Promoting Medical Research in India
By Ikyatha Yerasala
Medical education in India does not promote the culture of research, which has direct consequences on the growth of the healthcare sector and more.
There are 596 medical colleges and 64 stand-alone PG institutes in India. But among these, only a few colleges have dedicated their resources to research or have made research an integral part of their medical curriculum. In a report in The Economic Times in 2017, it was revealed that in a span of 2 years, 685 research papers were published by the ICMR scientists whereas All India Institute of Medical Sciences (AIIMS) published more than 1100 research papers in a year. Also, an extensive research paper on the state of research in India revealed many reasons for the sorry state of medical research in the country, which is alarming given we have more than 6,00,000 medical graduates per year.
Why is Medical Research Neglected in India?
The reasons for this deplorable state of research in medical education are many and issues exist at all levels of the hierarchy. Dr. Damodaran Vasudevan, Associate Dean of PG Programs and Research, Amrita School of Medicine, believes that medical colleges in India, in general, are providing only lip service to medical research. “The faculty members of colleges across the country are publishing very few research papers. Firstly, there are no incentives for doing research or consequences for not doing research. Only very recently, the Medical Council has taken research a little seriously. Secondly, the idea that research should be part of the teaching program has not gained adequate attention among policy-makers or decision-makers of the country. Thirdly, adequate funds are not allotted at the regional and national level for doing research. Adequate focus on research methodologies at the undergraduate level and active research at the postgraduate levels needs to be given. It usually takes about 20 years to translate research in the laboratory to apply it to medical practice. So, if we start now, we will reap some benefits only after 20 years.” Recently, Amrita Vishwa Vidyapeetham has announced a grant of INR100 crore to set up 50 state-of-the-art ‘New Discovery and Innovation Labs’ at its campuses across India. The new labs will drive cutting-edge innovation and discoveries in fields such as medical sciences and biomedical engineering.
Reiterating the sorry state of medical research in India, Dr. Sachin Nagendrappa, Assistant Professor, Department of Psychiatry, St Johns Medical College, Bengaluru (one of the very few colleges to have a separate research institute - St John’s Research Institute) says, “Whether it’s community-based or biological research, availability of funding and facilities is important. Most Government medical colleges have human resources available, getting approval from the ethics committee is important— not all colleges will have resources for a committee.”
Problem-solving at Institution Level
In a research paper which ranked top colleges in India for their medical research facilities and activity, for a decade until 2008, AIIMS, Delhi topped the country. However, compared to the number of colleges in India, research outcomes from institutions are very less.
Dr. Damodaran says, “Clinicians are overburdened with patient load. In the West, one doctor sees only about 10 patients per day, whereas in Indian Medical Colleges, a general medicine faculty member has to see hundreds of patients per day. In science colleges, the UGC stipulates that one faculty take 16 hours of classes per week. But a medical college doctor may sometimes devote 16 hours per day for teaching and patient service. One day per week can be earmarked for research, and on that particular day, the faculty should not be burdened with other work. But there should be additional faculty posted, funds allotted, etc., to apply this.”
Adds Dr. Sachin, “Lack of research is a systemic problem that pervades all levels. Students need to be exposed to research and should not think of it as an added burden— interest should be generated in research through various means. Central institutes like NIMHANS, AIIMS, JIPMER have shown great interest in research, unlike most private colleges. Problems need to be solved at all levels— from the Health Ministry to the administrative level. Also, people who take part in research need to be provided with incentives to participate in it.”
With limited funding available for research, lack of investment is a great drawback for the progress of medical research. “Rs. 5 lakh per faculty per year should be spared as research grant by managements of medical colleges. But most medical college managements are finding it difficult even to pay the basic remuneration for faculty, let alone fund research. The central Government, granting agencies, medical college management, etc., should be equal partners in providing such facilities. Directing at least 5-10% of the annual turnover towards medical research will make a big difference,” believes Dr Damodaran.
Incentivising Research
ICMR is the apex government body in India for the formulation, coordination and promotion of biomedical research, and is funded by GoI through Department of Health Research. However, ICMR has been met with several criticisms. According to the 2017 ET report, ICMR which has about 800 scientists working across 32 institutes in the country, cannot list even one new intervention -- in terms of new drug, vaccine, diagnostic test or treatment procedure developed by its hundreds of scientists over a period of last two years. The report even questioned how a whopping sum of INR1558.89 crore was spent between April 2015 and February 2017. To this, Dr Sowmya Swaminathan, Secretary, Department of Health Research and Director General, ICMR stated that compared to the expenditure of USA which is $32 billion dollars, the budget of ICMR is just $232 million. She also went on to add that it takes 3.2 billion to develop a new drug and 1000s of scientists working on it, going to show why the research outcome of ICMR is not upto the mark.
