology until this spring, when the first book 4 was translated. Most physicians do not understand study design and the possibilities of critical appraisal, believe information from drug company representatives, and do not understand the biases of unethical advertisements in medical journals. In one major medical journal in Russia recently the advertisement and the telephone number of the drug company representative were published in the middle of a 'scientific' report of a drug trial!

The main source of information on evidence based medicine for Russia is the pages of the Russian version of Evidence Based Medicine (Russian title 'International Journal of Medical Practice', published since December 1996). In 1997, the Ministry of Health started the program of 'standardization' in health care. In Moscow and in all regions of Russia health officials initiated the writing and official approval of 'standards' or 'medico-technological protocols' for all frequent conditions. These documents, usually two pages long, have no references and have nothing similar to the modern trend to 'evidence based guidelines'. They reflect the opinions of the authors and textbooks available to them. It is an example of how the implementation process of research findings may be erroneously reflected in the medicine of specific countries.

My Russian colleagues will condemn me for discussing Russian problems in the context of discussion of the medicine in developing countries. They have good arguments: e.g. in Russia there are more computer tomographs per million population than in England. I understand these arguments only as proof that the article by P. Garner et al. 1 relates not only to developing countries but to all countries where medicine is outdated.
V. Vlassov
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Vasiliy Vlassov Dr. Med. Sci., Professor
Saratov State Medical University
e-mail: vvvla@ssu.runnet.ru
snail mail: P.O.Box 1528, Saratov, 410601 Russia

Reference List

1. Garner P, Kale R, Dickson R, Dans T, Salinas R. Implementing research findings in developing countries. Br.Med.J. 1998;317:531-535.

2. Gibbs T. Implementing research findings in developing countries. Br.Med.J. 1998;317:

3. Pokrovskiy VI. Epidemiology - Russian science [Russian]. Zdravoohranenie Ross. Federatsii. 1993;3-5.

4. Fletcher RH, Fletcher SW, Wagner EH. Clinical Epidemiology [Russian]. íoscow: MediaSphera, 1998;