Medical Research in the Middle East: is there something missing

This is a copy of an email I sent to the Arab Federation of Evidence-Based Medicine Mailing list on September 19, 2007 in response to an inquiry about what is missing for medical research to florish in our region.

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Dear All,

Thank you very much for initiating and contributing to this important inquiry and discussion that is of interest for all members of the group, hence we joined the Arab Federation of Evidence-Based Medicine aiming for the best for our region. I guess we have lots of obstacles across the arab countries, some common to all countries and some are country-specific. I think the first step would be to differentiate evidence-based medicine (as the utilization and application of the available evidence to patient care) and research (i.e., doing the research). The way I look at the problem at a broader perspective is splitting research as a whole into planning, conducting and dissemination. I will go into each phase and the related obstacles in my opinion, posting some questions to stimulate other members to contribute.

1. Research Planning:
a. Needs Assessment: Do we need to do research in our region? What type of research? Therapeutic/experimental randomized trials, prospective prognostic cohorts, or regional cross-sectional studies? Can we just use (import) research done in other regions since we import other things as well? I am just asking.

b. Public Awareness and Acceptance: This the first point of a vicious cycle. Since we, currently, have attempts of experimental research in our region that sometimes are not strictly controlled by ethics committees, the public doubts the credibility of some researches. Some cultures would not even accept the idea of being treated based on flipping a coin! So we need to have more health education regarding this aspect. As far as the public is not interested, no national or private funding would be readily available.

c. Research Question: I agree with Dr. Attia, this is one of the crucial steps. Ideally, this should be posed by one person, brought forward to his/her research group for editing and reformulating. Then the group as whole (clinicians, research methodologist, biostatisticians, research assistants) works through the process from formulating the question, editing it, writing the protocol, revising it, re-writing it and so in. Definitely, they don’t need to be in a physical group, lots of these stuff can be done virtually by emails or tele-conferencing (which is expensive but cheaper than conducting an ill-designed study and cheaper than traveling).

d. Collaboration, Interest and Subspecialty: I think this is another major obstacle in our region. Even if some researches are conducted by research groups in our region, there is less collaboration between different research groups. For example, if a group (which consists of gynecologists, researches, biostatisticians) is conducting an RCT in gynecology, it is very unlikely that they will ask the help of a gynecologist researcher if he/she is not in the vicinity of that group (either because they don’t know that one exists or they like to deal with everything internally). I guess one of the nice features of this mailing list that it may act as a medium for dissemination of research expertise in our Arab world.

e. Research Funding: Governments, non-profit organizations, and private sectors funding is crucial for the success of research. Either way, this should be governed by a national body that regulates and monitors the conduct of research in each country; just like a national body that regulates the practice of medicine.
f. Ethics Boards: Availability and diversity of background of members.

2. Research Conduction:
a. Research Assistants: As we have done a great job in conducting lots of evidence-based medicine courses, we may start thinking of conducting more courses for nurses and other allied health care professionals to qualify them as research assistants (say to work as part time initially). As we all know, it is difficult to combine day-to-day running of research and day-to-day clinical practice.

b. Research Instruments/Scales: This point can be considered in the planning part. This is another major difficulty. The availability of reliable, validated Arabic measurement instruments, e.g., SF-36, is a major obstacle for conducting research. As we know, we cannot just translate the English version of SF-36 into Arabic, this need to go through vigorous process of validation and re-validation. This process by itself needs lots of research.

c. Recruiting Centers Collaboration: Professional education for colleagues that research is team-work, and that even if your name does not show up in the 5-6 names in the authors list, you are part of the list of researchers by recruiting patients to multi-center studies and you are contributing to the knowledge base of the world.

d. Research Centers: Although studies can be conducted across the country in different hospitals, a regional research center equipped with sophisticated data management facilities and experience personnel can help facilitate this.

3. Research Results Dissemination:
a. Medical Writing and Mentorship: In addition to EBM courses, we can do Research Methodology courses, Research Assistants courses and Medical Writing courses. However, one of my supervisors told me that better writing comes by mentorship. The more you write, the more your mentor corrects and guides you, the better you will be and the better the end result of research results report and dissemination would be. I believe that this is another fundamental aspect of research that we need to enforce. Mentorship, mentorship, mentorship.

b. Media Collaboration: Dissemination of the results of our own research in our regional TV, newspapers, and magazines will help shed light and educate the public on local research and the fact that we do do research.

c. Research Conferences: Both regional and national, specialty-specific conferences help to encourage other colleagues in contributing.

4. First of All, The Basics:
a. Improving Medical Schools Curriculum: Put more emphasis on research methodology and evidence-based medicine and the facts that research is not equal community medicine rotation. It is beyond that.

b. Encouraging Medical Students: By contributing to different aspects of research: planning, conducting or dissemination, to give them a hand-on exposure to research.

c. Research Consideration during Residency Application: If more emphasis is focused on research experience for medical students when they apply for residency and more weight is given for those with good exposure to research, definitely this will improve the overall attitude towards research and its importance.

Regards,

Sohail Bajammal