How to ensure provision of quality cost effective healthcare through indigenous research and rational use of modern technology

In his plenary talk at the EMMJ5 Medial Journals Conference organized by Eastern Mediterranean Association of Medial Editors (EMAME) in collaboration with Pakistan Associations of Medial Editors (PAME) at Karachi in 2010, Jane Nicholson from WHO EMRO laid emphasis on local, indigenous research. She further opined that journals should publish research which is relevant to the country, community, to patients and policy makers.1 Publishing research work which has no relevance to the country and region which the journal caters to is of no use. Different countries have their own problems and the best way to combat the diseases prevalent in their countries is through indigenous research and solutions. Somewhat similar views were expressed by Farrokh Habibzadeh President of World Association of Medical Editors (WAME) while speaking at the Asia-Pacific Association of Medical Editors (APAME) congress held at Kuala Lumpur Malaysia. He stated that “we should not accept all rules set by international organizations but customize them to suit our own requirements. Biomedical journals should publish research on locally prevalent diseases instead of covering more advanced subjects like molecular biology”.2 These both distinguished medical editors have rightly stressed the need for local research relevant to our needs and requirements. Not only that we have to think of ways and means to ensure provision of quality cost effective healthcare with rational use of modern technology. What is good for the West may not be suitable for the less developed countries with huge disease burden and financial constraints. Despite advances in modern technology, even the developed countries in the West are worried about the increasing cost of healthcare. While these days there is lot of emphasis on evidence based medicine but it is also important that this EBM should be based on results from studies done in the region and their own countries. For example at cardiology conferences in Pakistan there is often debate as to which one is best and most suitable treatment modality for Pakistani patients suffering from coronary artery disease i.e. interventional cardiac procedures or coronary artery bypass graft surgery (CABG). The speakers emphasize on evidence based medicine and refer to various studies done in the West which show that most often interventional cardiac procedures are much more cost effective but they forget the fact that it may be true for that country but not for the developing third world countries. What we need is local evidence based medicine studies because surgery is very costly in the West as compared to the developing world where most often CABG is the cost effective strategy while managing such patients. Moreover, treatment approach in each patient has to be individualized keeping in view various factors i.e. cost of stents, balloons, interventional procedures and CABG surgery, age and health condition of the patient, co-morbid diseases and above all financial position of the patient and the family more commonly known as “pocket biopsy”. However, it will be interesting to note that a comparative study done in Isfahan in Iran about late clinical events of drug eluting versus bare metal stenting conducted in four hundred forty two patients, one hundred sixty six in the DES group and one hundred ninety seven in BMS group showed that prevalence of the in-hospital major cardiac events, angiographic and clinical success rate were the same between both the groups. There were no significant differences regarding six and twelve month major cardiac events in patients treated by BMS or DES. The authors concluded that considering the same clinical outcome and Editorial