19 April 2019
Biomedical research in the Arab region
Published online 20 November 2014
In the not-too-distant past, biomedical research was conducted almost exclusively in North America and Western Europe. While Asia and South America have made impressive strides in contributing to scientific output over the past two decades, the Arab world is still lagging.
Populations in the Middle East are generally afflicted with diseases similar to those prevalent in Western countries. These include cardiovascular diseases, cancer, and neurological disorders. However, regional specificities have had an impact.
A high rate of consanguinity has led to various hereditary disorders. There has also been a significant increase in metabolic disorders, specifically in the Gulf region, largely attributed to widespread changes in diet and lifestyle. Furthermore, healthcare systems have been undermined by political instability and strife, resulting in an increase in infectious diseases, malnutrition and disability.
The concept of advanced biomedical research still does not exist in most of the region, with the exception of Turkey and Iran. Recent developments in biomedical research have surfaced in Saudi Arabia and the Gulf region as well, with major investment in the creation of research infrastructure and research funding. But the fruits of such effort are yet to appear because of the absence of a critical mass of committed scientists.
Most of the region’s medical schools and universities offer the transmission of ‘second-hand’ knowledge in the absence of a true research culture. A general disinterest in scientific research adversely affects the quality of teaching and cultivates a culture of apathy.
Most active research is championed by a few dynamic individuals, based on their earlier achievements abroad, with little or no institutional incentives. They mostly collaborate with their university of origin in the United States or Europe and there is scant meaningful collaboration between institutions at the national or regional level.
The region’s participation in the advancement of science and medical discovery is important. Breakthroughs will improve quality of life for Middle Eastern people and ensure better patient care. There is also a need to attract internationally renowned investigators to create a nucleus of future scientific leaders.
Scientists should be encouraged toward personal academic growth. We need to involve students in medical research by bringing the latest research findings, including the results of a faculty’s own research activities, into the classrooms. This will generate research productivity and quality publications to increase the success rate in extramural funding, and pave the way to establish PhD and MD-PhD programmes in basic medical science.
The culture of research must be nurtured across society. This should start at the most basic level; as part of school curricula. Research is a complex process requiring critical thinking and strategic planning. Teaching students these skills would motivate them to be involved in research and provide them with a solid basis for the future.
The public must also be educated about research. There are many non-governmental organizations in the region, some of which are involved in supporting patients with particular diseases. In collaboration with the local governments and universities, these NGOs could provide education to the public about the importance of proper research and how it should be conducted.
The development of basic biomedical research can be encouraged by building on the strengths of the few areas where a critical mass of high-quality research already exists. This could be achieved by establishing regional collaborative groups for translational and clinical research.
These groups could then be used to launch meaningful investigator-initiated clinical trials and to forge partnership with the pharmaceutical industry. Regional incubators or centres of excellence are also needed to better manage resources and to attract investigators from abroad. They can also generate science-based innovations if partnerships with industry are established.
These centres require solid evaluation, auditing and quality assurance mechanisms. Based on track record, size and relative stability, the American University of Beirut Faculty of Medicine and Medical Center in Lebanon, the King Faisal Specialist Hospital and Research Center in Saudi Arabia, and other centers in the Gulf area (such as Kuwait Science Foundation or Qatar Foundation) could spearhead this programme with the goal of integrating others at a later stage. The initial centres can establish a network that allows mobility of researchers, students and technicians.
A vital step in propelling research is establishing a regional, cross-border institute for funding of biomedical research. This should be similar to the National Institute of Health in the US or the European Research Council, and be funded by private donors, governments and foundations. Funding should be merit-based and dependent on the ongoing quality of research.
Research productivity must be scientifically evaluated through a regional watchdog with a special focus on promoting original publications in high impact journals. This body can also determine initial funding of the centres of excellence and regularly evaluate them. As research is now evolving rapidly at a high rate, support mechanisms and government regulations should allow for rapid decisions, quick customs procedures and easy international contacts.
We propose the establishment of a think-tank at the highest regional level (for example the deans of certain medical schools and heads of research institutes in the region) to develop the potential structure for the regional funding agency described above. This group would then become the figurehead for persuading governments, foundations and the private sector to create a regional NIH-like structure for the region.
This is a priority and an essential step to put the region on the map in biomedical research. We believe that we have the resources and the brainpower, but we need the stimulus.
As Seneca said: it is not because things are difficult we do not dare, it is because we do not dare things are difficult.
The authors are all members of the American University in Beirut's Faculty of Medicine.