Just prior to IndiaÕs Independence, the thenGovernment recognized that both the healthcare delivery services and medical educationfacilities, specially the postgraduate

education were woefully inadequate for the needsof the country. Therefore, a Health Survey andDevelopment Committee was appointed underthe chairmanship of Sir Joseph Bhore in 1942-43.The Committee submitted its report in 1946.Among its many recommendations were two atthe either end of the Health& Medical Educationsystem, i.e. theestablishment of PrimaryHealth Centres (PHCs) andthe creation of an apexinstitute for postgraduateeducation and research. Itwas, however, due to activeefforts of the newly installedNational Government thatthe first PHCs wereestablished in 1952 and the All India Institute ofMedical Sciences (AIIMS) in 1956. The existingdistrict and provincial hospitals wereprogressively upgraded and the number ofmedical colleges increased. Selected bright youngmedical graduates were sent abroad to centres ofexcellence for training in the newly emergingdisciplines like cardio-thoracic, plastic,neurosurgery and biomedical sciences. A numberof young persons went on their own initiative.Back home they enucleated these specialities thus

paving the way for achieving self-sufficiency inpostgraduate teaching and training and in turnstrengthening the research base.

Health Care Delivery: At the time India wonIndependence, modern medical facilities wereavailable mostly in our metropolitan and capitalcities. District hospitals and in some places talukhospitals existed but these were generally ill-equipped and did not provide any specialized

services. The country is nowserved with a vast network ofsome 120,000 rural subcentresmanned by one or twoparamedical workers,approximately 19,000 PHCs,each with a staff of 15paramedical workers and oneor two medical officers, 3,500community health centreshaving some specialityservices and 30 in-patient

beds. Each district has its own district hospital witha number of specialities -- medicine, surgery,orthopaedics, ENT, obstetrics and gynaecology,usually with over 100 beds with routine diagnosticlaboratories. The country has over 160 recognizedmedical colleges and some in the private sector; newones are being opened up. In addition there are anumber of national institutes and speciality centresdistributed around the country, staffed by specialistsin all conceivable disciplines and equipped with thelatest state of the art facilities.

178 P U R S U I T A N D P R O M O T I O N O F S C I E N C E

MEDICAL SCIENCES

C H A P T E R X V I I

SUKHAM SAMAGRAM

VIJNANE VIMALE C.A

PRITISHTHITAM.

ALL HAPPINESS IS ROOTED

IN GOOD SCIENCE.

C.ARAKA

179P U R S U I T A N D P R O M O T I O N O F S C I E N C E

HOW HAS THE COUNTRY BENEFITTEDBY THESE DEVELOPMENTS ?

Undoubtedly, the answer is that these develop-ments have resulted in a significant improve-

ment in our health indices. Life expectancy at birthwhich was around 30 years in 1947, is already 60+.The infant mortality has come down from 140 to 72per 1,000 live births and maternal mortality to 4.6 perthousand. No doubt, these are still unacceptablyhigh for any civilized society but trends are towardscontinuous improvement.

As a result of expanded immunization

programme, there has been a progressivereduction in several infectious diseases. Smallpoxhas been eradicated, indications are thatpoliomyelitis may also be eliminated in nearfuture. Already its incidence has been reduced tovery low levels. Dracunculosis or guinea worminfestation, a curse in some parts of the country,has been wiped out. Since the introduction of oralrehydration programme, the mortality fromchildhood diarrhoeas and cholera has comedown. There has been a perceptible reduction inthe incidence of leprosy. Except for a minor

outbreak, between August andOctober 1994 (affecting alimited geographical area andpromptly brought undercontrol), plague had virtuallydisappeared from the country.On the other hand malaria,kala-azar and some othervector-borne diseases whichwere fairly well controlledhave once again become amatter of concern. Tuberculosis

Health Indices1951 1961 1981 1991 1995 2000

Crude Birth rate (per thousand) 40.8 39.3 37.2 29.5 28.5 26

Crude Death rate (per thousand) 25.1 18.9 5.0 9.8 9.2 9.0 #

Infant Mortality Rate 148 138 110 80 74 72 *

Life Expectancy at Birth 32 41.3 56.0 61.2 - 60+

Total Fertility Rate 6 5.7 4.50 3.80 3.40 3.3

Couple Protection Rate - - 22.8 43.5 - 45.0

#In Kerala death rate is 6, Tamil Nadu and Karnataka 8, Andhra Pradesh 8.4.*In Kerala the infant mortality rate is already down to 16 per 1,000. In Punjab, Maharashtra and Tamil Nadu this is around 50.

continues to affect two million persons causing500,000 deaths every year. The situation is likelyto become worse with the emergence ofHIV/AIDS infection.

