Centres, Peripheries, Globalised Research and National Science

1
Centres, Peripheries, Globalised Research and
National Science

• Carlos F. Cáceres, MD, PhD
• and Walter Mendoza, MD
• Institute of Studies in Health, Sexuality and
  Human Development, School of Public Health and
  Administration,
• Cayetano Heredia University, Peru

2
Overview of this Presentation

• Consider the mission of scientific research,
  particularly in Public Health (PH)
• Analyse the current Peruvian research context,
  and discuss actors roles as related to national
  needs
• Reflect about conditionings for this context and
  for actors roles
• Discuss potential options to move forward.

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Mission and Actors The State

• According to PAHO/WHOs formulations, the 11
  Essential Functions of Public Health include
  Research, development and implementation of
  innovative solutions in PH (function 10), as
  defined by
• Constant innovation (from applied research
  seeking public health innovation, to formal
  scientific research)
• Development of the health authorities own
  research agenda, to identify innovative solutions
  with accountable impacts
• Establishment of alliances with academic
  institutions within and outside the health
  sector, to conduct studies aimed to support
  decision making at all levels.

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Mission and Actors The State

• PAHO/WHO identifies PH research as a matter of
  governmental concern, around which three distinct
  practices require State involvement
• Regulation, within the health sector, of research
  on human subjects, to protect their rights
• Implementation, by the health authority, of
  research oriented to improve public health
  policy
• Promotion of research in priority areas in PH.

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Mission and Actors Academia

• Aimed at producing scientific knowledge to pursue
  human wellbeing and development
• Conducting formal and applied research in
  distinct areas of sanitary knowledge (basic
  sciences, clinical, epidemiology, social
  sciences, administration, etc.)
• It is assumed that society values scientific
  knowledge, so that it funds and promotes its
  production
• Academia is regarded as supranational, as
  knowledge is assumed as universal
• Though certain commitment with practical national
  needs is assumed, in practice scientific
  endeavours are deemed worthier if they contribute
  to universal knowledge meeting excellence
  standards
• It is assumed that research (or at least parts of
  it), is performed to inform policy, as much as it
  is presumed that public policy is based on solid
  scientific evidence.

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The Peruvian Context The State

• Conclusions of the NIH/CIES study (2005) about
  MoH
• Significant organisational limitations to manage
  PH research. Research management not considered
  in its documents
• Lack of common procedures to manage studies
• The least developed component Policies for, and
  regulation and evaluation of, the management of
  research
• Few activities around research promotion and
  planning, needs assessments, dissemination of
  results, capacity building, and articulation with
  academic centres
• The most frequent formulation, approval and
  development of research, yet not framed in a
  comprehensive process, but responding to isolated
  initiatives
• Research is not seen as a tool for decision
  making. Incipient culture of evidence-based
  management.

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The Peruvian Context Academia

• Scarce formal research
• Limited number of academic centres working with
  excellence standards
• Islands of excellence based on individuals and
  connections with foreign networks/centres
• Research themes often defined according to the
  priorities of the foreign centre
• Problems in the formation of researchers and the
  massified use of research as a requisite to
  attain professional degrees
• Local scientific contributions not necessarily
  known in the country
• Limited number of publications, in part due to
  the limited opportunities to publish in Spanish
• The most important publications are in English
• Studies not always reflect local priorities or
  interests.

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The Peruvian Context Academia

• Applied research
• Scarce and generally defined by international
  cooperation
• Generally occurs as research consultancies, which
  establish subordinated conditions and restrict
  intellectual property
• Incipient culture of generation of information
  for decision making
• Rarely clear/steady channels for interaction
  between Academia and health authorities in order
  to define cooperation schemes
• Academia does not contribute to a debate on
  priority setting needs and strategies.

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Conditioning factors Centres/Peripheries?

