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The basics of research

It is imperative that people in developing countries know how to use the latest technologies as they become available

The basics of research

This week they gave out Nobel Prizes for different disciplines. From the time I graduated from medical college I have followed the prize given out for medicine or physiology. As a physician it was something I wanted to do.

Initially, I had a pretty good idea about the basic research and the resultant medical advances for which these prizes were given out. But over time, slowly but surely, the advances that these prizes were given for became a bit complicated for me in spite of my attempts at keeping up with the newest developments.

There is an old saying about medical practitioners. A generalist knows nothing about everything, and a specialist knows everything about nothing. Modern specialists now know about things that the rest of us cannot see and just have to take the specialists’ word that they actually exist.

Today, many medical conditions are almost entirely based on genetics. And when I can figure out what CRISPR or gene editing is all about, surely I will communicate that knowledge to my readers. Until then just say that you are against global warming and gene editing in humans.

Now about the Nobel Prizes in medicine; interestingly the last time a surgeon received the Nobel Prize for medicine was in 1912. Alexis Carrel was that surgeon. He developed basic techniques to allow blood vessels to be sutured together, showed that organs could be transplanted from one place to another within the body (auto-transplantation) and still survive.

Rumour has it that after Carrel got the Nobel Prize; other surgeons came out and insisted that they had done the same work before Carrel. Due to all the fuss the Nobel Committee evidently decided thereafter not to award the medical prize to any surgeons.

Interestingly the next surgeon to get a Nobel Prize got it for pioneering heart catheterisation. And if I remember correctly, the last time a physician got a Nobel for a ‘surgical’ procedure was in 1948. The procedure was what is now called a ‘frontal lobotomy’. This procedure has been abandoned and is in considerable disrepute.

Frankly, I am all for medical research and the wonder that is modern medicines. But people in Pakistan get quite bent out of shape by the fact that ‘no’ Muslim scientist has ever received a Nobel Prize in science. Of course, the only Pakistani scientist that did receive a Nobel Prize in a scientific discipline is according to the constitution of Pakistan no longer considered a Muslim.

Basic research is like mountain climbing. When Sir Edmund Hillary was asked why he decided to climb Mount Everest, he said “because it was there”.

The reason why I am dwelling on these prizes is because every now and then some ‘academic’ scientists in Pakistan brings up the issue of the importance of research. The example is given of the Indian space programme and the recent ‘moon shot’ and how it is all because of basic scientific ‘research’. Bah, humbug!

Indian space programme has as much to do with basic research in India as Pakistan’s atomic programme has to do with basic research in Pakistan. Research is expensive and most developing countries can obtain the latest technology and just learn how to use it. Both China and India are doing pretty well in matters relating to advanced technology.

There was some emphasis on ‘research’ and publication of scientific papers as a pre-requisite for promotion in academic medical positions. So many papers to become an assistant professor, so many papers to become an associate professor and so many papers to become a professor.

When I took over as professor and head of the department of cardiac surgery in King Edward Medical College (KEMC-KEMU)/Mayo Hospital in 2004, I decided to look up the ‘scientific papers published from my department. Sadly, all of them were based on unverifiable data.

And yet, academic promotions had occurred based on these scientific papers. Here it is important to differentiate between ‘basic’ research and ‘clinical’ research in medicine.

Basic research is like mountain climbing. When Sir Edmund Hillary was asked why he decided to climb Mount Everest, he said “because it was there”. Clinical research is like after Everest was conquered, people tried to find out what was the best way to do it and if that experience could help in climbing other mountains.

The point then is that we don’t all have to be like Hillary though some will and should try and be pioneers in their field. However, as medical teachers we must teach our students as well as doctors going for post-graduate training the proper way to do clinical research. But in both instances dedication and time are needed.

Here is an example of how research was an intrinsic part of medical training. Many of the cardiac surgeons I worked with in the United States (US) took off one or two years from the formal training programme to do basic or clinical research. And even when in clinical practice later on they continued to do clinical research and to teach their trainees how to do it.

There is a story about a surgical training programme in the US that was very research-oriented. The story told by one of its trainee residents goes like this. He was hired as a resident and after he completed two years he was sent to the ‘animal lab’ to do research. A few years later he met the chief of the training programme during a conference who asked him who he was! When he told the chief that he was one of his residents and had been in the animal lab for a few years, the chief was surprised and told him to come back to the formal training so he could graduate.

That is how research minded many of the university based training programmes are in the US and possibly other countries. When I took over in KEMC/KEMU, I inherited a number of trainees in cardiac surgery preparing for the Fellow of the College of Physicians and Surgeons (FCPS) examination.

Evidently, all of them had submitted a research paper/thesis to qualify for the written and the oral exams. All these ‘papers’ had been accepted. And yet when I looked at them, they were very poorlywritten and were based on dubious data. When I questioned the trainees the answer was, Sir, that’s how it is done in Pakistan.

Fortunately, during the thirty years I had spent in the US both as a trainee and then as a surgical consultant (attending) I had participated in many clinical research projects and even a few basic science experiments. So I was able to set up guidelines for clinical research in my department.

It is important in my opinion that medical students should in the final professional have a proper ‘examination subject’ course on basic research methods including statistical requirements. This should be taught by a qualified medical statistician.

So let me sum it up. Science and technology has developed to a point that basic research is now difficult and too expensive for a developing country. However it is imperative that people in developing countries know how to use the latest technologies as they become available.

And applied and clinical research should be encouraged as a part of medical curricula and post graduate training.

 

The writer has served as Professor and Chairman, Department of Cardiac Surgery, King Edward Medical University

Syed Mansoor Hussain

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The author has served as Professor and Chairman, Department of Cardiac Surgery, King Edward Medical University.

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