Extensive community studies revealed thatapproximately 170 million people were living iniodine deficient regions in the country. There wasan alarming incidence of cretinism (3-5%), feeblemindedness (IQ 69 or below in 29%) and hearingdeficiency (20%). With the introduction ofuniversal iodination programme since 1986, therehas been a perceptible reduction in iodinedeficiency diseases, specially the severe varietyof neonatal hypothyroidism with mentalretardation and cretinism in badly affectedregions of the country. Vitamin Asupplementation programme has likewise started

to show its beneficial effects for preventionof blindness. One could enumerate severalsuch success stories. Yet the very fact thattheir root causes, poverty, lack of supply ofsafe drinking water, malnutrition coupledwith unabated rise in population, highincidence of illiteracy and lack of adequatefinancial resources continue to bedevil theefforts, for which there are no S&T quick-fixes.

Similarly, if progress is to be measuredby the proliferation of curative services,both in public and private sectors, India hasmade significant strides. Today we canproudly say that while at the time of our

Independence we had no neurologist orneurosurgeon, no cardiologist or cardiac surgeon,only one cancer hospital worth the name, nospecialized research-cum-service institute in anyfield of medical science, we now have all thefacilities to train all our specialists in the country.A limited number of doctors from theneighbouring countries are also being trained.This facility could certainly be augmented ifrequired. It can be stated without risk ofcontradiction that no patient needs to go abroadfor any treatment or investigation. Renaltransplant, cardiac transplant, liver transplant andbone marrow transplant have been successfullyperformed in India. Several centres can boast ofresults comparable to the best, be it for cancer,cardiac surgery or brain surgery. These services

180 P U R S U I T A N D P R O M O T I O N O F S C I E N C E

Guinea worm infection. (Source: Proceedings

of National Academy of Sciences, India, 1966)

are also provided to patients from theneighbouring countries. No doubt there is still agrowing need for expanding these servicesquantitatively and geographically to make themavailable in every part of the country.

MEDICAL EDUCATION AND RESEARCH

In 1947, the country had only 16 medical colleges.While postgraduate speciality courses existed in

most of these, unless one had a diploma (FRCS,MRCP, DCH, DO, DTM&H) from the Royal Collegesin the United Kingdom, a person was not consideredadequately qualified for appointment as a specialist.Soon after Independence, there was a rapid growthof medical colleges all over the country. Today thereare more than 160 such institutions with an annualenrolment of 16,000 students.To meet the growing needs ofteachers for these colleges, aswell as to create an environ-ment for high-qualityresearch, in 1956, AIIMS wasestablished at New Delhi, byan act of the Parliament.Subsequently several suchinstitutes like Post -GraduateInstitute of Medical Education and Research(PGIMER), Chandigarh, The National Institute ofNeurosciences and Mental Health (NIMHANS),Bangalore, and Sri Chitra Tirunal Institute forMedical Sciences and Technology, Thiruvanan-thapuram, were started.