“Unfortunately, the percentage of money allotted to the Health ministry has eroded through the budgets of each year. The Government of India allotted large sums to research; but 90% of it was allocated to space research, atomic research and rocket research. In all these fields, India has made great strides and is now internationally recognised. We have never invested enough money in health, and not even considered medical research. The Council for Scientific and Industrial Research (CSIR) and the ICMR were established in the 1950s. The CSIR has expanded exponentially, while ICMR has not,” says Dr. Damodaran.
However, things are moving towards in a better direction, believes the doctor. “The Central Govt has identified that we are way behind in biological and medical research. Last year, about 400 crores were allotted by the Government for basic research in medicine. This will be amplified every year, and I hope that within a few years, India will become a strong force in medical research,” he believes.
With the Union Budget for 2022-2023 seeing the Government allot Rs 3020 crore to the department of health research, one can hope that India makes great strides in medical research. However, a mere 0.2 percent rise in fund allocation for the health sector has garnered flak.
Major institutions including the AIIMS, PGIMER and(JIPMER have their funds raised by a few hundred crores. “The money has to be decentralised and focussed at the community level,” shares Dr. Sachin.
The Promise of Biomedical Engineering
Biomedical engineering, which is responsible for medical innovations and technology needs a push too. “BME programs are the backbone of the medical devices industry in any country. As long as the BME programs are not strengthened, any country would depend on foreign technologies for its healthcare technologies. While BME is the most preferred profession in western countries, it is the least preferred profession in India. Indian clinicians are yet to realize the importance of BME in a successful wellness delivery supply chain. In India, engineers sadly don't play any role in the health industry. Few programs offer solace, but they’re not sufficient. Clinical Engineering Programme at IIT Madras with CMC Vellore and Sree Chitra Tirunal Institute of Medical Science and Technology, Stanford India Biodesign, The School of International Biodesign at AIIMS New Delhi, Medical Device Innovation Program at IIT Hyderabad currently cater to only a minuscule requirement of India. What is needed is a mass frugal innovation that is a culture in medical education in India,” opines Dr. M. Manivannan, Professor of Biomedical Engineering at IIT Madras.
The Indian Medical system AYUSH can be a solution, however it needs a revamp, he believes. “Without research, AYUSH cannot offer a solution. IITs can play a major role in marrying modern scientific technologies and AYUSH. In a recent effort, the government has planned to integrate AYUSH knowledge into the curriculum right from the school level as part of National Education Policy, 2020, is a welcome move. However, without adequate research, without measuring instruments in AYUSH, this move will only lead to chaos,” he opines.
Push from Medical Council
MCI introduced an online course for PG students and faculty from academic year 2019-20 onwards. Called ‘Basic Course in Bio-medical Research’, the 8-week course was said to be compulsory for all PG students in the country and for faculty with no prior research training.
The NMC is also implementing a new curriculum proposed by the erstwhile MCI. The new competency-based curriculum focuses on early clinical exposure, horizontal and vertical integration with other disciplines as well as on attitude, ethics, and communication. “One course won’t change things for medical research– it’s important to incorporate it in the medical field. The MBBS curriculum does not give importance to research, so to draw students towards it, one should make research look interesting to students. Very few people choose research as a full-time career as there are very few institutions in the country that provide good research jobs. It’s not a rewarding career. Other countries have better opportunities in research careers,” states Dr .Sachin.
With university rankings being greatly influenced by research in these colleges, medical colleges have started to recognize that research is essential for good ranking in the national and international levels, which may be a driving force to focus more on research.
The Post-COVID Effect
Post COVID, ICMR engaged with various scientific organisations, government medical colleges, and high-quality private laboratories to intensify testing facilities. “Due to the pandemic, most of the medical colleges have upgraded their laboratory services to include molecular biology division. That itself is a great step forward,” believes Dr. Damodaran.
Medical research, which is the backbone for growth in the healthcare sector, is far behind in India when compared to many other countries, but with the pandemic, focus on medical research has been more than ever, and this may steer the medical sector to take research seriously and inculcate the culture of research in the curriculum.