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Disseminating information through research journals
BACK in 1947, Pakistan faced a setback because of emigration of highly educated professionals of the minority community to India. The new country’s meagre resources were stretched beyond limit coping with the new challenges, specially the rehabilitation of refugees from India.
In these critical times, Pakistan also faced mounting problems in the health and education sectors. With Partition, the well-established Indian Medical and Research Council (IMRC) would not support health research in Pakistan. In these turbulent circumstances, Pakistan was able to establish the Pakistan Medical and Research Council (PMRC) as a counterpart of IMRC. However, this body was not able to develop and sustain a culture of research. There were multiple reasons for their failure; for instance, (1) a strongly bureaucratic working method of PMRC; (2) lack of incentives for research workers; (3) lack in guidance and training of medical students in health-related research; (4) frequent changes in political set-up of the country with resultant lack of consistency in efforts of PMRC; and (5) failure in disseminating information to donor agencies.
As such, medical research made a late beginning in Pakistan, and still continues to be given low priority both in medical education and the health system. Research here is inadequately financed, and given less recognition when appointments and promotions are being made in medical institutions. Most of the medical research is hospital-based and individual-initiated rather than problem-oriented and, therefore, has limited relevance to national needs. There is poor communication between researchers, the users of the research and the policy-makers who are generally unaware of the need to use research-based policy options.
In Pakistan, there is a felt need for local data on patient care, health management, service delivery, education, training, community development and prevention of diseases, as well as maintenance of health. There is inadequate emphasis on research methodology in the curriculum of medical, dental and other health professionals. Besides we have a dearth of trained epidemiologists and bio-statisticians.
The current research scenario is grim. There is a frightening rise in the incidence of mental illnesses that, even if recognized and treated, place heavy economic burden on the families. In order to avoid this from happening, research into the root causes, specially the social ones, should be carried out as this would help in identifying preventive aspects, and in planning mental health promotion strategies.
Research is of vital importance for policymakers in order for them to understand real issues, for only in the light of research can they devise effective policies.
Authors: Under the present circumstances, it is essential that Pakistani authors produce research-based textbooks and reference books, focusing on the local problems, and identifying remedial strategies for the local patient. While a few psychiatrists do contribute to international journals, their collective research output is simply insignificant. Moreover, very few foreign journals publish articles from Asian countries.
For various reasons, publication of articles in foreign journals is even less. A recent press report reveals that acceptance rate of scientific articles from Asia is very low as it is “assumed” that research facilities in this part of the world are meagre. It has been observed that only those articles find their way in the pages of reputed foreign journals in which one of the co-authors is from a western country.
In Pakistan, there is also limited provision for training in research methodology; the clinicians feel they do not have time to get involved in research. Moreover, there is no incentive for research except that it is a “short-cut to promotion” for medical teachers. As the PMDC requires a specific number of publications for granting promotions, research is carried out but only half-heartedly and often even scientific methodology is not followed.
Psychiatry needs community-based prevalence studies, which can form a database and help to understand real magnitude of mental illness. Because of low priority given to this discipline, adequate funding for basic research is also scarce. The only recourse left for the research-orientated professional is to turn to those few pharmaceutical companies which set aside some budget for sponsoring research in the country where they are operating.
The reasons, or excuses, commonly given by medical professionals for not conducting of research include:
(1) Lack of trained manpower;
(2) Lack of research infrastructure;
(3) Lack of incentive for research workers;
(4) Lack of financial resources;
(5) Lack of training and guidance in the fields of medical research such as epidemiology, medical sociology, medical anthropology, health economics, etc;
(6) Frequent changes in the political set up of the country;
(7) Failure of dissemination of information to donor agencies and others;
(8) Difficulties in identifying research priorities due to lack of (a) understanding, both current and projected, of national health needs, (b) national health policies and other ways in which they call for research support and give direction to research, (c) linkages between policy makers and researchers, (d) research policies which follow, to a large extent, national health policies, (e) national research capacities, (f) national resources available for research, (g) international resources, support systems and research concepts;
(9) There are many funding agencies throughout the world, but the ones having the local presence are the Pakistan Science Foundation, University Grants Commission (now HEC), Pakistan Medical Research Council, and the pharmaceutical companies.