• M. Worboys Centres and peripheries
• With regard to knowledge building, no absolute
  centres nor peripheries exist in the history of
  science but islands of excellence, alternation
  and localisms
• But the scientific institution is centred around
  institutional mechanisms of the technological
  centres
• Publications (English), networks, funding
  priorities, schemes to judge relevance and
  quality
• Professional progress (and success?) require
  adherence to paradigms whose visions of merit are
  not neutral (e.g. hard data)
• Frequently the success of researchers from
  peripheral countries requires assimilation to
  discourses that may reflect colonized thinking
• e.g., cases in which researchers from the
  periphery reproduce a central discourse about
  their own reality, to increase their options for
  receiving funding
• Also, limitations with dominant paradigms
• e.g. preeminence of positivistic/universalistic
  perspectives within evaluating mechanisms of the
  most important funders of biomedical research

10
Conditioning factors Globalisation of scientific
research?

• Increasing implementation, in peripheral
  countries, of large population-based studies led
  or co-led by researchers of the centres,
  justified by
• The value of generating evidence from diverse
  populations
• Populations in higher risk (more in need, but
  also allowing for smaller sample sizes)
• Possible lower cost local operators (franchise
  research) and less regulation?
• Capacity to influence process in host country
• Research agenda themes of particular interest
  might appear inflated as relevant
• Regulatory mechanisms particularly bioethics
• Concern about clinical trials in lower-income
  countries and/or with highly vulnerable
  populations
• Helsinki Declaration clinical trials sponsored
  by rich countries in poor countries should be
  accompanied by similar studies in the rich
  countries
• Concern with respect for autonomy (co-option) and
  justice (future access)

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Implications of Globalised Studies in the
ethical regulation of research

• Misbalances across countries due to
• Distinct development of regulatory institutions
• Differences in level of acquired experience
• Different visions of the individual, the
  collective and the balance amongst the two
• Regulatory standards in central countries might
  be loosened in studies taking place in a
  peripheral country
• Challenges
• Incipient debate about intercultural bioethics
  (e.g. elements of informed consent)
• Paradox the central country establishes the
  criteria to be accomplished by the peripheral
  country IRBs for certification as suitable
  evaluators of international studies
• Certification by a central entity precedes
  certification by the peripheral authority (if
  any) and frequently defines its criteria.

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Conditioning factors National science?

• In Peru we can certainly find
• An academic discourse academic institutions
• Researchers (with diverse levels of insertion in
  the international system)
• But it is more problematic to talk about a
  national science
• Partial debate about research priorities (neither
  academic nor governmental)
• No appropriate use of research findings
• Limited local funding for research
• No policies to retain or repatriate researchers.

13
Conditioning factors National Science?

• Research activities High symbolic power
• Hegemonic views of research formal activity
  basic science paradigm, a luxury of rich
  countries (i.e. the centres)
• Consequently, limited funding sources to conduct
  research at local level it is assumed that
  good research implies international funding
• Conditions to conduct research are, for those
  reasons, difficult (even precarious)
• The presence of globalised research generates
  huge inequities among researchers in access to
  resources
• Dominant representations of Academia are still
  centred around aspects of professional training,
  while leaving research aside

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Options forward MoH/State

• According to the NIHCIES study, it was seen as
  necessary to
• Revise the organization of the MoH
• Establish policy guidelines about health
  research
• Consolidate the processes around research
  management (i.e. organization and policies)
• Develop capacities to manage and conduct
  research
• Publish/disseminate findings.
• Intervene the organizational culture to strongly
  promote evidence-based health programming.
• Foster a clear discussion of priorities that
  keeps in mind the various potential goals and
  relevance levels of research, as well as
  identifies key needs for the development of a
  national science and proposes balanced criteria
  for international collaboration
• The State as a whole foster scientific research
  through establishing promotion policies,
  attracting/repatriating/keeping well-trained
  researchers, and broadening funding opportunities.

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Options forward Academia

• Promote institutional frameworks and policies
  favourable to research development and
  implementation
• Discourage the persistence of the requirement
  original-research theses to attain degrees in
  professional (rather than academic) careers,
  particularly in undergraduate programmes
• Promote the consolidation of a local community of
  researchers
• Promote spaces for fruitful interaction,
  involving researchers and policy makers, about
  the relationship between research and public
  policy
• Promote alternative research funding sources at
  various levels, including the liberation of
  teaching time to do research
• Promote research out of the centre
  sub-regional networking
• Monitor the State record regarding PH research
  and contribute to the debate about an agenda on
  national research priorities and national
  science
• Promote the publication and dissemination of
  research, and highlight the message that research
  has a real social value.