Compared to the scenario fifty years ago,medical research has certainly progressed. Thereare a number of institutes created by the IndianCouncil of Medical Research (ICMR), Council ofScientific and Industrial Research (CSIR),Department of Biotechnology (DBT) and otheragencies which are actively involved in biomedicalresearch. Many of these have set up centres toaddress problems of specific diseases such as theMalaria Research Centre, Delhi; the CholeraResearch Centre, Kolkata; Tuberculosis Research

Centre, Chennai; Vector Control Research Centre,Pondicheery; National AIDS Research Centre,Pune; Enterovirus Research Centre, Mumbai; andLeprosy Research Centre, Agra. Others are morebroad-based like the Virus Research Centre atPune, Institute for Research in Reproduction andInstitute of Immuno-haematology at Mumbai,National Institute of Nutrition, Hyderabad andNational Institute for Communicable Diseases,New Delhi. In addition to the ICMR, severalscientific agencies have created research centres inspecialized fields related to medical sciences likethe National Institute of Immunology, New Delhi,National Centre for Cell Sciences, Pune; Centre forDNA Fingerprinting and Diagnostics, Hyderabad;National Brain Research Centre, Manesar;

Functional GenomicResearch Unit at Centre forBiochemical Technology,Delhi by DBT. Like-wise theCentral Drug ResearchInstitute, Lucknow; IndianInstitute of ChemicalBiology, Kolkata; IndianInstitute of ChemicalTechnology and Centre for

Cellular and Molecular Biology, Hyderabad;Industrial Toxicology Research Centre (ITRC),Lucknow; and Central Institute of Medicinal andAromatic Plants, Lucknow; were established bythe CSIR and Radio-pharmaceutical Centre andCancer Research Centre by the Atomic EnergyCommission. Thus a network of centres providethe infrastructure for medical research in thecountry. In recent years a few research centres havebeen established by major pharmaceuticalindustries and private organizations. Research isalso being carried out at medical colleges andmajor hospitals in the country.

Even prior to mentioning some of theoutstanding research findings of the Indianbiomedical fraternity, it is important to explain theneed for carrying out research. It has often been

181P U R S U I T A N D P R O M O T I O N O F S C I E N C E

A STRONG S&T BASE IS

CRUCIAL FOR SOLVING

HEALTH PROBLEMS FACED

BY A COUNTRY.

stated that developing countries should not wastetheir limited resources on research since applicationof the already existing knowledge can solve manyof their health problems. Experience has taught thatwhereas a strong S&T base is essential for survivalof any country in this competitive world, it is evenmore crucial for solving the health problemspredominantly faced by a country. Many diseasesprevalent in the developing countries are of littleinterest to those in the developed world. Worldwide investment for research on health has beenestimated to be about 30 billion dollars but only 5per cent (1.6 billion) is devoted to the healthproblems of developing countries, which accountfor 93 per cent of the global burden of preventablemortality (measured in years of potential life loss).Out of $ 1.6 billion spent on developing country-oriented research 42% originated in the developingcountries. It is now well established that the samedisease prevalent in different parts of the world maynot manifest identical problems, thus requiringlocale-specific studies. Different ethnic populations,different genetic make up, varying socio-economicconditions or ecological environment modify themanifestations and therapeutic responses of adisease which prevent application of knowledgegenerated elsewhere to effectively deal with it. Atthe same time without indigenous competence inS&T, it is not possible to identify and utilize oneÕspotential strengths taking advantage of theindigenous heritage and resources.

COMMUNITY BASED RESEARCH

Anumber of important contributions of nationaland international significance have been made

in recent years in every sphere of biomedicalresearch. It is not possible to present a comprehen-sive account but a few are listed here to illustrate theabove premises and to provide an idea of the rangeof activity. Thus amongst the community based stud-ies one could unhesitatingly mention BCG trial, theoral poliovaccine studies, the iodine deficiency syn-dromes, the indigenously developed leprosy vaccine

trials or the bio-environmental approaches to controlmalaria, epidemiological studies on cholera, malaria,filaria, leprosy, tuberculosis, cataract, coronary heartdisease, stroke and cancer.

BCG Vaccine Trial: BCG had been universallyacclaimed as the most effective vaccine availableagainst tuberculosis. It was therefore accepted as acomponent of the Tuberculosis Control Programmefrom its very inception. However, doubts were soonraised about its efficacy in Indian population. TheTuberculosis Research Centre, Chennai, underlooka controlled field study in 1963. After an extensivecarefully planned and executed study, it wasestablished that BCG offered, i) low levels ofprotection in those aged 0-14 years, ii) no protectionagainst the development of adult type bacillarytuberculosis, and iii) 20% protection against leprosy.

