CORRESPONDENCE: LETTER TO THE EDITOR
The Challenges of Cardiovascular Research in Developing Countries
Habib A. Dakik, MD, FACC*
* Associate Professor of Medicine, American University of Beirut, P.O. Box 11-0236/A38, Beirut, Lebanon (Email: hd01{at}aub.edu.lb).
We read with interest the recent article by Prabhakaran et al. (1) reporting the results of the Global Cardiovascular Disease Research Survey. Not surprisingly, the study shows a low research output in developing (low-income and low-middle-income) countries. The authors postulate that a major reason for this low output is low government spending, and they recommend that governments in these countries increase their research funding to improve research output.
The issues related to research and funding in developing countries are complicated and multifactorial. It is easy to say that increasing research funding in these countries will improve their productivity, and this is probably true. Yet, the implementation of this recommendation is difficult. It is very difficult to convince governments in developing countries, with limited financial resources, to invest in research when a significant percentage of their populations still does not have water and electricity supplies. Similarly, it is very difficult for universities and hospitals to invest in research when their financial resources can barely fulfill their basic requirements in medical care and medical education.
Furthermore, although funding is certainly an essential component in the advancement of research, it is not the only one. Another very important component, which is not easy to study and analyze, is human resources. Performing high-quality research requires the recruitment of established senior investigators who can enhance research productivity and, more importantly, train young junior investigators to sustain research activity. These high-quality investigators require not only funding but also political, economic, and social stability. The U.S. and Europe have thousands of investigators who originally came from developing countries. These scientists reside in the U.S. and Europe not only because of the availability of funds but also because of political, economic, and social stability that they do not have in their home countries.
With all of these limitations, does this mean that developing countries should forget about medical research? No, but they should have realistic expectations and rational policies that can guide the utilization of their very limited resources. These policies should probably focus research funding on selective centers with selected high-quality investigators who can use these resources to produce high-quality research. It is also very important to encourage collaboration with investigators and institutions in developed countries. We have recently analyzed the research productivity of the medical faculty in our institution (2) and found that collaboration with investigators in developed countries significantly improved the quality of our medical center's research output.
Cardiovascular research is essential for the advancement of human health. The study by Prabhakaran et al. (1) indicates that developing countries have not yet made significant contributions in this field, in spite of the fact that their populations carry a major percentage of the global burden of cardiovascular diseases. The problem is clear. The solutions, however, are very difficult.
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1. Prabhakaran P, Ajay VS, Prabhakaran D, et al. Global cardiovascular disease research survey J Am Coll Cardiol 2007;50:2322.[Free Full Text]2. Dakik HA, Kaidbey H, Sabra R. Research productivity of the medical faculty at the American University of Beirut Postgrad Med J 2006;82:462-464.[Abstract/Free Full Text]
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