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Opinion: Medical Research — A General Perspective

The greatest scientist of our nation Dr APJ Abdul Kalam has taught us what research is — take the example of creating carbon-carbon a light compound for use possibly in missile technology — the formulation and development of carbon-carbon compound is fruit of basic research. The resultant compound when he used to manufacture callipers of 400 gm weight to help handicapped children — is applied research (original callipers weighed nearly 4 Kgs). The smile he saw on the face of our beloved late president through the glow in the face of those children made him say that is the best contribution he has made through his research. What a humane human who had his science tempered with humility and lived as a living example of true scientist apart from being the first citizen of our country, a great ambassador of our country and the beacon who gave direction to our youth and children — an aspiration so needed for our youngsters to find a way for their lives and also making them realize they are the investments for the future of India (to become a developed nation by 2020). Words do not explain or capture or deeds cannot replicate our beloved Kalamji who proves that “Life levels all and Death reveals the sparkling diamond of our country.”

Dr D S Sheriff
Dr D S Sheriff

Medical research is defined as “all scholarly activities that deal with any of the areas of studies being conducted in the pre, para and clinical areas being taught in a medical school”. Such a definition is somewhat arbitrary, as medical research covers much larger field and ultimately affects every individual. The results of research activities are directly translated into social action, such as pollution control, vaccinations, mass fluoridation and nutritional improvements. The eradication of diseases like small pox, poliomyelitis and plague, the decline in the death rate from infectious and cardiovascular diseases, and the diagnosis of genetic disorders are some of the examples to show how medical research helps to provide improved healthcare. Thus, the wealth of medical knowledge which grows through the process of discovery and research development becomes part of daily living. The aim of research in science is always to extend the frontiers of knowledge and to discover rational correlations and principles.

The medical research can be clearly divided into biomedical (basic medical), clinical and health science research. The areas overlap each other and health science research has a component of social research. Experimental research covers areas such as physiology, biochemistry, microbiology, pharmacology and pathology and is relatively easy to conduct. If adequate financial support is obtained, necessary infrastructure for laboratory research could be built and experimental animals maintained in an animal house. For clinical research, the patients with a particular disease are the direct object of study. This type of research involves dealing with the clinical picture, diagnosis, therapy and prognosis of the disease. Dealing with human beings requires stringent regulations and precautions to be observed. It requires setting up of a research team in the hospital to monitor and chart out guidelines involving the ethical dimension of the problem to be studied and maintain a systematic medical recording system. Moreover, it is through a prolonged study of a large number of cases of the same disease that the clinical research learns to predict the likely prognosis and judge the efficacy of the treatment. This type of research activity has limitation in the form of having restricted number of cases of the disease under investigation, a need to update one’s knowledge with respect to laboratory techniques from which he obtains his ‘cues’ and the longer time interval required to complete the work. Health science research is a recent development of medical research due to the demands placed on many health services. More often basic medical and clinical research go hand in hand and are inseparable. Furthermore, clinical research workers often conduct studies on experimental animals, due either the limited number of human cases or for ethical considerations.

Medical Research Worker

An experienced research worker is one who has the capacity to recognize a problem, to analyse its various hypotheses, and to choose the appropriate methods that are at his disposal during the study. The organisation of research requires good experience in various laboratory techniques, a trained mind that has the ability to dissect a problem into its essential components in a logical sequence and analyse the findings of the investigations. Scrupulous honesty, persistence, hard work and intellectual integrity are some of the basic requirements of a good research worker. Therefore, a research worker attains his proficiency only after a period of disciplined training.

It is extremely beneficial to encourage and conduct research in a medical school, which could be applied towards improving health conditions and to promote the teaching of undergraduates, postgraduates and junior teaching staff. Progress in medical research is hampered due to lack of opportunities to recruit good scientists. Another drawback is the inflexible training programmes followed for medical graduates coupled with lack of financial support and of research coordination and integration. Medical science research is usually undertaken both by medical and science graduates with an intention to develop an academic career and also to work in a hospital department of medicine. Research in a department is supervised and led by the head of the department in association with senior members and postdoctoral staff.

Plan of Research: the Central Dogma

Biomedical research could broadly be classified as fundamental (basic) research and applied research. However, there is considerable overlap between the two. Basic research, though it may not have specific applications, is directed towards advancing scientific knowledge. On the other hand, applied research is of practical value and beneficial to the community. Most medical research is usually of the latter type where the information gathered by scientists is applied to the diagnosis, treatment and prevention of human diseases.

The selection of a research project often involves a critical appraisal of the existing knowledge on a particular subject, thus prompting a certain question to be answered after a carefully planned scientific study. In addition, certain phenomena may be observed that cannot be explained on the basis of current knowledge, thereby necessitating research into potential causative factors and management of complications. Certain form of research is conducted to test or prove the hypotheses of other researchers.

The research plan in a medical school needs careful scrutiny. The interest and background of the researcher plays an important part in the choice of the research project. Encouragement must also be given to studies related to community-based genetic or acquired diseases pertinent to the environment and to the community at large. Most of the research in medicine is interdisciplinary in nature bringing clinicians closer to scientists. This has led to great advances in medical research and to shed greater light on diagnosis and/or management of health disorders.

The Planning of Research: How to Start It?

After selecting a good research project the following steps need to be taken:

• Literature review: A comprehensive and critical review of the existing knowledge on the work needs to be carried out to extract information relevant to the project.
• Formulation of a hypothesis, project preparation including experimental design.
• Application to relevant sector or agency for financial support.
• Acquisition of research tools, laboratory equipment and materials.
• Implementation of the work-plan, including initiation of experimental investigation.
• Tabulation of study data and statistical analyses.
• Drawing research conclusions and reporting.
• Periodical checkup and submission of progress report.

However, a research worker has to overcome many problems before a successful research project could be initiated.

Finance

Financial support is given to a research project through several agencies (national/private). Such finance requires support of the institution where the research work is to be carried out. The institute has to provide the following facilities:

* Basic laboratory facilities (equipments, technical/personnel).
* An undertaking by the institute to support throughout the tenure of work.
* Qualified staff members to start such a project.

Basic Requirements of Research

Getting the laboratories equipped with standard instruments and chemicals is a basic obstacle in developing countries. Some of the sophisticated instruments need to be purchased from abroad and this takes time due to various causes including custom restrictions. Instruments such as electron microscopes, radioimmunoassay systems, automated instruments, high-voltage electrophoresis apparatus etc need special space and installation conditions. Tissue culture studies, genetic engineering, biotechnology experimentations and working on certain organism and animals need extra financial support. Apart from providing the basic facilities, the installation for instruments, maintenance, training of personnel and updating the equipment are very essential and usually not given adequate attention.

The information explosion, statistical evaluation and three-dimensional elucidation of structures are some of the areas which require the participation of computer technology. Such a computer-aided provisions remain an important area for consideration for furthering research studies.

Financial constraints, administrative delays, teaching loads, poor study designs lack of statistical support, improper motivation of research in the minds of undergraduate students through threat of examination system and lack of co-ordination between different departments are some of the grey areas one needs to watch for improving and initiating research projects in a medical school or university or an organization.

by Dr D S Sheriff

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