The problem of evidence-based medicine in developing countries
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* Ahmad A. Sabri
* Muhammad Ahad Qayyum

In a recent article, Caleb Alexander and associates1 elucidate the issue of prioritizing and stopping prescription medicines, pointing to a lack of data on the safety and optimal means of discontinuing drugs.1 This may be the core problem in developed countries, but the situation is altogether different in developing countries, where a poor research culture is the biggest obstacle to the promotion of evidence-based medicine and in turn to the prioritization and discontinuation of prescription medicines. 

The utilization and production of research, along with human and institutional development, are 2 important components of health research.2 Without these, it is very difficult to practise evidence-based medicine. 

The utilization of research, which is the backbone of evidence-based medicine, is in a terrible state in developing countries. A recent study conducted in a hospital in Pakistan found that only 20% of residents read medical journals monthly, only 12% had ever written for medical journal publication, and 12% had never read a medical journal.3

The state of the production of research is also not encouraging. In all disciplines of science and technology, India and Pakistan combined have 208 researchers per million citizens; the comparable figure for the United States is 4526 researchers per million.4

By highlighting this issue of poor research culture, we hope to contribute to increased awareness among those who read journals and who can bring about positive change.

## REFERENCES

1.  1. Alexander GC, Sayla MA, Holmes HM, et al. Prioritizing and stopping prescription medicines. CMAJ 2006;174:1083-4.
    
    [FREE Full Text](http://www.cmaj.ca/lookup/ijlink/YTozOntzOjQ6InBhdGgiO3M6MTQ6Ii9sb29rdXAvaWpsaW5rIjtzOjU6InF1ZXJ5IjthOjQ6e3M6ODoibGlua1R5cGUiO3M6NDoiRlVMTCI7czoxMToiam91cm5hbENvZGUiO3M6NDoiY21haiI7czo1OiJyZXNpZCI7czoxMDoiMTc0LzgvMTA4MyI7czo0OiJhdG9tIjtzOjIxOiIvY21hai8xNzUvMS82Mi4yLmF0b20iO31zOjg6ImZyYWdtZW50IjtzOjA6IiI7fQ==) 

2.  2. Sadana R, D'Souza C, Hyder AA, et al. Importance of health research in South Asia. BMJ 2004;328:826-30.
    
    [FREE Full Text](http://www.cmaj.ca/lookup/ijlink/YTozOntzOjQ6InBhdGgiO3M6MTQ6Ii9sb29rdXAvaWpsaW5rIjtzOjU6InF1ZXJ5IjthOjQ6e3M6ODoibGlua1R5cGUiO3M6NDoiRlVMTCI7czoxMToiam91cm5hbENvZGUiO3M6MzoiYm1qIjtzOjU6InJlc2lkIjtzOjEyOiIzMjgvNzQ0My84MjYiO3M6NDoiYXRvbSI7czoyMToiL2NtYWovMTc1LzEvNjIuMi5hdG9tIjt9czo4OiJmcmFnbWVudCI7czowOiIiO30=) 

3.  3. Aslam F, Qayyum MA, Mahmud H, et al. Attitudes and practices of post graduate medical trainees towards research – a snapshot from Faisalabad. J Pak Med Assoc 2004;54:534-6.
    
    [PubMed](http://www.cmaj.ca/lookup/external-ref?access_num=15552293&link_type=MED&atom=%2Fcmaj%2F175%2F1%2F62.2.atom) 

4.  4. Aslam F, Shakir M, Qayyum MA. Why medical students are crucial to the future of research in South Asia. *PLoS Med* 2005;2(11):e322.