We have read with interest the editorial titled "Research Integrity, Governance, and Misconduct"1 that highlighted the crucial issue of research integrity in Pakistan. We agree with the author's concern for the lack of a robust research culture in Pakistan, and the heavy reliance on data and findings originating from the West. Based on our experience of working with medical students, residents, and faculty for research and writing, we would like to offer some comments and possible solutions to address the concerns raised in the editorial.
In our view, a key reason for the lack of a strong research culture in Pakistan is the absence of adequate formal training in research ethics.2 There has been an increase in the quantity and quality of biomedical research in Pakistan. However, many residents and consultants involved in clinical research are not formally trained in different aspects of human research ethics like the need for trial registration, components and procedure of informed consent, process of patient recruitment in clinical research, maintaining patient confidentiality and privacy, community engagement, data security, research staff training, dealing with negative results, and timely dissemination of research findings in an appropriate manner.2 While they are taught research methodology and biostatistics, they often receive minimal or no formal training in research ethics. This can lead to questionable research practices and even misconduct, which may go unnoticed. This is compounded by absence of robust ethics review committees/institutional review boards (ERCs/IRBs) and human research ethics policies in many institutions. In addition, many developing countries in this region, e.g. India,3 Iran,4 Malaysia,5 and Saudi Arabia6 have developed their own research ethics, policies, and guidelines. At present, there are no such national guidelines available for Pakistan. This reflects the actual importance being given to research ethics by the concerned governing bodies.
To address this issue, we recommend that all undergraduate medical education programmes in Pakistan incorporate mandatory courses on human research ethics. At present, they are offered in only a few medical colleges and institutes.2 Additionally, residency programmes should include training in research ethics as part of their curricula. Furthermore, faculty members involved in research should also receive regular training in research ethics, as well as in mentoring and supervising students and junior colleagues in ethical research practices.
In addition to training, there is also a need to strengthen ERCs/IRBs in Pakistan. These committees should be independent, multidisciplinary, and transparent, with clear guidelines for the review and approval of research proposals. Furthermore, there should be strict enforcement of ethical standards and accountability for those who violate them. We also support the author's suggestion to conduct a national survey to understand the extent of the problem of research misconduct in Pakistan. This information will help institutions to develop effective research governance processes, provide awareness, and improve current practices.
The author was correct in suggesting that research needs to be promoted as a career with financial incentives to attract individuals with high intellect. This will encourage individuals to pursue research as a career. By nurturing and incentivising talented researchers, a thriving research community can be fostered that produces high-quality, internationally recognised research and innovative solutions, particularly tailored to the local context.
In conclusion, we believe that Pakistan has the potential to contribute significantly to international research and innovation. However, to achieve this, there is a need to strengthen the research culture, provide adequate support and ensure that ethical research practices are followed.
The authors declared no competing interest.
FR: Substantial contributions to the conception or design of the work, drafting, revising the manuscript and final approval of the version to be published.
FF: Drafting the work, revising it critically for important intellectual content, and final approval of the version to be published.
All authors agreed be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.