Oral Polio Vaccine Trial: WHO recommended threedose oral polio vaccine regime as a component ofneonatal immunization programme. Unfortunatelya number of children so vaccinated developedparalytic polio. Initially it was blamed on failure ofcold chain. However, carefully carried out studiesat Vellore and New Delhi unequivocally establishedthe inadequacy of this regimen in India resulting ina radical change in the national programme whichnow seems to be producing desirable results. Iodine Deficiency Studies: The prevalence of

182 P U R S U I T A N D P R O M O T I O N O F S C I E N C E

Paralytic poliomyelitis due to wild poliovirusinfection has declined by more than 85% in mostparts of India. More than 1,000 cases ofpoliomyelitis were annually reported from thecity of Mumbai in the mid-1980s, in 1999, only18 virologically proven poliomyelitis cases werereported from the entire state of Maharashtra ofwhich 3 were from Mumbai. It is inspiring tonote that Orissa has emerged as a polio-free statein the year 1999.

thyroid goitre in several regions of the country waswell-known, however, its real gravity andetiopathogenesis were only brought to light withthe utilization of the latest techniques ofchromatography and radioimmunoassay by a teamof researchers from AIIMS among some others. Itwas not the clinically obvious goitre but theincidence of cretinism, mental retardation and deaf-mutism that forced the Government to introduceuniversal iodination of the common salt as animporant component of the National IodineDeficiency Control Programme.

These three examples justify the need ofcarefully conducted research to solve national healthproblems rather than relying on knowledgegenerated elsewhere.

Bio-environmental Control of Malaria: Concernedwith resurgence of malaria, increasing resistance topesticides, rising cost and health consequences of

newly developed ones, emergence of drug-resistantparasites, it became obvious that a new strategyneed to be evolved to fight this menace. The MalariaResearch Centre experimented with alternateregimes of bio-environmental control to suit thelocale-specific requirements of different geo-graphical sites in the country (for details see chapteron ICMR).

Kyasanur Forest Disease (KFD): A viral diseaseemerging as a consequence of deforestation inKarnataka was investigated by the NationalInstitute of Virology, Pune. Not only was the virusidentified but the puzzle of the origin andpersistence of KFD virus in nature could be solved.A formalized vaccine was prepared.

Several such examples could be added butspecial mention may be made of the recentepidemiological studies on cholera epidemic causedby a new strain 0139 and the hepatitis E epidemic

183P U R S U I T A N D P R O M O T I O N O F S C I E N C E

Iodine Deficiency Disorders: Before and After Salt IodinationLocation % of Children with UIE % Hypothyroidism among Neonatal Hypothyroidism;

Prevalence of Goitre < 5,ug/dl (Iodine deficiency) school children incidence per 1,000 birthsPre- Post- Pre- Post- Pre- Post- Pre- Post-

Iodination Iodination Iodination Iodination Iodination Iodination Iodination Iodination

Delhi 55% 21.8% 70% 0.64% - - - -

Gonda 70% 25.8% >50% 0.75% 21% <1% 75 9Iodine deficiency disorders: Before and after salt iodination (Courtesy: N.Kochupillai)

in Kanpur. Needless to reiterate, these studies couldonly be done in India, by scientists fully trained andequipped with latest techniques and technologies.

BASIC SCIENCE RESEARCH

Demands of clinical work and urgent needs fortackling mounting public health problems did

not permit as much attention to basic medical scienceresearch as requires. Nevertheless, a number of ded-icated teams in practically every discipline of basicsciences Ñ anatomy, physiology, biochemistry,microbiology, pharmacology, and pathologyÑadvanced the frontiers of knowledge. In recent years,with the advent of molecular biology, immunology,biotechnology, genetics and genetic engineeringthere has been a rapid expansion in the base of bio-medical research. Most of these researches have alsobeen directed to address problems of national inter-est or areas of expertise of individuals or groups.Once again, the following have been cited as repre-sentative examples. This should not detract from thevalue of a large number of other works not includedhere.