To get funding for health-related research is too difficult in Pakistan. For one, there are very few funding agencies, and even fewer that would sponsor research on mental health — WHO being a notable exception.
It is generally assumed in the west that in developing countries such as Pakistan, there is a lack of infrastructure for research, a low standard of knowledge, and a dearth of high-tech equipment — all leading to non-acceptance of scientific articles in prestigious international journals. WHO recommends the following measures to improve the current situation:
1. Individual journals: Educate editors and reviewers on research needs of and research infrastructure in low- and middle-income (LAMI) countries; use surveys of various stakeholders such as readers (including those from other regions) for shaping journal’s priorities; sensitize readers and other stakeholders to international mental health issues (for example, through special sections and special issues of journals, guest editorship and commissioning of relevant research from LAMI counties); a critical re-examination of the use and limitation of measures such as citation rates and impact factors; adopt a multilingual approach, such as translation of relevant articles and abstracts into other languages; include reviewers and correspondents with a special interest and expertise in LAMI countries on editorial boards; accept a higher proportion of submissions from LAMI counties for review; and encourage general medical journals to publish mental health research especially in countries/regions where no mental health journal exists at present.
2. Supporting authors and researchers: Familiarize researchers from LAMI countries with the peer review process; provide constructive critical feedback/ detailed recommendations for revision; make provision for extra rounds of editing, assistance with language and use of technical editors; pay attention to the educational goals of the review process (for example, availability of reviewer’s comments to readers or recruiting young researchers in low- and middle-income countries to referee papers); mentorship and interaction prior to submission; organize training courses/ workshops for LAMI country researchers and students on scientific writing and research methodology; facilitate the involvement of researchers in multi-centre projects and research groups; accept and process submissions online; and devise strategies to prevent economic exclusion of researchers from low- and middle-income countries in author/input paying publishing models.
3. Supporting journals from low- and middle-income countries: support “twinning” or “ pairing” arrangements, such as invited editorials, exchange of journals, cross-publication of contents/ abstracts/ summaries/ articles and joint publications; agree to serve on editorial boards or as reviewers; agree to mentor reviewers and editors; provide training courses/workshops for editors and reviewers; and support national/regional journals in developing their own websites and/or seeking inclusion in specialized websites on mental health.
4. Dissemination initiatives: participate in electronic dissemination initiatives or provision of free access through journal’s website; participate in “buddy system”/peer sponsoring initiatives; mirror and replica sites and user-friendly technology for easier downloads; subsidize journal subscription for LAMI countries; and explore mechanisms for publication of selected papers in more than one journal for wider dissemination.
5. Editor’s associations: develop guidelines for good editorial practice concerning ethics and conflict of interest; facilitate access to literature and bibliographic services (for example, through a directory of databases); support authors to reach appropriate specialized journals and specific audience (for example, through a database of journals and instructions to authors); facilitate mentoring for editors, reviewers and researchers; organize training of editors, reviewers and researchers from LAMI countries; and facilitate the multidirectional flow of articles, resources and expertise (for example, translation of relevant articles and support with information technology).
6. International organizations: support mental health research, research infrastructure and publications; influence other international institutions to give priority to mental health research in their agendas for LAMI countries; support national institutions in low- and middle-income countries to advocate that their governments give higher priority to mental health; support inclusion of researchers/editors from low- and middle-income countries in discussions and decision-making processes; and facilitate capacity building for researchers and journals.
7. Dissemination: assess information needs in Low LAMI countries and raise awareness these; provide access to research publications; and encourage and enable the use of information technology.
8. Collaboration: develop networks between editors, editorial organizations, professional bodies, publishers, funding agencies, national and international organizations and the media); and adopt a systematic approach for follow up: statement of improvements expected, development of outcome criteria, assessment of progress.
There is thus a high hope for the change in scenario if these recommendations/suggestions are implemented.
The writer is professor and head of the psychaitry department, Hamdard University Medical College, Karachi
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