Importance of Medical Research, Scientific Writing, Institutional practice and cost effective solution to health problems


 View Point

Importance of Medical Research, Scientific
Writing, Institutional practice and cost
effective solution to health problems

Prof. Emeritus Lt. General Mahmud Ahmad Akhtar
Former Surgeon General Army/ DGMS (IS)

Many thanks for gifting a copy of the book “Scientific Writing: A Guide to the Art of Medical Writing and Scientific Publishing” edited by Shaukat Ali Jawaid and Dr. Masood Jawaid. The book is a valuable guide for undertaking medical research and scientific publishing for medics and also for para medics as the paramedics are also very important for holistic health care. There is a well-known adage “Publish or Perish”. The Nations who do not publish, perish- there is no innovation which is very important for progress.

Lt. Gen. (R) Mahmud Ahmad Akhtar

Medical research should be done at all levels to improve health care. It should be productive cost effective- solving country’s health problems. It is imperative for poor countries with over 60% population living below the poverty line or just above the poverty line.

An example of “Research for All” is of Dr. Fry a General Practitioner in the UK who undertook research on peptic ulcer at the Primary care/General Practice/Family Medicine field. His remarkable eye- opening findings were published in the form of a book “Peptic Ulcer” widely read in those days. I also had the opportunity to read it for writing a “Dissertation” on “Peptic Ulcer” for the grading in Medicine examination of the Armed Forces Medical College (Now AFPGMI). Dr. Fry’s studies substantially changed the concepts of peptic ulcer disease, prevailing at that time. Earlier studies done at the hospitals showed “Peptic Ulcer to be a dreadful disease with high rates of serious complications, hemorrhages, perforations etc.” Dr Fry’s studies done on a vast scale in the primary care settings revealed a large number of peptic ulcer patients were having mild to moderate symptoms with much lower incidence of complications. His studies helped in identifying peptic ulcer patients at early stages and in detection and prevention of complications at earlier stages. In 1950s I read a book “Research for All”. The author emphasized that everyone should develop the art and science of doing research including paramedics particularly the Nursing Profession who have close contact with patients.

In the United India, Indian Medical Services (IMS) doctors did remarkable researches solving many of the health problems of India. In this respect there are a few names Dr Boyd did research on “Bacillary Dysentery” isolated Bacilli –‘Shiga Boyd’. Post war Dr Boyd in 1945 was Head of the Indian Typhus Research Team- my father Prof. Nur Ahmad Later Commandant of the AFIP and after retirement the Director of the Pak American Research Lab at Lahore, was a member of the team. Col Short, a physician did remarkable researches on malaria, Kalar- azar and detected fluorosis as a cause of bone deformities in patients at Madras (now Chennai) by tracing a common source of drinking water contaminated with fluorides. British troop’s successes in Burma Campaign in 1945 depended upon their tackling the malarial menace in the Burma jungles. Maj Majeed an IAMC officer (later PAMC) did work in the malarial research team. He discovered a species of Anopheles Mosquito named Anopheles Majidae. He was in the AFM College Army Health Department having training in 1955. He was fondly called Maj Machar, when we were undergoing “Basic Army Health” training at the AFM College.

In the united India, Indian Medical Research Council published the Indian Medical Research Journal. After independence, Pakistan Army Medical Corps started the Army Medical Corps Journal in the early 50s and there was a journal 'Medicus' edited by Dr Siddique a gynecologist at Karachi. Medical Colleges published college magazines annually. Later Pakistan Medical Association started publishing its journal from Karachi and later CPSP and other organizations.

In Pakistan Mr. Shaukat Ali Jawaid developed his career in "Medical Journalism". Currently he publishes a medical journal, “Pakistan Journal of Medical Sciences" which has earned the highest impact factor amongst Pakistan's medical journals. His other medical publications include Fortnightly "The Doctor" which was later renamed as "Pulse" International” on January 1st 2000. These publication’s keep the healthcare professionals updated. He has also published a large number of useful books. He is a pioneer in the field of medical journalism.

