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In today’s era, the importance of medical research cannot be overemphasized. The goal of medical research is to improve healthcare. A peep into history reveals that the earliest narrative describing a medical trial is found in the Book of Daniel, according to which, the Babylonian king Nebuchadnezzar ordered youths of royal blood to eat only red meat and wine for three years, while another group of youths ate only beans and water.¹ The experiment was intended to determine if a diet of vegetables and water was healthier than a diet of wine and red meat. At the experiment endpoint, the trial accomplished its motive: the youths who ate only beans and water were healthier.¹

The health-care system across the world has witnessed a major revolution with rapid strides in technological advances. The increased longevity of the human race today has been the result of decades of medical research worldwide, resulting in improvements in diagnosis and treatment. No wonder, medical research assumes huge significance globally. Given the fact that India contributes to a fifth of the world’s share of diseases, the health research output needs to be substantially increased in order to meet the challenges ahead. So, are we doing enough in this sector?

Let us look at a few statistics to answer the question. Sample this. A study published by Ray et al in the year 2016 evaluated the research output from 579 medical institutions and hospitals in India during 2005-2014 and compared their output with some of the leading academic centres in the world.² The results revealed that only 25 (4.3%) of the institutions produced more than 100 papers a year, and their contribution was 40.3% of the country’s total research output.2 Alarmingly, 57.3 % of the medical colleges did not have a single publication in a decade. In comparison, the annual research output of the Massachusetts General Hospital and the Mayo Clinic was 4,600 and 3,700 respectively.² The investigators found that the majority of institutes that accounted for the bulk of research output in India were publicly funded.² The study concluded that the overall research output from Indian medical institutions is poor.²

India has a wealth of human resources. With our huge reserve, we can surely do a better job. However, in order to improve the current scenario, we need to identify factors responsible for this state of affairs. Some believe that the clinical burden in large hospitals is a major reason for sub-optimal performance, leaving less time for meaningful research. However, this argument does not always hold true as the largest number of high quality publications come from institutions that serve the highest volume of patients. This can be said not just of India (AIIMS AND PGI have a prolific publication record), but also of many renowned hospitals all over the world.

Another factor that is often held responsible is lack of infrastructure. Not everyone aspiring to do quality research is fortunate to get an opportunity to work at places with well-equipped infrastructure and resources, which may result in lack of motivation. Further, there is little incentive for doctors to conduct research as faculty promotions in the majority of medical colleges are time bound, rather than based on research and publications. Research is not viewed as a profitable activity by most clinicians, who would rather invest their time and energy in treating patients and earning a livelihood. Another reason for poor performance could be the lack of mentors among faculty who can inspire and motivate young enthusiastic minds to take up medical research as a career.

And finally, but most importantly, are we spending enough? Research output is closely linked with expenditure on research. According to a study on Asian countries, there is a positive correlation between the country’s expenditure on research & development, larger number of universities and more number of scientific indexed journals and the research outcomes as measured by the total number of research publications, citations per document and H-index.³ In the United States, the expenditure on biomedical research and development was 119.3 billion dollars in 2012, with the National Institutes of Health (NIH) being the main source of federal support for biomedical research. The Indian Council of Medical Research (ICMR), funded by the Union Ministry of Health and Family Welfare, is the apex organisation in India that was established to formulate, conduct, coordinate and promote biomedical research in India. It is one of the oldest medical research bodies in the world. As per available figures, while the budget of NIH in the US is 32 billion dollars a year, the budget of ICMR is only around $232 million.

When we talk of medical research, it is important to bear in mind that this term is not limited to clinical research, as some clinicians might interpret. Rather, it refers to a wide spectrum that encompasses basic research, translational research, pre-clinical research and clinical research. Therefore, it is important for institutes that are involved in medical research to recognize the need for fostering collaborative ties between clinicians, basic scientists and biomedical experts. While all leading institutes and universities in the world have developed a strong link between basic and clinical sciences, unfortunately, the same cannot be said of most institutes in India.

Can we improve the situation? It is certainly possible for us to do so. But we need to recognize our shortcomings and work systematically towards achieving the goal. Friends, I leave you here with some food for thought. Meanwhile, sit back and enjoy the scientific feast that this issue has to offer. We have an array of interesting articles for you, with a pan-India representation, which is the essence of our journal that we nurture, cherish and feel proud of.

Looking forward, as always, to your valuable suggestions and feedback,

Warm personal regards,

Editor-in-Chief, Delhi Journal of Ophthalmology

Dr R.P.Centre, AIIMS

Email: editordjo2017@gmail.com