CORR® International - Asia-Pacific: The Opportunities and Obstacles Associated with Clinical Research in Asia

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One of the benefits of working in the Asia-Pacific region is knowing that both the government and funding agencies, in an effort to create a global identity [2], are committed to promoting clinical, laboratory, and biomedical research. Historically, the West has led the way in growing and developing modern medicine, but the economic slowdown in the United States resulted in, among other things, reduced research budgets for many large scientific institutions [7]. In the Asia-Pacific region, however, the budget allocation for biomedical research is steadily increasing [3]. In fact, China could become the world's leader in science and technology spending by 2019 [10]. Indeed, China, South Korea, Japan, and Singapore are fast becoming research powerhouses.
This is likely the best time to be a researcher in the Asia-Pacific region. In a sign of scientific progress, we are seeing more international collaboration among biomedical scientists across the globe. Professional groups such as American Academy of Orthopaedic Surgeons promote multicenter studies involving eminent surgeons from renowned institutions in various countries. Such multicenter studies break ethnic and racial barriers and minimize geographical biases, and produce high-level evidence that point to holistic solutions.
Orthopaedic surgeons from Asia-Pacific regions must utilize such collaborative efforts in conducting clinical trials. Furthermore, there is no shortage of healthcare-related problems that are unique and relevant to Asians that require more clinical trials. For example, anthropometric studies can guide implant designs for arthroplasty and trauma surgery in ways that may improve results for Asian patients [6, 8]. Although the quality and quantity of TKA research has increased considerably in the last decade, most notably from Japan, Korea, and China, there remains a great need for basic and epidemiological research on the differences of Asian population from their Western counterparts [5]. For example, even the smallest femoral intramedullary nail is sometimes too big for insertion in Asian women. Additionally, there is an increased focus on unplanned readmissions after joint replacement in North America, and this research can guide best practices and improve health economics, but little information is available on this topic in Asian countries [9].
Although research funding and manpower are not major obstacles, surgeons in Asia face unique challenges that may hinder their research activities. First, many Asian surgeons bear huge patient loads with lengthy clinic hours. Rather than fretting over the burden or the repetitiveness, I see this as an opportunity. A large number of patients is the best means we have to answer the important unanswered research questions that remain. With that spirit, time spent in clinics can be delightful. But everyone has his or her limits. At a certain point, the clinical burden simply takes up so much time that high-quality clinical research simply cannot be added to the workload. How many quality clinician-scientists are we losing to the outpatient clinics? Limiting the number of patients in outpatient clinic by streamlining appointments as well as hiring more junior doctors and researchers to strengthen the team might mitigate this important problem.
Second, a lack of mutual trust among patients and doctors leading to violence against doctors (especially in China and India) is an issue more common in Asian medicine than in the West. Many factors contribute to dissatisfaction among patients: Unrealistic expectations of patients from healthcare providers, growing discontent among patients because of soaring healthcare costs, and a lack of empathy and compassion among some physicians. It is time to get to the root of these problems. Proper counselling of patients and their family members should be a priority.
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