Pakistan is afflicted with a very heavy burden of communicable diseases- having the highest rate of still births and new born death rate in the world. There is an epidemic of metabolic syndrome consisting of a cluster of abdominal obesity, diabetes mellitus, hypertension, hyper dyslipidemias, fatty liver leading to their complications and sequelae. All these problems need researches for containing them. Sadly the quality of clinical research output is very low with the exception of Agha Khan Medical College though in the earlier period in spite of heavy clinical work load and meagre resources, the clinical research output was satisfactory. The major factor is unlimited private practice. Even the clinical teaching is very poor with few a few exceptions.

For resolution of the problem the teachers should be paid well and controlled. Institutionalized private practice as is done at the Agha Khan Medical College be organized and not the so called uncontrolled institutionalized practice which is being done. I and Prof General Muhammad Aslam recently published an article in the fortnightly “PULSE International” advocating the initiation of pure doctorate level research degrees for the clinicians for Academic career after obtaining the clinical qualification. If a scholar takes two to three years for the doctorate level research, the results would be worthwhile. Adequate incentives should be offered to the doctors holding academic degrees in addition to the clinical qualifications with the availability of teacher supervisors. The research scholar working for the ‘Doctorate level Research’ are likely to produce good results- It is solving the myriad health problems confronting the country. In UK, the colleges produced clinical qualifications and the universities researches/qualifications. Mr. Shaukat Ali Jawaid and his team has produced the book “SCIENTIFIC WRITING- A GUIDE TO THE ART OF MEDICAL WRITING AND SCIENTIFIC PUBLISHING”.

This book very well serves the purpose of guiding health care personnel to undertake research and publish at all levels i.e. the research for everyone. This book should be available at every library and department of the medical institutions. The book has been appropriately dedicated to Prof. Maj Gen. Muhammad Aslam along with Prof. Arshad Javed Vice Chancellor of Khyber Medical University. Prof. Maj. Gen. Muhammad Aslam is playing an important role in the team efforts. The need of the hour is for the clinician to undertake steps to promote the clinical research oriented to solve the Nation’s problems.

An example of research saving millions of lives is discovery of oral rehydration salt or ORT oral rehydration therapy by two American doctors David Nalin and Dr Richard Cash. The preparation of simple solution saved lives of millions suffering from cholera and also diarrheas due to other causes.

In August 1967 the two doctors landed at Dacca for voluntary works. They noted the problem of cholera killing people in enormous numbers- the problem was impacting families, communities as a society as a whole. They thought “If you wanted to change the lives, this was the problem to solve. People will waste away in a matter of days and die a painful death. They were not cholera experts. They delineated the problem “Dehydration” and concluded that rehydration was the key. Electrolytes importance had already been established. There was also importance of glucose of carrier of electrolytes across the intestinal absorptive epithelia. The science was their- in piers close enough but still elusive. It was the time to put the pieces of the puzzle together. The main challenge was not that just what to give the patients but also how. They came up with an oral rehydration mechanism recognizing the importance of electrolyte replenishment and started a risky trial at Cholera Research Lab at Dacca by working day and night. The trial began in April of 1968. To their delight all the 29 patients who were given the oral rehydration salt recovered in a matter of three days. The results were a resounding success. Lancet published it 50 years ago (August 1968). Subsequently trials with younger patients and in rural areas further established ORS/ORT s POTENT LIFE SAVER. Sir Fazle Hasan, a Bangladeshi social worker made ORS/ORT more accessible to rural women. The solution became a simple chant-a pinch of salt, a fistful of sugar and half liter of water. It was the simplicity of innovation, resting of strong science that made possible for vulnerable babies to survive.

David and Richard wrote a piece reflecting on legacy in Lancet mid of August 2018 (50 years after discovery). They point out four key lessons guiding principles. These include strong scientific evidence needed for innovation and therapeutic intervention. Second doing research in the field and the areas that are epicenters of the problem that is critical. Third there are field trials and international support to generate across the board evidence and finally continuing the path to innovate. The third world owes a lot to David, Richard and those who have helped to save lives- but not just their work on ORT but also on teaching us how to create public health miracles.

Note: The Book “Scientific Writing: A Guide to the Art of Medical Writing and Scientific Publishing” is available from Med-Print Services. Price. Rs. 1500/- inclusive of courier charges. Contact: Mr. Mubarak e-mail: This email address is being protected from spambots. You need JavaScript enabled to view it. At Lahore it is available at the Library of University of Health Sciences. Contact the Librarian.

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