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.

3. Mission and Actors – The State • According to PAHO/WHO’s 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.

4. 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.

5. 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.

6. 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.

7. 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.

8. 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.

9. 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)

11. 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.

12. 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

14. 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.

15. 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.