So, how this research is done and how it has affected the modern day medicine? To do a research, we take a problem prevalent in the society, identify its cause, plan the strategies to solve it, do scientific evaluation of outcomes and finally collect the evidences of outcome. Then we use this evidence to solve similar problems. This is what we call as ‘Evidence Based Medicine’. Thus with proper research we get evidence to treat similar problems, which is the basis of Evidence Based Medicine and with use of this Evidence Based Medicine we solve similar newer problems. Thus we can create further evidence for newer problems.
Developed countries, with proper research, have formed and created their own database and evidence based medicine for their own problems. Medical treatment in these developed countries is thus based on this data base and their evidence. But in developing countries like ours, we lack in proper research, scientific writing and publishing, hence do not have our own evidence based medicine. Hence we rely or look for the data, literature and evidence from the west for our own problems, which are different from the developed countries.
Does this evidence of the developed countries, really hold true or correct for our problems of developing countries? The answer is obviously a big NO. Reasons are many. We tend to forget that the two systems in developed and developing countries are totally different. Firstly, due to different demographic and climate patterns, our set of problems are different than those of west like nutritional deficiency and infections are more prevalent in ours whereas in developed world they have obesity or other issues. Secondly, in developed countries the diagnosis and treatment is early and prompt, whereas in developing countries like ours, the presentation is delayed and neglected. Patients are aware and educated in west, whereas our patients are illiterate and less demanding. The infrastructure and health system in developed countries is organized with state of art facilities and no financial issues. Whereas our health system is disorganized and there is gross imbalance which is divided into rural/urban, public/private along with other pathies of treatment, which is further complicated by lack of basic amenities and overburdened infrastructure. Further, the needs of our patients are also different, our patients wants to sit cross leg, kneel or squat, which is hardly done in west. Safety norms, insurance and proper documentation grossly lack and are neglected in developing countries. Research, which is given high priority and importance in west, is hardly done in developing countries like ours.
Thus in nutshell, the developed countries, which have difference in problems, infrastructure, health sector and needs of society from developing countries, with proper oriented research have formed the database and evidence for themselves. Hence evidence based medicine of the developed countries cannot be fully and correctly applied to developing countries like ours. So the question arises what needs to be done. The answer is simple, conduct proper research on our problems & form our own data base. This further give rise to a new question, that who will do this research for our problems? Obviously, we need to do it.
We have clinical problem at hand, have the intellectual capacity, have huge number of patients, we know the technical know-how, have infrastructure to do but what needs to be added is only the will to do. We need to overcome our inhibitions. Start from identifying and picking simple, commonest, day to day problems like result of alternate vs daily dressing, early and late removal of wires in supracondylar humerus fractures or above elbow slab vs below elbow slab for distal radius fracture rather than taking special topics to study, like metal ion in serum after replacement, which may not be feasible at our centres. To overcome the problems of restricted resources and infrastructure, we can judiciously use our resources and clinical material and can share along ourselves, knowledge, data and infrastructure. We also need to be organized with proper record keeping and documentation.
Once we complete our research, the next important part is to communicate and share it with others, which is equally important as doing the research. This can be done by publications or presentations. This communication of the research provides satisfaction, is a good clinical practice, improves quality of clinical work and skills, increases knowledge, teaches about literature survey, gives appreciation & publicity, keeps alive as a researcher, motivate others to do research and finally helps in career advancement also.
Publication as a means to communicate your research has certain advantages over presentation in conferences. It has larger coverage, available to all at any time / anywhere, it is documented evidence, is available both in print and electronic form and can be retrievable beyond your life. Further the publication forms the evidence based medicine, which is necessary for growth of science. Whereas the presentation in conference, as a means to communicate your research, has lesser coverage i.e. only audience of hall and that too during the event which present only in electronic form, which is difficult to retrieve after the event.
To conclude, the scientific publication is an art which comes by practice, which is like having a baby, the gestation period is long and difficult, but at the end you have something to show.
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