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A bibliometric study of medical research in India has concluded that much of the work being done is not directly relevant to the most urgent health needs of the population.

According to government statistics, diarrhoeal, respiratory, infectious and parasitic diseases account for most deaths and morbidity in India (see Table 1). But the study shows that researchers have been more active in studying diseases such as cancer and neurological disorders, whose significance is felt to be relatively limited, rather than more widespread diseases such as malaria, which affects 2.5 million Indians each year (see Nature 386, 536; 536; 1997).

Table 1 Leading causes of mortality and morbidity in India 1991-93
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Subbaiah Arunachalam of the M. S. Swaminathan Research Foundation in Madras — now Chennai — carried out a scientometric study in 1995, based on Indian medical papers cited in Science Citation Index, which showed a similar result. But this covered only one Indian medical journal out of the 250 or so published.

He has now carried out a study based on data from Medline, which indexes 30 Indian medical journals. The results, published in the journal Current Science (72, 912; 1997) of the Bangalore-based Indian Academy of Sciences, reached the same conclusion.

Arunachalam found that, between November 1987 and December 1994, Indian authors published 18,224 articles in 45 medical fields in 1,368 journals. One conclusion was that, in terms of the number of papers published, neither tropical medicine nor respiratory diseases figure in the top 10 fields in Indian medical research (see table 2).

Table 2 Ondian research papers covered by Medline, 1987-94, by subfields (first 10)
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Indian researchers published 584 papers in 101 journals in neuroscience, 1,367 papers in 94 journals in pharmacology, and 821 papers in 56 journals on cancer. But they published only two papers in an epidemiology journal in seven years.

Although agricultural research played an important role in transforming India from a food-deficient country into one with food surpluses, “medical research in India, but for a few exceptions, has not covered itself with glory despite the fact that medicine enjoys a better status and image than agriculture in Indian society,” writes Arunachalam. He says the question of relevance is especially important in a developing country where scarce resources have to be used judiciously.

The Indian Council of Medical Research (ICMR) has challenged the study's conclusions, denying any mismatch between the work of its researchers and national needs. All the 21 ICMR institutes and five regional medical research centres in different parts of India “direct their efforts for research on diseases or disciplines which are on the national health agenda,” the council said in a statement. “Evaluating their contributions in terms of mere publications in indexed (or even other) journals would be not only unfair but unrealistic.”

ICMR's deputy director general, Lalit Kant, says that most Western databases, including Medline, cover diseases of the developing countries inadequately. “Any analysis of the relevance of medical research in India should be supplemented with authentic information from other databases like tropical disease bulletins and national databases,” he says.

Marthanda S. Valiathan, a leading heart surgeon and vice-chancellor of the Manipal Academy of Higher Education, says that Arunachalam's findings “reveal a lopsided order of priorities in Indian medical research”. Valiathan traces the origin of the mismatch to the nineteenth century, when Indians started using Western research tools and techniques without developing their own.

But Balasubramaniam Ramamurthi, one of India's leading neurosurgeons, based at the Voluntary Health Service Centre in Chennai, warns against blaming scientists. “Abolishing diarrhoea, tuberculosis and malaria requires public, political and administrative action, and not research,” he argues.