Lam, CLK

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Title Knowledge can flow from developing to developed countriesAuthor(s) Lam, CLKCitation British Medical Journal, 2000, v. 321 n. 7264, p. 830Issued Date 2000URL http://hdl.handle.net/10722/43072Rights B M J. Copyright © B M J Publishing Group.Knowledge can flow from developing to developed countriesEditor—I am pleased that this issue of theBMJ explores the many aspects of researchin developing countries. The first thing thatcomes to mind on this issue is howdeveloped countries can teach developingcountries, but few people realise that theflow of knowledge can sometimes bereversed. Developed countries can learn andbenefit from research in developing coun›tries, particularly from research on infec›tious diseases and alternative treatments.More international travel has led to aresurgence of infectious diseases and to arapid spread to developed countries ofdiseases that used to be exclusive to the devel›oping world. The emergence of HIV infec›tion has warned us about the global threat ofnew infections, which are more likely to startin developing countries.1 Research andsurveillance on infectious diseases are mosteffectively done in areas where the diseasesare common. Early communication andattention to this epidemiological informationfrom developing countries can preventpotential global disasters.The different needs and healthcaresettings in developing countries often stimu›late new treatment methods, some of whichcan be more cost effective than establishedpractices in developed countries. Directlyobserved therapy, short term (DOTS) fortuberculosis was shown to be effective inAfrica and Asia in the early 1950s and hasbeen the standard method of treatment inHong Kong since then. It was only in 1993that the US Centers for Disease Controlrecommended it be considered for allpatients with tuberculosis.2 Earlier adoptionof this research evidence might haveprevented some of the deaths and multipledrug resistance associated with tuberculosisin many developed countries in recent years.Traditional medical practices in devel›oping countries can be a treasure box ofalternative or complementary treatmentsfor people in developed countries. Researchon the effectiveness of acupuncture hasmade it a standard treatment in many devel›oped countries. Qing hao su, a Chineseherbal medicine, has been proved to be aneffective and safe treatment for malaria.3Trials of many Chinese herbal medicines forthe treatment of HIV infection and cancerare currently under way.The lack of advanced technology andsophisticated equipment may limit the qualityand scope of some research in developingcountries, but a lot of knowledge can beacquired through careful observations andinnovative ideas, which do not need a lot ofmoney. Mutual exchange is a more satisfyingprocess than one›way transfer of knowledgeand resources. Developed countries will getmore in return for their investments inresearch in developing countries if they aremore receptive to findings from thesecountries.Cindy L K Lam associate professorFamily Medicine Unit, Department of Medicine,University of Hong Kong 3/F, Ap Lei Chau Clinic,Hong Kong SAR, China1 LeDue JW. World Health Organization strategy for emerg›ing infectious diseases. JAMA 1996;275:318›20.2 Morse DI. Directly observed therapy for tuberculosis—spend now or pay later. BMJ 1996;312:719›20.3 Hesketh T, Zhu WX. Traditional Chinese medicine: onecountry, two systems. BMJ 1997;315:115›7.Let’s consider ethics of medicalpractice firstEditor—During the past year I haveattended three meetings on the ethics ofresearch sponsored by the World HealthOrganization, the Harvard School of PublicHealth, and the Indian Council of MedicalResearch. They were all ignored by themedia, although the Indian media reportdaily on the poor state of the health serviceand unethical medical practices. The recentalleged maltreatment of a central govern›ment minister who died in a private hospitalin Delhi has caused particular publicconcern.1That medical research in developingcountries is meagre and of generally poorquality is well known,2 and it has notimproved in the past 20 years. Should onetherefore discuss research ethics in develop›ing countries when they barely exist?In my view the ethics of medical practiceis more important. To see how the public canbe safeguarded from an inefficient and oftencorrupt medical system and receive compre›hensive health care of a reasonable quality isparamount. Ordinary people have to choosebetween an underfunded and inefficient pub›lic sector with its long queues, dirty hospitals,and rude staff (not infrequently on strike formore pay) and the expensive private sector,perceived as being run by avaricious doctorsfleecing patients through overinvestigationand overtreatment. Many patients, under›standably, turn to the more accessible andcheaper practitioners of alternative systemsof medicine or even to quacks, who regularlyprescribe a cocktail of antibiotics, antimalar›ials, antipyretics, and steroids for fever.Despite this, 80% of the Indian gross domes›tic project spent on health care goes to theprivate sector.3The medical councils, the main regula›tory bodies, are generally ineffective, claim›ing that they do not have the necessarypowers. Only one doctor (a well known actorwho used his medical status in an advertise›ment) has been struck off since theirinception. Even the Consumer ProtectionAct, which includes medical practitioners inits ambit, has not successfully curbed unethi›cal medical practices because of the hugedelays in its legal process.In January 2000 the Ministry of Healthrecognised the growing concern about theabsence of standards to measure the qualityof health services and that the medical com›munity in India is not accountable in anymanner. It proposed setting up a system ofmonitoring hospitals and doctors in boththe public and private sectors. Perhaps thesad and unfortunate death of a youngminister will now result in some belatedaction.Samiran Nundy gastrointestinal surgeonSir Ganga Ram Hospital, New Delhi 110060, Indiasnundy@hotmail.comAdvice to authorsWe prefer to receive all responses electronically,sent either directly to our website or to theeditorial office as email or on a disk. Processingyour letter will be delayed unless it arrives in anelectronic form.We are now posting all direct submissions toour website within 24 hours of receipt and ourintention is to post all other electronicsubmissions there as well. All responses will beeligible for publication in the paper journal.Responses should be under 400 words andrelate to articles published in the precedingmonth. They should include <5 references, in theVancouver style, including one to the BMJ articleto which they relate.We welcome illustrations.Please supply each author’s currentappointment and full address, and a phone orfax number or email address for thecorresponding author.We ask authors to declareany competing interest. Please send a stampedaddressed envelope if you would like to knowwhether your letter has been accepted or rejected.Letters will be edited and may be shortened.bmj.comletters@bmj.comLettersWebsite: bmj.comEmail: letters@bmj.com830 BMJ VOLUME 321 30 SEPTEMBER 2000 bmj.com

Knowledge can flow from developing to developed countries

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Knowledge can flow from developing to developed countries

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