IMA reacts on various reports in media about medicine in India Of late, there have been unfavorable reports in the media about the status of medicine and healthcare in India. • A story reported April 21, 2016 in the Hindustan Times, ‘Just 4 institutes account for a third of India’s research output’ by Sanchita Sharma, said that India has the best and the worst medical education in the world, according to a review of the world’s largest database of peer-reviewed literature. Four medical colleges in India are among the top 10 global institutions that published the most research between 2004 and 2014, while around 60% of the country’s 579 medical institutions have published no research in a decade. Only 25 (4.3%) institutions published more than 100 papers a year and, among them, accounted for 40.3% of India’s total research output of a little over 100,000 papers in the decade. In comparison, the annual research output of the Massachusetts General Hospital was more than 4,600 and the Mayo Clinic was 3,700. The All India Institute of Medical Sciences, with more than 1,100 annual publications, ranked third. Dr Samiran Nundy, Dean, Ganga Ram Institute For Postgraduate Medical Education & Research (GRIPMER) and the author of the study said, “What’s most shocking is that 332 (57.3%) medical colleges had not a single publication during this period. The states with the largest number of private medical colleges did the worst, with more than 90% of the medical colleges in Karnataka and Kerala having no publication at all.” GRIPMER was ranked 11th in the list of institutions that published the most research. According to the journal Current Medicine Research & Practice, between 2005 and 2014, the total research output in the country was 101,034 papers. All the institutions surveyed were either recognised by the MCI or the National Board of Examinations, the two bodies that regulate medical education in India. The MCI’s 2015 guidelines require at least four research publications for the post of an associate professor and eight for the post of a professor. Dr K Srinath Reddy, president, Public Health Foundation of India said that there is a need to incentivise quality research, which is an “indicator of an institute’s quality of education and clinical care”... • Max Bearak reported in The Washington Post on April 21, 2016 that most medical colleges in India are “very bad”. In his report, “How bad are most of India’s medical schools? Very, according to new reports” he says that though India produces some of the world's best doctors, from reputable institutions in and out of the country and it has 579 medical colleges and teaching hospitals, the highest in the world. However, recent studies have cast serious doubts on the quality and ethics of the country's vast medical schooling system. The most recent revealed that more than half of those 579 did not publish even a single peer-reviewed research paper in more than a decade (2005-2014), and that almost half of all papers were from just 25 of those institutions. Dr Samiran Nundy, a senior GI surgeon in Delhi and author of one such study told The Telegraph that these findings support long-standing suspicions that for many private colleges in the country, medical education is just a business. AIIMS was the most productive medical college in India. In the 10-year period that Samiran Nundy and his colleagues examined, AIIMS published 11,300 research papers. For context, that is about a quarter of what Massachusetts General Hospital produced in the same time frame. A four-month-long probe by Reuters found that since 2010, "at least 69 Indian medical colleges and teaching hospitals have been accused of such transgressions or other significant failings, including rigging entrance exams or accepting bribes to admit students," and that "one out of every six of the country’s 398 medical schools has been accused of cheating, according to Indian government records and court filings." In a country with the world's heaviest health burden, and highest rates of death from treatable diseases like diarrhea, tuberculosis and pneumonia, corruption at medical schools is an extremely pressing issue. The Indian Medical Association estimates that nearly half of those practicing medicine in the country do not have any formal training, but that many of those who claim to be qualified may actually not be. The 2011 court case against a man, Balwant Arora, was one of the earlier indications of the massive levels of fraud. Arora brazenly admitted to issuing more than 50,000 fake medical degrees at around $100 apiece from his home, saying that each of the recipients had "some medical experience" and that he was doing it in service to a country that desperately needs more doctors. He had served four months in jail in 2010 for similar offences. The number of private medical colleges has grown rapidly in India. Now, there are 215 private colleges and 183 public colleges as against 100 public colleges and 11 private in the year 1980. Last January, an article by Jeetha D'Silva in the British Medical Journal reported that many private medical colleges charged "capitation" fees, which are essentially compulsory donations required for admission. “Except for a few who get into premier institutions of their choice purely on merit, many students face Hobson's choice — either pay capitation to secure admission at a college or give up on the dream of a medical degree,” he wrote. The original article titled “The research output from Indian medical institutions between 2005 and 2014” by Samrat Ray, Ishan Shah, Samiran Nundy was published online April 18, 2016 in the journal Current Medical Research & Practice. Background: The research output from Indian medical institutions is generally regarded to be poor but there have been no previous studies to document this especially after the recent proliferation of 263 medical colleges, mainly in the private sector and under the aegis of the National Board of Examinations, as well as the 316, mainly public sector, colleges under the Medical Council of India. Methods: Using the SCOPUS database we analyzed the research output from 579 Indian medical institutions and hospitals between 2005 and 2014, including the contributions of individual states and compared the output of Indian medical institutions with some of the leading academic centers in the world. Results: Only 25 (4.3%) of the institutions produced more than 100 papers a year but their contribution was 40.3% of the country's total research output. 332 (57.3%) of the medical colleges did not have a single publication during this period. The states which had the largest number of private medical colleges fared the worst with more than 90% of the medical colleges in Karnataka and Kerala having no publication at all. In comparison, the annual research output of the Massachusetts General Hospital was 4600 and the Mayo Clinic 3700. Conclusion: The overall research output from Indian medical institutions is poor. This may be because medical education has now become a business and there is little interest in research which is not thought to be a profitable activity. We believe that a drastic overhaul of Indian medical education is necessary similar to that initiated by Flexner in the USA in the beginning of the last century. IMA Views • There has been a systemic attack on the quality of Indian doctors for more than a decade. • Our doctors are best in the world; there is no doubt about it. • We are aware of quacks and IMA is fighting against it. Witch doctors exist all over the world. • Private medical colleges do not mean that medical education is inferior. Most colleges in the US are private. • Fee in US private colleges is far more than any standards of Indian education. • Every PG, whether DNB or MCI based education, cannot clear his/her exam without a thesis. This means that more than 25000 theses are cleared every year. Is this not research? • Unlike in the US, most of these theses stay in the library of the university in print form and do not get translated in Indian Medlar. • There are over 3000 medical associations in the country, where doctors present their data and work done. There is no central registry. That does not mean that doctors are not compiling their data. • Not getting published in Medline, Pubmed, or any other international database does not mean Indian researches are inferior or bad. • West only analyses researches published in international databases. • For example, way back in 1983, my research on leprosy and immunology got never published. • In India, you cannot get promotion without research papers, only these research papers may get noted during compilation. • About 80% of research in the the private sector does not get published. Their research gets limited to presenting in conferences. And these presentations do not get included when compiling these reports. • We should all react to such International reporting, which degrade our doctors. • To augment quality research in postgraduate medical education, the MCI has made it mandatory since 2010 that every postgraduate student registered for the Degree in a medical college under the ambit of MCI permitted / approved / recognized for the said postgraduate course in his / her three years period of study has to present a scientific poster in first year, scientific presentation in second year and research publication out of thesis for the said degree, which is a condition precedence for appearance at the theory, practical, viva-voce examination. • Further, in the year 2015, the medical council has made it mandatory for every medical college to have a ‘Research Cell’ for the purposes of promotion of quality research in the said institution (Dr Vedprakash Mishra, Chairman, Academic Committee, Medical Council of India).