One-size-fits-all approach has its own limitations
Basic purpose of research is to provide a new insight into what is already known. Hence everybody should and is being (rightly) promoted to provide one's own point-of-vision in patient care. And collectively this knowledge is supposed to lead us to a brave-new-world where management of illnesses is simple, affordable and human suffering is reduced.
But fixing a quota for research poses new challenges and raises new questions. Last year Dr. Rakesh Aggarwal, Professor at SGPGIMS Lucknow, penned an editorial on this issue and that was published simultaneously in almost all the journals of repute. BMJ too covered the theme (1). Several points raised by Prof. Dhastagir Sheriff on this webpage are already covered in that editorial. What we want to highlight is that sometimes it becomes difficult even for top scientists/artists/thinkers to convince the world about their views, and judging that too demands another level of understanding. If everything is pulped to a single lump, there may (rightly) be question-marks about our intellect.
Charles Darwin, proponent of famous Theory-of-Evolution by Natural Selection, made his observations while he was on a voyage in a ship. His theory provides us one-of-the-most fundamental insights into animal (including human) biology (2). Now MCI wants everybody to be trialists. If Darwin were to present his great theory to present day MCI inspectors, they may place the great observer at the end of the promotion-list, as he simply did not conduct a trial. Observational studies, as per our understanding, are uncommonly published as original articles, and original article are the trump cards to get promotions as per existing (funny and impugned) rules.
Ignaz Semmelweis, a physician, more than 150 years ago made an observation that puerperal-fever is common among mothers whose delivery is conducted by doctors, as compared to those made by midwives. Based on the observation he promoted hand washing technique. This is still one-of-the-most fundamental principles of safe motherhood (3). If Semmelweis were to present his observation in front of MCI inspectors today, they would gently tap him on the knuckles, and perhaps advise the astute observer to conduct some trial, if he wishes to get promotion.
Werner Forssmann, a daring doc, inserted a wire into his own heart and then got himself X Rayed. This was for the first time in known human history in a living body. The wire was found inside his heart and the finding challenged the then prevalent theories. After getting to know about the experiment, senior professors banned his entry to the lab, yet the discovery put the foundations for current day cardiac catheterization and interventional cardiology. Later on Forssmann was awarded the Nobel Prize for the discovery in 1956 (4). If he were to present his experiment to present day MCI inspectors, after that groundbreaking X Ray, he will simply be asked to do what everybody is doing - a worthless clinical trial or two, and then get promotion.
When Galileo Galilei directed his telescope towards Jupiter and saw its moons and then shook the very foundation of the then dogma, he was not conducting some sophisticated scientific trial. Religious bodies then used to preach that this world was Earth-centric and everything revolved around the Earth. When Galileo saw moons revolving Jupiter, he put that theory upside down (5). No credit was given to him in his lifetime, he was jailed and lost his eyesight there. Alas, if he were to present his observation to present day MCI inspectors, they again will label that observation as a mere ordinary case report, and he will not be promoted. We shudder to think that how many such fundamental observations have been relegated to a corner, and how many times such honest medical observers have been asked to do something useful as per standards of our MCI inspectors.
LIGO experiment is being conducted to listen to gravitational waves (tweets) of collision of distant stars (6). As per some accounts, this is the biggest endeavor in scale and scope of mankind tio date to unravel the mysteries of the universe, which all of us share. If MCI were to assess the data generated in the mammoth tunnels, quickly they will provide credit to the first 2 researchers, as that is the existing rule. As per existing promotion rules of MCI, only the first 2 researchers get the credit howsoever large or small the study is. Therefore LIGO researchers , to some extent are fortunate that they are not under the direct scrutiny of MCI. If that were the case, instead of putting their brains to analyse the data and interpreting its results, and then designing even a better experiment, the researchers would have been reduced to squabbling about deciding the first 2 authors. This is the way we in India treat the hardworking scientist, whose work has the potential to change the future of all of us.
Nowhere we intend to belittle the importance of clinical trials, or the significance of the data generated by that tedious process. What we want to point out by citing these geniuses and those historical moments which changed the history, is that that is not the only way that science progresses. There is an urgent need to relook and revisit existing MCI rules. Yesterday while throwing open its new National Museum, President Barack Obama says that America is a constant work-in-progress (7). We believe that same principle of work-in-progress is also true for another circumstances -- aligning promotion rules for existing evidences and realities in India too. If in the name of conducting and promoting clinical trials, creativity is suppressed, free opinion is bulldozed and original ideas are scorned; all of us will gradually drift towards a world where all the top positions in all the top academic universities will be occupied by duplicates.
(1) Travasso C. Indian editors urge Medical Council to rethink publication guidelines for academic promotions 2016 ;352 : i344, available at http://www.bmj.com/content/352/bmj.i344
(2) Natural Selection, on Wikipedia , available at https://en.wikipedia.org/wiki/Natural_selection
(3) Macnerney S , on Big Think . Decision making has its Semmelweis , now it needs a Gawande , available at http://bigthink.com/insights-of-genius/decision-making-has-its-semmelwei... 2015
(4) " Werner Forssmann - Facts " nobelprize.org Nobel Media AB 2014 Web 26 Sep 2016 , available at http://www.nobelprize.org/nobel_prizes/medicine/laureates/1956/forssmann...
(5) Galileo Galilei, on Wikipedia , available at https://en.wikipedia.org/wiki/Galileo_Galilei
(6) Castelvecchi D. LIGO detects whispers of another black- hole merger. Nature 15 June 2016 ;534 : 7608 , available at http://www.nature.com/news/ligo-detects-whispers-of-another-black-hole-m...
(7) "We Are America" : Obama opens National museum of African American history and culture. NBC Washington ,24 Sep 2016 , available at http://www.nbcwashington.com/news/local/Smithsonian-National-Museum-of-A...
Competing interests: No competing interests