Diarrheal diseases are killers. In the developed world this statement might be redolent of historical difficulties, but in poor countries like ours it is still a reality. In 1970s, worldwide, there were estimated 500 million annual episodes of diarrhea in children under five years of age resulting in at least 5 million deaths per year. These are staggering numbers; losing millions of our children to diarrhea is heart-wrenching. It is quite understandable how desperate an issue it might have been to the people working in this field to bring down the mortality from these diarrheal illnesses. Unfortunately, there were no effective treatments that were accessible to poorer countries where the majority of the mortality occurred. Intravenous fluids were effective in saving lives but this was impractical to cover majority of the population in resource-starved countries. A simple discovery in the late 1960s offered a dramatic remedy. A solution made of salt, sugar and water was found to be very effective at saving lives. This is now known as oral rehydration therapy (ORT). Furthermore, families could be educated to administer the cure: there was no need of expensive health care workers to treat the ailment. Population-wide measures to make ORT accessible to the needy started in the 1970s. By 1995, 58-81% of the needy population had access to ORT and by 2000, mortality reduced by 50%. That is the number of lives saved in millions by a simple idea, a simple solution.
However, the history of the discovery of ORT is quite complicated. It involved meticulous lab experiments, clinical studies, casual experimentation, meticulous clinical trials, opinions, assertions, competitions, authority, serendipity. Several of these events found a place in several journals of the time. But what struck me was the frenzy and desperation that existed in these researchers to try to find a solution to this killer disease. The problem was the soul of these efforts. The publications in journals were secondary. Journals articles did not precede the horizon-changing discovery. The zeal to find a solution superseded everything else.
As I look at the list of the medical journals published from Nepal, I can not stop asking myself, "do these articles published in these journals have souls: like the innocent children dying of diarrhea?" If they indeed have souls, the sheer number should indicate that we are on a warpath with the health issues in this country. But having worked at a busy public hospital for a year, I had hardly shared the chest beating of a war. Instead I was bothered by indifference, fatigue and dejection of the health care system: so disconnected from patients, so disconnected from ailments. While the energy expended and enthusiasm expressed in publishing these journals is appreciable, the value of these efforts should by scrutinized, mainly because it might not be a harmless exercise.
Lessons from those societies where these are scrutinized are especially illuminating to us. Those who have worked in both the worlds know that the rigor of science and scientific integrity is dramatically much better in the developed nations which have done science for much longer than what we have. But some of the recent articles about the published findings in scientific literature even at these shores are alarming. Nature, the journal, reports that, "in 2012, scientists at Amgen, a drug company based in Thousand Oaks, California, reported their failure to replicate 89% of the findings from 53 landmark cancer papers." A highly cited article in PLoS Medicine, a reputed journal says, "It can be proven that most claimed research findings are false." If that is the state of affairs in the much evolved scientific publications, do we claim we are doing a better job? I would not.
A little while back, I was granted an acquaintance of an eminent doctor who was making rounds at the academic communities while on a vacation trip to Nepal from the US. He was certainly a successful doctor, he had already climbed up the academic ladder at a US university to be the chair of the department, this is no small feat for an immigrant doctor. He had a good list of publications under his belt. In response to another doctor questioning his contribution to the society he argued, "Dr. Saab, I am not just doing a private practice and seeing patients, I have been publishing, doing science that has implications to the whole of humanity, not just in the US or Nepal."
It seemed like a plausible argument at the time. But as I look at these publications, these journals, I feel offended that he thought he was a superior social contributor compared to his peers who do primarily patient care. If we are to go by the findings of the above articles, this gentleman is more likely to be contributing to the junk (forgive the candidness) than to any significant contribution (in all fairness, he might be doing significant science as well; I have not read his articles). To the soulless junk. But the soul lives in the suffering patients. At least he would be doing justice if he did not think himself more valuable than his peers who are directly tending to the sufferings of day-to-day patients.
There might be a plethora of reasons of why someone wants to publish or write in journals. But we can not skip asking, do these articles have a soul, are they true? Furthermore, in situations like ours with dire health care landscape, it would do more justice if we try focusing on tending to the sufferings of the people by means already available to us than be sidetracked in this mushy exercise of producing junk. Journals are useful tools to communicate our strives but there should be striving to start with. Clearly, this tiny country does not need 33 medical journals to communicate. Those in academic fields in Nepal would do tremendous justice to all if they stopped and did some reflection amidst this race of producing medical journals.
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