Fatema Jawad ( Editor-in-chief, Journal of Pakistan Medical Association, Karachi, Pakistan. )
Original biomedical research that meet the international standards is scarce in Pakistan. Some handful of researchers having the resources and expertise conduct high quality research and have it published mostly in foreign journals. Although the quantity of research has increased in Pakistan the quality can improve tremendously. The reason for the rise in quantity can be attributed to the rules laid down by the regulatory authorities such as Pakistan Medical and Dental Council (PMDC) and Higher Education Commission (HEC). Most of the medical schools have added research to their curriculum, however there is still a long way to go. Medical students have to undertake a research project before they reach their final year of college. Faculty members need a certain number of publications for promotion. Some clinicians need additions to their list of publications to adorn their CVs. If accessed in depth, there are few true researchers who truly have genuine research questions and try to find answers.
Research is essential for progress in every field. A country lags behind if there are not sufficient researchers and publications. Research in the biomedical field brings about new discoveries, more effective ways of treatment, increasing awareness on diseases and prevention strategies. The categories of research have been pre-defined with Randomized Controlled Trials (RCTs) being the most effective and prestigious. Unfortunately there is no trial registration authority in Pakistan, writes Akhter Sherin in his editorial of Khyber Medical University Journal.1 Everywhere else in the world RCTs are conducted through national or regional registries and monitoring authorities. RCTs need more finances, time and dedication. It is also an accepted fact that the results of RCTs are much more authentic and it is the best category of original research. RCTs are usually multicenter or country wide having interventional designs.
Pakistan has little expertise and minimal funds to conduct medical research. This is compounded with shortage of time. Most researchers perform small studies which can be questionnaire based surveys in one institution or retrospective clinical data analysis of one or more department or institute. At times, clinicians try to get an audit of a technology or Knowledge, Attitude and Practice Surveys published as an original article. In the absence of clearly defined criteria of the categories of research, authors demand that their research be treated as original because it is the requirement for faculty promotion. Such rules are imposed by the Institutional Promotion Committees, PMDC and HEC.2,3
All the leading international journals having high impact factors and a very low acceptance rate, publish three to five Original Articles in an issue, which have been pre-defined as RCTs or Meta-Analysis. The problem in Pakistan is that the PMDC does not define the research categories on its website. It only asks for three or five Original Articles published in a PMDC-recognized journal to be presented by the candidate for promotion.
This situation leads to a dilemma. On the one hand, the three Pubmed indexed biomedical journals in Pakistan find it difficult to be at par with international journals as New England Journal of Medicine, Journal of American Medical Association, British Medical Journal and Lancet. In the absence of clear-cut definitions the authors naturally insist on having their work published in these leading Pakistani journals as Original Articles. Many articles which are good could still be published but under a different category. Thus these journals would maintain a high standard.
On the other hand, if the PMDC and HEC do not amend the requirements for promotion hardly anyone would qualify for promotion or for applying for an examination. The fact is that there is hardly any original research being conducted in the country due to the constraints mentioned above.
The most feasible approach would be for our authorities to define the criteria for research more clearly and closer to internationally recognized definitions than they are at present. They will also have to redefine the qualifications for promotion or for applying for examinations. It is not rational that an article on 35 patients if published under the caption of an Original Article is acceptable to the authorities but loses its importance if the same article if placed in the category of case series. The authorities should be more concerned about the quality and content of an article to decide its importance rather than its category as determined by the journal.
If we want to be on an equal level with the rest of the world we have to make sensible and plausible changes in our rules and definitions. The regulatory authorities have to give a second thought and change their obsolete rules. The members responsible for taking a decision, should be experts on research and its publication and give a fair judgement on the contents of the article and not on the caption of the category under which it is placed.
1.Akhtar Sherin. Clinical trial registration: Can we establish national clinical trial registry of Pakistan? Editorial. (KMUJ) Khyber Med Univ J 2012; 4: 37-38.
2.Pakistan Medical and Dental Council. Regulations for the appointment of teachers and examiners in undergraduate and postgraduate medical and dental Institutions of Pakistan http. [Online] 2007. (Cited 2016, November 24). Available from: URL: http://www.pmdc.org.pk/appoint.pdf.
3.Regulations for qualification of reasearch and scholarly performance. (Online) (Cited 2016, November 24). www.neduet.edu.pk/ASRB/ResearchPaperRegulations.pdf.