Catalysing India’s National Engine for Medical Research - Dr Lokeswara Rao Sajja

India’s clinical burden is unique in scale and diversity, young patients with early coronary artery disease, rheumatic and congenital heart diseases that persist, and rapid transitions in cancer and metabolic diseases. This diversity is not a handicap; it is our opportunity. If we align policy, infrastructure, and incentives, India can move from sporadic breakthroughs to a predictable pipeline of practice-changing research.

Build a dependable research backbone: data, ethics, and trials

a) National pragmatic trial network. Create a funded, standing network of public–private hospitals capable of running multi-centre randomized controlled trials (RCTs) with shared SOPs, master contracts, and pre-approved templates. This lowers start-up friction and allows faster, adequately powered Indian trials that answer Indian questions.

b) Interoperable registries. Mandate minimal common data elements and Fast Healthcare Interoperability Resources (FHIR) based interoperability for disease registries (cardiac, oncology, maternal-child health, rare diseases). Good registries are the runway from which RCTs take off.

c) Ethics committees that enable quality. Strengthen IEC capacity with standardized training, service-level timelines (e.g., 21–30 days), and centralized scientific review for multi-centre studies to avoid redundant back-and-forth. Ethics must protect participants while enabling timely, methodologically sound research.

Make research a first-class citizen in medical education

a) Protected time and incentives. For faculty in medical colleges, ring-fence protected time (e.g., 8 hours/week) for research and embed outputs (trials, datasets, protocols, and implementation studies not only impact factors) into promotion criteria. Reward team science and reproducible datasets.

b) Clinician-investigator pathways. Create MD–PhD/DM–PhD/MS-PhD/Mch-PhD and modular research diplomas with real mentorship, biostatistics support, and grant-writing training. Every medical college should have a small Biostatistics and Methods Core that clinicians can access without bureaucracy.

c) Research literacy for undergraduates. Early exposure to study design, ethics, and data handling will normalize research as routine clinical work, not an extracurricular.

Fund what matters and pay for quality, not only novelty

a) Milestone-based public funding. Shift a portion of funding to milestone-based tranches: protocol approval → first site initiated → 50% enrollment → database lock. This improves accountability and completion rates.

b) Priority disease portfolios. Ring-fence calls for high-burden Indian conditions (rheumatic heart disease, coronary artery disease, renal disease, TB, maternal health, environmental cardiopulmonary disease) and for implementation trials that adapt global evidence to Indian realities.

c) Open science, open data. Require pre-registration (CTR-I/ClinicalTrials.gov), publish protocols, and release de-identified datasets with a 12–18-month window. Transparency accelerates secondary discovery and trust.

Make translation real: from bench to bedside to population

a) Simple, affordable innovation. Focus on frugal devices, dosing strategies, and care pathways that can scale in district hospitals. A trial that changes a protocol for thousands of centres is as valuable as a new molecule.

b) Technology transfer and co-development. Encourage consortia where academia designs, industry engineers for manufacturability, and hospitals validate. Clear IP and revenue-sharing frameworks prevent stalemates and speed diffusion.

c) Implementation science. Fund “phase IV” style studies how to make a proven intervention work in PHCs and tier-2/3 hospitals. Without implementation, efficacy is just potential.

Safety, ethics, and public trust are non-negotiable

a) Participant-first trial design. Simple consent, multilingual materials, and mechanisms for participant feedback. Compensation, insurance, and grievance redressal must be transparent and swift.

b) Data security and governance. Standardize de-identification, access controls, and audit trails. A national data-use framework will reassure patients and enable collaboration.

c) Independent monitoring. Data Safety Monitoring Boards (DSMB) and adverse event reporting need consistent, resourced structures across networks. Safety signals must be visible and acted upon quickly.

What medical colleges and hospitals can do tomorrow

• Establish a Research Operations Desk (one door for contracts, IEC liaisons, budgeting, data capture).

• Subscribe to a shared electronic data capture (EDC) platform and train study coordinators.

• Partner with a statisticians’ pool (regional hub-and-spoke).

• Start one pragmatic registry-to-trial project in a high-volume clinical area (e.g., STEMI, valve disease, sepsis) with clear endpoints and affordable follow-up.

• Celebrate negative and replication studies, they prevent waste and refine practice.

The role of national bodies

The National Medical Commission can anchor research literacy and faculty promotion standards; Indian Council of Medical Research (ICMR) and Department of Biotechnology (DBT) can underwrite the trial network and priority portfolios; state health departments can integrate registries with public hospitals. Together, these levers convert isolated efforts into a national program with compounding returns.

Conclusion

India’s advantage is volume, diversity, and clinical ingenuity. By building dependable trial infrastructure, aligning incentives in medical education, funding with milestones, and insisting on open, ethical science, we can routinely produce evidence that changes practice, not once a decade but every year. The reward is profound: better outcomes for Indian patients and knowledge that informs the world.

Disclaimer: The views expressed in this article are of the author and not of Medical Dialogues. The Editorial/Content team of Medical Dialogues has not contributed to the writing/editing/packaging of this article.