OPINION: An honest perspective about conundrum of health research

Thursday September 12 2019



Professor Zulfiqarali Premji

Professor Zulfiqarali Premji 

I was surprised and somehow amazed at how professionals who have become politicians can easily forget their professional careers.

It is also sad to see high-ranking professionals with decades of experience just nodding to the directives issued. I am specifically referring to clinical research directive recently issued by the Deputy Minister of Health, Community Development, Gender, Elderly and Children Dr Faustine Ndugulile (pictured).

It was reported that he ordered the National Institute of Medical Research to do research on why there is an increase of cancer cases in Lake Zone regions and provide the findings before the end of this year. The last few words are really astounding.

I remember the days when Augustine Mrema was in government and directed every issue to be resolved in seven days.

A political directive that is time limited does not apply to clinical research and the deputy minister should be aware of this.

Surprisingly the Director General of NIMR a renowned professor quietly and humbly accepts the directive, after all what can he say.

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Clinical investigation is that area of academic and clinical medicine in which the physician explores in depth a specific question that relates directly to patients seen in clinical practice.

This investigative approach allows the physician to satisfy intellectual and academic curiosity about disease and its management either through bedside or laboratory research.

I think, this is one of those unique opportunities that provide exciting and fulfilling experiences for a physician with interest and imagination.

It satisfies a thirst for new knowledge, and a means to affect the course of disease. It is a truly unique privilege for an inquiring physician to develop new fundamental knowledge about disease and to apply that information at the bedside.

The clinical investigator, therefore, must be trained to apply the scientific methods of how to do research.

This process follows the very same principles pursued by any scientist: formulation of a hypothesis from the question generated which is subsequently retested by controlled experimentation. Of course, the data derived must be reproduced until the final principle or answer is achieved or refuted.

These principles have been applied over the centuries with the same rigor.

However, more recently, the nature of the clinical problems and the means for pursuing answers have been rendered more complex by many new constraints levied by society.

In previous years, many of the questions suggested clinically could be resolved by careful and objective description of one’s clinical observations.

The complexities surrounding clinical investigation today include the necessity to obtain funds to conduct modern research and to satisfy the rigorous ethical and regulatory controls imposed by our social structure.

Notwithstanding these constraints, the opportunities and excitement for the clinical investigator remain limitless.

There are multiple health institutions in the country that give ethical clearance to perform research. It is quite common to get clearance from NIRM but the same research proposal is either delayed or not given clearance by MUHAS.

Thus this issue of ethical approval of a research project is a big unnecessary hurdle that needs to be sorted out.

Every country should have a cancer registry, this is an information system designed for the collection, storage, and management of data on persons with cancer.

There are two types of cancer registries viz population-based registries and hospital-based registries.

Registries play a critical role in cancer surveillance, which tells us where we are in the efforts to reduce the cancer burden.

Surveillance data may also serve as a foundation for cancer research and are used to plan and evaluate cancer prevention and control interventions.

The question that the deputy minister is asking can easily be answered from a well-managed cancer registry and NIRM does not have a cancer registry.

The National Cancer Registry was started a few years back at Ocean Road Cancer Hospital. What is the present status I wish I knew?

Thus it is totally unrealistic to find evidence-based reasons why cancers cases have increased in the Lake Zone in three months.

First and foremost how many cancer epidemiologist and cancer specialist does NIRM have? It was common corridor talk at Muhimbili that NIRM was not a medical research institution, it was a Parasitology Institute and if you look into the history and published research from NIRM it will become obvious that the strength of NIRM was in parasitic infections like malaria.

In all honesty NIRM needs to build clinical research capacity.

I will be surprised if after three months a real research report with findings is submitted. I predict a report showing hospital prevalence of cancer and a flimsy reason based on some social survey to indicate that due to availability of oncology services health seeking behavior has changed thus more cancer cases are seen but this does not mean there is an increase in cancer cases. I hope NIMR can prove otherwise.

Zulfiqarali Premji is a retired MUHAS professor. His career spans over 40 years in academia, research and public health.