Neurophysiological Investigations: The demons-tration of well defined feeding and satiety centresin the hypothalamus of different species of animals,

was followed by the studies on reflexmechanisms at the spinal cord andbrain stem level, as also the role offeed back from the periphery.Comprehensive studies on the role oflimbic system were carried out.Mechanism of sleep, wakefulness,and yogic state were explored.

J-receptors and Other Visceral Receptors: Spread over nearly five

decades, persistent efforts at VP Chest Institute ofUniversity of Delhi, have revolutionized visceralphysiology. Beginning with type B atrial receptors,successively, gastric stretch receptors, ventricularpressure receptors, J-receptors (juxta pulmonarycapillary receptors), mucosal mechano receptors ofthe intestines and pressure-pain receptors of musclewere identified. J-receptors have acquired specialrelevance owing to the role they play in producingbreathlessness and respiratory sensations leadingto dry cough.

High Altitude Physiology: Soldiers guarding ourfrontiers at the inhospitable Himalayan peaks werefound to suffer from life threatening pulmonaryoedema and other physiological disorders.Pioneering researches by a group at AIIMS led bySujoy B. Roy and his colleagues, as also by scientistsfrom the Defence Research Laboratories and theircollaborators have unravelled the underlyingphysio-pathology, leading to a managementstrategy practically abolishing the risks.

Nutritional Pathology: Starting with the initialstudies of scientists at the Nutritional ResearchLaboratories, Coonoor, several major groups in thecountry at Delhi, Hyderabad, Vadodara,

184 P U R S U I T A N D P R O M O T I O N O F S C I E N C E

A case of endemic thyroid goitre (left)

and mentally retarded progeny

of a mother with severe iodine

deficiency (right).

Phot

o: N

. Ko

chup

illai

Chandigarh, Varanasi, Vellore and Bangaloreexplored the various facets of nutritional deficiencyin a variety of animal models and also humanbeings. These included morphological, biochemicaland behavioural effects of not only protein-caloriemalnutrition but also micro-nutrient deficienciesincluding iron, iodine, magnesium and variousvitamins specially vitamin A, folic acid, Vitamin B 6 and B12. Simultaneously studies were carriedout to evaluate the effect of corrective replacementat various stages of development. On the basis ofthese studies, national programmes were initiatedto overcome their adverse effects on human health.

Immunology Approaches to Fertility Control:Population explosion being a subject of national

concern, a variety of programmes and researchstrategies were initiated from time to time. Onesuch novel approach was the immunologicalcontrol of fertility using anti-hCG vaccine infemales and anti FSH vaccine for males. At thesame time another interesting approach was basedon active immunization against riboflavin carrierprotein to suppress pregnancy. Preliminary dataand even clinical trials provided promising results.Unfortunately, there still remain severalunresolved problems in applying these for controlof fertility.

Molecular Biology of Malarial Parasite: A numberof groups in the country specially those at IISc,Bangalore, AIIMS, ICGEB, NII, Malaria ResearchCentre (all at Delhi) and CDRI, Lucknow, have beenexploring the various facets of molecular biologyand biochemistry of malarial parasite speciallyPlasmodium falciparum. As a result of these studiesefforts are going on to develop one or morevaccines. Major progress has been made inunderstanding the basis for chloroquin resistance.It was shown that the resistant strains of parasitehave significantly higher levels of cytochrome P450.More recently, it has been demonstrated for the firsttime that intraerythrocytic stage of the malarialparasite degrades haemoglobin and utilizes theamino acids, thus generated for making its ownproteins and also generate large quantities of hemesufficient to meet its own requirements. The latestdiscovery of fatty acid synthesis pathway in themalarial parasite and its inhibition by hydroxy-diphenyl ethers opens up new targets for drugdevelopment.

