Indian Crab Syndrome by Shobha John

I remember watching the movie 'Ek Doctor Ki Maut' on DD many many years ago. Pankaj Kapoor plays a doctor whose seminal research is met with stiff peer opposition. The movie was inspired by the real-life story of Dr. Subhash Mukhopadhaya. Dr. Subhash's story is tragic and the movie brilliantly portrays his frustration and in effect portrays the story of all individual in India who dare to have a mind of their own, or is creative or has seminal ideas. Sadly, hierarchical structures in all aspect of human life is a truth in India and this fosters nepotism, false sense of entitlement and concentrates all power at the top. Energy is spent on fighting this structure instead of doing something constructive. A piece in the Times of India made me remember the movie and I felt like sharing that article on this blog. The article titled 'Indian Crab Syndrome' can be fond here. The article follows.

Indian Crab Syndrome by Shobha John

Anyone who challenges the prevailing orthodoxy finds himself silenced with surprising effectiveness — George Orwell

Doctors, especially those in India, can relate to this. When the 2010 Nobel Prize for medicine was given to Dr Robert G Edwards, many said it was 32 years late. Edwards and fellow researcher Patrick Steptoe did pioneering work on IVF but had to constantly wage a psychological and physical war on the opposition. They also had to battle to pay the bills. Eventually, they won through. But so many don't, particularly in developing countries like India.

WHAT MIGHT HAVE BEEN 

Kolkata doctor Subhash Mukhopadhyay developed an IVF technique and was instrumental in the birth of the world's second test tube baby, Durga, just three months after the first, Louise Brown. It was Edwards and Steptoe who proudly fathered the IVF technique that brought Louise into the world in July 1978.

Mukhopadhyay has long claimed he — and India — would have got there first. Instead, he was attacked by peers and the state government and prevented from publishing his research outside India. Mukhopadhyay committed suicide in 1981. In 2005, the Indian Council of Medical Research (ICMR) acknowledged Mukhopadhyay as creator of India's first test tube baby, but it was too little, too late.

Doctors admit the going is tough in the Indian universe of scientific and medical research. There are various ways in which research is impeded, explains Dr G P Talwar, founder-director of the National Institute of Immunology (NII), who has discovered two vaccines. "Heads of department (HoDs) put up opposition to anything unconventional and are part of expert groups, which one can't fight against."

THE INDIAN CRAB SYNDROME

A doctor at a well-known institute recalls drafting a paper with other researchers 15 years ago, on an instrument that treated asthma in smokers. Their head of department rejected it eight times in a row. But today, the instrument is used the world over. The doctor admits it was time needlessly lost and "I feel sad and hurt today and try to rationalize. Perhaps there were pressures on the HoD to reject it".

Talwar admits he too has suffered as a consequence of the Indian crab syndrome. "I was selected as associate professor at the All India Institute of Medical Sciences (AIIMS) in 1956. When the post for professorship came up, I and 22 others were rejected by an expert who hoisted a relatively unknown student there." And that's why, he asserts, research at Indian institutes rarely comes up with path-breaking work. Staff selection may be biased and meritorious students may find it hard to survive or prosper unless they have a godfather, he says.

Talwar recounts the tremendous opposition he faced while conducting clinical trials on a leprosy vaccine at AIIMS in 1970. The obstructionism delayed the research work by at least three years, he claims. "In 1983, I founded NII. Field trials had started but people alleged I had stolen the idea, despite the Drug Controller and the US FDA approving it. I was asked to leave NII in 1994." But he had luck on his side — he was taken on as a consultant at the International Centre for Genetic Engineering and Biotechnology. In 2008, the bacteria, mycobacterium indicus pranii, was named after him (Pran is his first name). "I felt vindicated."

Talwar's birth control vaccine also ran into heavy weather. A persistent and damaging rumour was put around that the anti-hCG vaccine would render a woman sterile. But at an international Congress, Talwar's paper was noticed by Dr Sheldon Segal, director of Population Council, a non-profit organization. Segal mentioned it to the Population Council's founder John Rockefeller III. He, in turn, persuaded Karan Singh, then India's health minister, to patent it in the 1980s. Many trials were conducted and Talwar received grants from Canada and the Rockefeller Institute.

RESEARCH PAPERS

Talwar was lucky. Often, senior people insist their name be put on research papers written by junior colleagues. Research papers, either delivered at seminars or published in journals, are an important part of peer acceptance. In established medical journals abroad the name of the researcher comes first and that of principal investigator last. In India, the person who is overall in charge of the research usually wants his name first, say doctors.

Dr Anoop Misra, director and head of the department of diabetes and metabolic diseases at Delhi's Fortis Hospitals, was professor of medicine at AIIMS for 30 years. He says, "Some of my juniors at AIIMS weren't allowed to do research on HIV. Even the patient registry which has personal details such as address, phone number, etc, was controlled by the HoD."

THE BABU LAG

Bureaucratic tangles can delay research as well. At AIIMS, says Misra, one has to apply to a senior, then the HoD, who approaches the director. It might take six months just to be given money to buy even small research tools (from grants awarded either by the Indian Council for Medical Research or the Department of Bio-technology or the Department of Science and Technology). "In private institutions, one just needs to get the research cleared by an ethics panel. Viable research can be set up within a month."

Ethics can, however, be a tricky matter and it can cut both ways. Guwahati cardiac surgeon Dr Dhani Ram Baruah ran into intense trouble in 1997 for transplanting a pig's heart, lung and kidney in a 32-year-old man. The patient died within a week and Baruah was roundly vilified by the scientific community. His lab was burnt down and he was thrown into prison, charged with violating human organ transplantation laws.

WHAT'S THE SOLUTION?

* Have institutional reforms and a process to keep heads of department in check. Beat the system, says Talwar. Be courageous and persevere.

* Search for greener pastures. Misra has never regretted leaving AIIMS. "I am doing more research than ever before, 3-4 hours every afternoon, I get grants from the UK, Sweden and India and have 10 research officers working for me."

* Find someone senior to help. Misra works closely with his juniors, checking every aspect of their research and papers before sending them to established journals for "peer review". Some of his juniors have published as many as 15 papers in established journals such as the Journal of the American College of Nutrition and Diabetes Care. They may be the lucky few.