Correspondence

www.thelancet.com Vol 382 October 12, 2013 1245

We declare that we have no confl icts of interest.

*Muhammad Asif Qureshi, Muhammad Saquib Qureshi, Muhammad Rafi q Khanania.qureshi@duhs.edu.pk

Dow University of Health Sciences, Karachi 74200, Pakistan (MAQ, MRK); and Faculty of Pharmacy, University of Karachi, Karachi, Pakistan (MSQ)

1 Ghaff ar A, Zaidi S, Qureshi H, Hafeez A. Medical education and research in Pakistan. Lancet 2013; 381: 2234–36.

2 Mushtaq A, Abid M, Qureshi MA. Assessment of research output at higher level of education in Pakistan. J Pak Med Assoc 2012; 62: 628–32.

3 Andriole DA, Whelan A, Jeff e DB. Characteristics and career intentions of the emerging MD/PhD workforce. JAMA 2008; 300: 1165–73.

4 Solomon SS, Tom SC, Pichert J, Wasserman D, Powers AC. Impact of medical student research in the development of physician-scientists. J Investig Med 2003; 51: 149–56.

Clinician scientists are rare in Pakistan, and this is one of the main causes of the scarcity of medical research done in the country.1 Despite the establishment of the Higher Education Commission in 2002, which has resulted in recent advances in the research output from the Pakistani medical universities,2 less than 8% of the postgraduate supervisors holding a PhD degree have a medical qualifi cation. It is therefore important not only to highlight the scarcity of clinician scientists in Pakistan, but also to identify the underlying causes, and to implement policies that can revive the medical research culture in Pakistan.

Several reasons could explain the reduced number of medical doctors pursuing a research career. For example, because medical research is not incorporated in the medical degree curriculum at a national level (with a few exceptions) junior doctors could find it difficult to develop research interests. Another reason could be the absence of MD/PhD programmes, which have proven beneficial to medical research in other countries, such as the USA.3 An example of initiatives to promote research at the undergraduate level in the USA is the medical student research fellowship programme of the National Institutes of Health, which has been very well rated by the medical students and recommended to strengthen medical research.4 Using these examples as a road-map, research attitudes in Pakistan need to evolve to put in place appropriate strategic planning in the health-care sector.

There is a dire need for centralised programmes and policies to promote medical research and increase the number of clinician scientists. Pilot studies are needed to assess the willingness of the students, the teaching community, and the government bodies. Generating, enhancing, and promoting research in Pakistan could change the current status of research within the medical community.

Health and research in PakistanWe read with interest the Lancet Series on Health Transitions in Pakistan. In their Comment1 on medical education in Pakistan, Abdul Ghaffar and colleagues have concerns regarding the increasing number of private medical colleges.

Health services in Pakistan need medical graduates in primary and secondary care settings. To address these needs, we propose that the Pakistan Medical and Dental Council should encourage new medical colleges to focus on producing primary care physicians, which are what the country badly needs.

Over the past decades, medical practice within and outside tertiary care hospitals have been diverging. There is a mismatch between clinical training in tertiary hospitals and the needs of the health services outside of these hospitals

We quest ion the current requirement of the Pakistan Medical and Dental Council that undergraduate medical education be exclusively carried out in well-equipped and well-staffed tertiary care hospitals. Tertiary care hospitals should be for training of postgraduates in different clinical specialties and subspecialties. We must utilise primary and secondary care facilities for undergraduate training and focus on producing primary care physicians. We declare that we have no confl icts of interest.

*Naeem Jafarey, Nighat Huda, Rukhsana Zuberinaeem.jafarey@gmail.com

Ziauddin University, Karachi 75600, Pakistan (NJ); Department of Medical Education, Bahria Medical and Dental College, Karachi, Pakistan (NH); and Department for Educational Development, Faculty of Health Sciences, Aga Khan University, Karachi, Pakistan (RZ)

1 Ghaff ar A, Zaidi S, Qureshi H, Hafeez A. Medical education and research in Pakistan. Lancet 2013; 381: 2234–36.

For the Lancet Series on Pakistan see http://www.thelancet.com/series/health-transitions-in-Pakistan

Although philanthropic funding for health has gained momentum in recent years, spending on health-care research in Pakistan is still virtually non-existent.1 International donors such as the Bill & Melinda Gates Foundation and the Wellcome Trust are trying to help, but the eff orts are limited because of the paucity of infrastructures, scarcity of centres of excellence, absence of a structured training programme for health-care research, and limited access to medical journals. The Higher Education Commission has done a fabulous job in promoting research in diff erent fi elds, but for health-care research the progress is very much limited. International initiatives such as HINARI do not include Pakistan in journal access programmes. The alumni associations of some medical schools such as King Edward Medical College, Lahore, and Aga Khan University, Karachi, are playing their part, but this has resulted in limited research clustered at these institutes.

Sania Nishtar and Zulfi qar Bhutta’s contributions to public health and maternal and child health, respectively, are important, but collective rather than individual eff orts would result in greater success.

Pakistan requires public-private partnerships, involving government,

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