CLINICAL RESEARCH

Overburdened with demands for patient careservices notwithstanding, astute clinicians have

made significant dents in clinical research.Delineating the profile of known diseases affectinglocal population, defining their natural history,developing appropriate diagnostic and therapeutic

185P U R S U I T A N D P R O M O T I O N O F S C I E N C E

PROFESSOR V. RAMALINGASWAMI

Professor V.Ramalingaswami (1921-2001),FNA, FRS, Past-President of INSA, was one

of the most illustrious scientists of India, whogave a new direction to biomedical research. Heinitiated a paradigm shift by extending thesophistication of laboratory research to the bed-sides of the hospital and to the outreaches of thecommunity in remote areas. His major scientificwork consisted of studies on nutritional patholo-gy, specially protein-calorie malnutrition, iodinedeficiency disorders and nutritional anaemia.His studies on liver diseases in the tropics includ-ing Indian Childhood Cirrhosis, Non-CirrhoticPortal Hypertension. The pathogenesis of so-called Nutritional Cirrhosis bear the stamp of sci-entific excellence. As Director of the AIIMS, hegave a new direction to education and asDirector-General of the ICMR, provided newimpetus to strengthen relevant and yet excellentresearch. He guided the national programmesand policies on health care delivery and researchand generously extended his expertise to worldbodies such as WHO, UNICEF and IDRC.

regimes (often at variance with the established prac-tices), identifying new disease entities and syn-dromes have helped raise the standards of medicalcare and research. More recently, increasing collabo-ration between clinicians and biomedical scientistshas provided rich dividends. Once again the follow-ing account is highly selective and may not neces-sarily represent the most outstanding.

Rheumatic Fever (RF) and Rheumatic HeartDisease (RHD): It was generally believed that RFand therefore RHD did not occur in tropical India. Itwas left to the astute observations of K.L. Wig todisprove this notion. The large number of cases ofrheumatic valvular disease, which constitute asizeable percentage of anycardiac-surgeonÕs work beartestimony to the continuingcurse of these disorders. Asyndrome of juvenile mitralstenosis has come to berecognized.

Indian Childhood Cirrhosis:As the name suggests thisdisease, affecting youngchildren in India, attracted anumber of studies bypathologists, nutritionexperts and paediatricians.Even though its real etiology still remains a mystery,its morbidity and mortality have been markedlyreduced.

Non-Cirrhotic Portal Hypertension: A clinicalsyndrome, quite different from the well knownpost-cirrhotic variety, was delineated, its pathologyand clinical picture elaborated and appropriatetherapy standardized as a collaborative effort ofscientists from different centres in the country. Itmay be pointed out that studies by ProfessorV.Ramalingaswami and colleagues, established thatthe well-entranched term Ñ Nutritional Cirrhosis,

was a misnomer.Endomyocardial Fibrosis: A devastating heartdisease, usually terminating fatally has been thesubject of careful studies. There is evidence tosuggest that magnesium deficiency and higherlevels of cerium may be responsible for thisdisorder. This finds support in an experimentalanimal model developed for further studies. Thegeochemical basis of this disorder has attractedwide scientific attention.

Tuberculosis including neurotuberculosis: Thehigh prevalence of this disease with its proteanmanifestations, affecting practically every organof the body, defying most conventional strategies

to control it, has notsurprisingly been the subjectof many pioneering and nowinternationally recognizedstudies. The short-termchemotherapy and thesupervised domicilliarytreatment in place ofsanatorial management arejust two of these. All aspectsof neurotuberculosis Ñpathology and pathogenesis,variety of clinicalsyndromes, diagnosticcriteria and management

strategies Ñ have been critically documentedusing the latest microbiological, immunologicaland imaging techniques. Based on these studiesmedical treatment for intracranial tuberculomashas replaced the usual surgical managementearlier advocated. These contributions have beeninternationally recognized as is obvious from thefollowing statment, In more recent years, the majorcontributions on both pathology and varied clinicalmanifestations of tuberculosis of the brain and spinalcord have come from workers in India, ------- (R.Kocen in Infections of the Nervous System editedby P.G.E. Kennedy and R.D. Johnson,

186 P U R S U I T A N D P R O M O T I O N O F S C I E N C E

ALL ASPECTS OF NEURO-

TUBERCULOSIS Ñ

PATHOLOGY AND

PATHOGENESIS, VARIETY

OF CLINICAL SYNDROMES,

DIAGNOSTIC CRITERIA

AND MANAGEMENT

STRATEGIES Ñ HAVE BEEN

CRITICALLY DOCUMENTED.

