BIOMEDICAL RESEARCH IN DEVELOPING COUNTRIES: NEW INSIGHTS INTO AN OLD PROBLEM

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BIOMEDICAL RESEARCH IN DEVELOPING COUNTRIES NEW
INSIGHTS INTO AN OLD PROBLEM

• Diaa E.E. Rizk, Fikri M. Abu-Zidan,
• Faculty of Medicine and Health Sciences,
• United Arab Emirates University,
• Al-Ain, United Arab Emirates.

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• To invent, you need a good imagination and a pile
  of junk.
• Thomas Edison
• The danger is not that we will aim too high and
  fail to achieve our goals, but that we will aim
  too low and achieve them.
• Michelangelo Buonarroti
• A pessimist sees the difficulty in every
  opportunity an optimist sees the opportunity in
  every difficulty.
• Winston Churchill

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Background

• The real strength of biomedical or health care
  research in the so-called developing world stems
  from its ability to generate possible solutions
  for local health problems that are usually
  numerous.
• The growing complexity of biomedical research
  now also requires new methods of discovery,
  interdisciplinary approach and novel models of
  team science.

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Introduction
Biomedical and Health care researchers from
developing countries who have been trained for a
reasonable time in developed countries may decide
to work in their own countries for different
social, financial or scientific reasons. They
will directly realize the huge task ahead if they
want to pursue their research career because the
problems that hinder health care research in
developing countries are long-standing, complex,
interrelated and often poorly understood.
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Major Problems

• 1- Special bioethical standards and concerns
• 2- Inadequate research education and training of
  local health professionals as a result of brain
  drain
• 3- Lack of societal and cultural appreciation of
  the value of scientific research in general and
  heath care research in particular as an important
  tool for development
• 4- Shortage of funding, research infrastructure
  and resources
• 5- Difficult access to health informatics
• 6- Individualism of biomedical researchers and
  their relative inability to collaborate, interact
  or work within groups.

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The Ethical Problem

• International trusts and research organizations
  traditionally fund a significant number of
  biomedical research projects in the developing
  world with a very serious and grossly unequal
  burden of disease.
• The priority setting is usually decided by the
  fund donators and may not serve the national
  health plans of the developing countries. In
  fact, only 10 of the funds spent on health
  research globally cover 90 of the disease burden
  centered in developing countries.
• The WHO and Council for International
  Organizations of Medical Science jointly produced
  guidelines on ethical research in developing
  countries in 1993.

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The Main Concerns

• 1- Universal standard of care
• Participants in internationally-funded projects
  should ideally receive the standard of health
  care available in the funding developed country.
  Improvements in health care in the developing
  country as a result of these studies may not be
  maintained after the trial.
• 2- Informed consent
• Study subjects do not often truly understand the
  nature of intervention, accept the placebo
  concept and enjoy individual autonomy to give
  informed consent. The balance of equity between
  physicians and patients is also different.
  Improved access to medical services as a result
  of research enrollment may constitute an
  inappropriate incentive that compromises the
  consent.

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The Main Concerns

• 3- Professional role Research or Service
• Health care researchers in academic health
  centres often focus on their primary mission-
  research and their perception of their
  professional role as service providers versus
  investigators is not clearly understood.
• 4- Service provider Generalist or Subspecialist
• Academic physicians with special clinical
  expertise and who are heavily involved in
  research projects may find it also difficult
  morally to reject requests to participate in
  daily health care that is not directly related to
  their own area of expertise.

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Possible Solutions

• A- Biomedical researchers in the developing world
  should
• 1- Be constantly aware of their social and
  philanthropic mission and the extent of their
  obligation to improve the health care, service
  development and quality of life in their country
• 2- Acknowledge their need to adopt strict ethical
  guidelines in collaborative clinical research
  protocols
• 3- Have confidence that they will be capable of
  solving their national health problems only if
  they understand these problems and set them as
  research priorities.

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Possible Solutions

• B- Academic health research centres should be
  actively involved in the continuing debate about
  the ethical implications triggered by their
  establishment.
• C- National guidelines defining moral and
  professional responsibilities of academic
  physicians have to be established to protect
  these experts from being burned out in health
  services routine in order to pursue their primary
  scholarly commitment to research progress.

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Solutions to other problems

• 1- Promoting research education and training of
  all health professionals
• 2- Raising socio-cultural appreciation of the
  developmental value of scientific and biomedical
  research
• 3- Enlisting community participation in funding
  and provision of research resources
• 4- Improving access to biomedical knowledge and
  information
• 5- Encouraging a paradigm shift in the prevailing
  biomedical research culture towards more positive
  partnership and pedagogy.

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CONCLUSION

• Strategic development and improvement of the
  current biomedical research agenda in the
  developing world can be achieved by following
  standard international bioethical guidelines and
  implementing simple educational, societal,
  cultural, administrative and professional
  measures.
• Local understanding of health problems and
  setting priorities is of paramount importance.
  Bringing packed solutions from abroad and
  depending on parachuting consultants who land
  for a short period and rehash local wisdom into a
  quick report may not be the best remedy for the
  problems of developing countries.

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Migration and Brain Drain is Increasing
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Biomedical Research is still important !!