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Priorities for research in developing countries
Seeking collaboration within the developing regions and training
manpower should be our priority- Prof. Russel De’Souza
Working group with research knowledge should be formed to identify
research areas and remove barriers- Prof. Sharma

From our correspondent

COVENTRY (UK): One of the important salient features of the Midland Psychiatric Research Group’s annual meeting this year was an interactive workshop on “Priorities for research in developing countries” which generated lot of discussion. It was chaired by Prof. Sawarn Singh from UK. The panelists included Prof. Sharma from India, Prof. VK Varma from USA, Prof. Madionas from Greece and Prof. I.A.K.Tareen from Pakistan.   In his introductory remarks Dr. Afzal Javed said that the objective of having this interactive workshop was to generate some ideas on identifying some research projects in developing countries. We do have some limitations in the developing world but still we can help in certain ways to initiate some research.

Prof. Swaran Singh in his speech pointed out that one cannot do things here which you can do in developing countries; for example treating manics with placebo. Whatever we do must meet international standards, he remarked. We should not do research in developing countries simply because patient population is there but we must do a proper job. Rewards of research come very late and it is an important commitment. Speaking about social epidemiological psychiatry Prof. Swaran Sing said that in the past people used to duplicate studies done in UK in their own countries. There were very few original studies. There is lot of room for research in developing counties but sadly the attitude of seniors is not encouraging who most often do not appreciate the juniors asking any questions. We have to change this culture in the developing third world countries, he remarked.

Prof. Russell De’Souza from Australia who is also chairman of research in WPA section on psychiatry in developing countries was the first speaker. He was of the view that we must do research which is applicable in developing countries. We have large services and clinical needs but limited resources. Research is most often a low priority in our countries. However some places are better than other.

Speaking about the challenges  Prof. Russell De’Souza mentioned about funding sources, government bodies, NGOs, lack of infrastructure, focus on teaching and training, non-availability of trained manpower for conducting research, quality assurance programmes, conducting research that is relevant and practical. He also talked about the relevance of high impact factor journals. Unethical research, he stated, is not useful. The areas to consider he felt were  opportunity for collaboration within the developing regions, training new models for service delivery, creating effective evidence base and giving back something to our countries.  South Asian Forum, he remarked, has initiated the idea of cross fertilization. The brain circulation concept is gaining momentum. We need Ethics Committees, Institutional Review Boards to regulate research.

Dr. Angelo Barbato from Italy talked about mental health research in low income countries. He stated that almost 94% research is done in high income countries. Speaking about citation of papers in psychiatry during 1996-2000, he pointed out that 61% of citations came from United States, 16% from UK and  6.5% from Canada.  Almost 45% of mental health research in developing countries is conducted by the research scientists from their own resources which unfortunately do not figure in developed countries. It was also pointed out that it is also a fact that clinicians in developing third world countries have much more clinical experience than the researchers in the West.

Prof. S. Sharma spoke about mental health research in India. He was of the view that mental disease patients are going to increase in our countries with the increase in life expectancy, migration and urbanization. When more people go to disaster areas, they become a barrier rather than a help. He also talked about issues related to homelessness and mental health. The real issues in research relevant to low income countries are manpower training, lack of incentives for researchers, fiscal support, problems in collaboration besides ethical issues. Government support, financial assistance from pharmaceutical companies, private foundations, World Bank and WHO also came under discussion. He also talked about how one can become a principal investigator, the peer review process and what research is available and the barriers to research.

Prof. Sharma suggested that we must establish a working group with knowledge of research work. It should identify research areas. It should find funding sources, train staff, identify barriers and then remove them. He also referred to the rising patient expectations in the domestic set up, conflict of interest issues and confidentiality. It is the duty of scientific community to respond to these issues so that these problems should be resolved.

Prof.  V. K. Verma spoke about baseline and constraints of developing basic research data. Healthcare professionals, he said, are being drained away from the developing third world countries to the developed world. It has its adverse effects not only on services but on research as well. With the introduction of market economy concept, now every hospital is being asked to generate its own resources. Since the number of trained psychiatrists is limited, many countries have successfully used primary healthcare workers to teach the family how to look after mentally ill patients, he stated.

Prof. I. A. K. Tareen from Pakistan suggested developing links between institutions and countries. Sometimes some people get away with research data which is questionable published in prestigious journals and when you write to the Journals, they seldom respond. He particularly referred to a study done in rural areas of Rawalpindi which showed the prevalence of depression 66% but another study conducted in urban slums showed the prevalence of depression as 20%. It provides a simple solution to solve the problem of depression i.e. convert all rural areas into urban slums, he asked. This type of research does not do any good to any one, he remarked. Dr. Afzal Javed was in Pakistan and then he decided to come here. It has been a great loss for Pakistan. He advised all those present to go back to their respective countries and think what they can do. We have to learn from our mistakes and find solution to our problems ourselves. We need to develop community service, he added.

The presentations were followed by lively discussion in which a large number of the delegates actively participated.  A participant who had come to UK from Nepal said that he did his FCPS from Pakistan and before coming over to UK trained quite a few people. Dr. Anjum Bashir referred to the lack of resources for conducting worthwhile research. Mr. Shaukat Ali Jawaid Chief Editor Pulse International remarked that it was not the lack of funding but ensuring proper utilization of the available funds which was also important. He further stated that now National Bioethics Committee has been formed in Pakistan. Efforts are underway to establish provincial and institutional Ethics Committees. Higher Education Commission is providing lot of funding for research provided the research protocols are properly prepared and get approval after peer review.  Pharmaceutical industry in Pakistan, he said, was involved in lot of unethical practices in collaboration with the medical profession. Hundreds of doctors are taken on joyrides overseas regularly by various pharmaceutical companies just to influence their prescription practices. If the pharma industry was asked to contribute the same amount for some research projects, it will make available lot of funds, he added.