Butterworth, London 1987).Leprosy: Beginning with the originalwork of Dharmendra and Khanolkar,a large number of past and presentleprologists have contributed to abetter understanding of this disease.These studies include clinicalclassification, immunology,pathology, reconstructive surgeryand more recently development of atleast two vaccines, which are by farthe best so far available.

Diarrhoeal Diseases: Ravaged by ahost of pathogens resulting in loss ofthousands of lives every year,especially children, biomedical scientists in India havecontinuously been engaged in research in thesedisorders. Just to name a few, the identification of

cholera exotoxin, detection of a new cholera toxin,mapping the vibrio cholera genome, nationalsurveillance of the epidemics, role of rehydrationtherapy and more recently development of a candidatevaccine which is already in limited phase II trial,deserve special mention. In addition to cholera otherenteropathogens causing diarrhoea such asenterotoxigenic E.coli, shigellosis, amoebiasis, giardiasisand rotavirus have been thoroughly investigated.Recently two rotavirus candidate vaccines have beendeveloped in collaboration with the US scientists underthe Indo-US Vaccine Action Programme (VAP).

Lest it is understood that biomedical researchin India has mainly concentrated on infectiousdisease, it may be mentioned that outstandinginvestigations have been carried on in other fieldsas well. Limitation of space does not permit adetailed account, but mention is made ofepidemiology and etiopathogenesis of cataract,tobacco and arecanut related oral cancer and cervicalcarcinoma, coronary heart disease, atherosclerosis(clinical and experimental studies), stroke in young,neurolathyrism (including identification of its toxicfactor BOAA from the grain legume Lathyrus sativus),veno-occlusive disease of liver (role of aflatoxins inits causation) and epidemic dropsy (caused byArgemone mexicana toxin).

187P U R S U I T A N D P R O M O T I O N O F S C I E N C E

Leprosy: before (top) and after (below) combined

chemotheraphy and immunotheraphy.

Psychology: In the earlier years, like most othersubjects, psychology education and research,followed the directions set in the West. However, itsoon became obvious, that the subject is deeplyrooted in the socio-cultural milieu of a communityhence the ÔtoolsÕ used for its study, cannot be directlyadopted from other cultures. These were, therefore,modified tested and standardized for local use.Mention may be made of the work of Bhatia, Kamathand more recently of the work at PGIMER,Chandigarh, and NIMHANS, Bangalore, amongothers. Similarly the national needs dictated thedirection of research in the fields of social psychology,industrial psychology, education psychology andanthropological studies on special population groupslike tribals, or professionals like armed forcepersonnel, or clinical psychology to evaluate patientswith mental and neurological disorders and morerecently persons at risk for sexually transmitteddisorders and HIV/AIDS infection. This is not to saythat work on more basic areas, includingexperimental psychology, cognitive science, ordevelopmental and cross-cultural psychology of avery high calibre was not carried out.

Psychiatry & Mental Health: Research onpsychiatry and mental health in India hasprogressed from hospital based descriptions ofclinical syndromes to epidemiological and outcomestudies. The clinical studies have contributed to theinternational recognition and acceptance of thesyndrome of acute, brief psychoses which are seento occur more in the Afro-Asian Region. Researchon outcome of severe illnesses like schizophreniahave indicated more favourable outcome inÕdevelopingÔ countries like India, attributed to thehigher level of family and social support availablein these societies.

The specific role of the social and culturalfactors in depression has been studied, along withthe study of suicide. Clinical and BiologicalResearch on Depression and other disorders likeobsessional disorders and groups of disorders like

Substance Use Disorders has also been carried out,in the past few decades. Community based researchon extending the mental health services to primarycase has been processed at a few centres and is beingapplied as a service programme.

Neuroscience: A number of important contributionsin the field of neurosciences Ñ both basic andclinical have recently been summarized in a paper,Neurosciences in India: An Overview (Annals of IndianAcademy of Neurology, 3, 3Ð21, 2001) and hence onlya brief summary is included here.

Some of the important contributions toneurophysiology and neuropharmacology arementioned elsewhere. Major additions to knowledgehave been made in the field of developmentalneurobiology which include neuromorphologicalstudies on developing embryo, both animal andhuman in respect to spinal cord, visual system andcerebellum. Alarge number of studies have dealt withmorphological, biochemical and behaviouralconsequences of under-nutrition and malnutrition.At the other end a number of investigators haveelucidated the biology of aging brain. Foetal neuraltransplant in rodents and monkeys provided valuableinsights in its utility and pitfalls for replacing damageor degenerating brain tissue. Neurochemists in thecountry including B.K.Bachhawat put India on theinternational map. A major research outcome of hisgroup has been tracing the biosynthetic pathway ofcerebroside-3-sulphate and other enzymes associatedwith sulphate metabolism. For the first time it wasestablished that deficiency of an enzyme(arylsulphatase A) was responsible for metachromaticleucodystrophy - an inborn error of metabolism. Thistradition of pursuing neurochemistry is being carriedforward. Similarly researchers at IISc and NIMHANS,Bangalore, and ITRC, Lucknow, alongwith a numberof clinicians have done pioneering work onneurotoxicology specially in respect to neurolathyrismand pesticide toxicity. The underlying pathogeneticmechanism, including the role of cytochrome P450 inxenobiotic metabolism and detoxification of drugs

188 P U R S U I T A N D P R O M O T I O N O F S C I E N C E

189P U R S U I T A N D P R O M O T I O N O F S C I E N C E

and toxins deserve special mention.The clinical neuroscientists along with

neuropathologists were primarily concerned withdelineating the pattern of neurological disorders asseen in India, establishing the differences in theirmanifestations and natural history, laying downdiagnostic criteria and guidelines for therapy. Notsurprisingly most of the internationally acclaimedinvestigations belong to the areas of infectivedisorders and epidemiology. In addition, significantstudies were made in the field of congenitalmalformations, epilepsy, stroke and subarachnoidhaemorrhage and neural trauma.

Biotechnological Approaches for Development ofImmunodiagnostics, Immunomodulators, Vac-cines, Immunotherapeutics and Gene Therapy:Several diagnostic kits have been developed duringthe last few years. This became necessary not onlybecause the imported kits were expensive but oftenthese were not based on the prevalent strains ofpathogens in the country. These include diagnostickits for malaria, filaria, leischmania, hepatitis,HIV/AIDS, a-foetoprotein. A PCR based diagnostickit for tuberculosis is in the final stages of validation.

In addition to the leprosy vaccine mentionedearlier, hepatitis B vaccine based on indigenousefforts is already in the market. A candidate vaccineagainst cholera is currently in Phase II trial. Two rota-virus vaccines have completed Phase I trial and havebeen approved for limits Phase II trials. Work oncandidate vaccines for Japanese encephalitis, malaria,tuberculosis and rabies is being pursued vigorously.

MISCELLANEOUS

There has been renewed interest in scientificallyestablishing the value of traditional medicines,

several of these are undergoing clinical trials. Thus avariety of uses of neem oil as a bactericidal, spermi-cidal and mosquito repellant have been establishedscientifically. Similarly the antioxidant, anti-inflam-matory and anticarcinogenic properties of turmericand curcumin have been evaluated. Some traditionalhealth promoting practices like yoga and meditation,are being critically evaluated utilizing the latest scientific tools and techniques. At the same time as aresult of researches in our laboratories, the countryhas developed indigenous capability to produce anumber of bulk drugs and expensive importeddrugs and make them available at affordable priceby innovative process development e.g. AZT, vincristine and others.

At least a few biomedical devices, based onresearches in the country, are already in the market.These include the well known Jaipur foot foramputees, shunts for treatment of hydrocephalusand an indigenously devised Tilting Disc CardiacValve and Spectra Oxygenator.

In conclusion, this very brief review shouldconvince any one of the immense strides that medicalscience has made in India during the past 50 years.Compared to the developments in the 50 yearspreceeding Independence, there has been a quantumjump. Nevertheless, a great deal needs to be done ifwe have to meet the growing health needs of ourpeople and share our knowledge with others, speciallydeveloping nations in this era of globalization.

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