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The pros and cons of practicing scientific research in Romania:
The perspective of a Romanian Medical Doctor with specialty training in United States

Paula Zimbrean
New York, USA


Thank you, Ad Astra, for asking this question as a first step in trying to improve scientific research in Romania. Since I assume this is your goal, I take the freedom to object to the way the title of this essay challenge was formulated: "why I would go back (or not) to do research in Romania". This implies that one has already adopted one of the two incompatible positions: You either want, or not to return to Romania to do research. The formulation suggests a definitive answer, and I want to emphasize that, no matter what position one adopts at a certain moment, this position can change as conditions change. That's why I modified a little the title and I will proceed in analyzing the factors that might influence my decision in this regard, without adopting one.

There are two types of reasons for which one person who spends some time working abroad would consider in deciding to return to Romania for research. There are personal reasons: Family, friends, emotional adjustments in the new country. These factors are individual and relate to the psychological adjustment to changes in culture, which is too broad a subject for this essay.

I would rather discuss the second category of reasons that relate specifically to research itself, which can be generalized to some extent. What follows applies to medical/clinical research in general (i.e., research that involves patient care), with some specifications for research in Psychiatry, which is the field I am practicing in.

The Cons

The first thing that comes in mind when considering doing clinical research in Romania is the quality of the people in charge of the medical system: Chiefs of hospitals, research coordinators, department heads, governmental workers at any level. I am not discussing individuals; you may find enthusiastic and intelligent people anywhere. However as a whole, the above group discourages any research project before it even begins. Judging from their decisions and vocabulary, they come across as not up-to-date on medical knowledge, as inflexible, not interested in or rejecting suggestions from experts, looking for immediate personal gain and lacking any long term perspective over their work. Research initiatives are rejected or modified to the point that their scientific character is lost.

The second, still crucial, aspect is the financial resources required for good clinical research. Medicine has moved a long time ago from exclusively descriptive studies (that identify and describe health problems in a specific population). The prospective studies (that look at cause-effect relationship) require at least two sets of carefully selected patients (one for placebo), usually hundreds of them, repeated clinical appointments, multiple and expensive tests. Often these studies are blind, i.e., the evaluators do not know if the patient is under medication or placebo, causing additional complications. All these cost money. Good research that results in useful information, not only in papers for the authors, requires grants of billions of dollars; part of this funding ensures a decent lifestyle for researchers. There are no resources in Romania for this. However, I think this could be overcome but participating in multicenter international studies.

The next important impediment to research in Romania is lack of access to information, such as medical journals, textbooks, and clinical guidelines. This could be partially reversed by unlimited, high-speed Internet access and online subscriptions (which increases the costs of infrastructure).

The Romanian medical system continues to have well-qualified and intelligent staff, and I am listing this aspect both as an advantage and a disadvantage. Is hard to work with a group of people in which everybody wants to be the boss, to give orders and criticize all the time without offering solutions. Sometimes one just has to do his job well, be a team player and give up the wish for glory.

Although the qualification of the workforce is excellent, lack of discipline can make all efforts futile. I totally agree with long Christmas vacations and maternity leave, but work, however, needs to be done.

Phones, faxes and e-mail are essential for coordinating research sites and for reaching out patients for follow-ups, rescheduling or emergencies. Often research staff needs to contact the patient's family physician for coordination of care. The lack of a reliable and accessible communication system in Romania would complicate a research project and increase the costs.

Last but not least, research in Psychiatry requires some additional factors that would interfere with any research project. Most important is the stigma associated with mental illness; in Romania it is still unconceivable that a person with a psychiatric disorder can continue to work, have a family and a social life. This results in a lot of information being withheld by patients and family out of shame, which can significantly influence the research results. On the other hand many of the services for people with mental illness that in the Western World are a part of routine clinical care, such as group therapy, social work or rehabilitation programs, are very scarce in Romania.

The Pros

The best advantage at this time is the Romanian legislation regarding medical practice, which is very permissive and allows one to focus more on the actual practice of medicine and less on avoiding lawsuits. We still see in Romania the assumption that the doctor is trying to help, while in the United States that assumption is almost lost, which results in a lot of litigations and increased the health care costs tremendously.

The enrollment of patients would be easier since the requirements for informed consent are less strict. It might sound paradoxical, but the bureaucracy in the research field is far more extended in the United States.

In terms of expenses, such as supplies, maintenance, workforce, Romania remains relatively cheap compared to the United States and Western Europe.
And as I said before the fact that qualified and intelligent staff is available can be a blessing if the team is reliable and motivated.

These being said, I am not rejecting any possibility of medical research in Romania. I will be happy to discuss some other ways in which the medical research in Romania can be changed, if anyone is interested. I repeat that: if anyone is interested. Because help might come from outside, but change starts from within.


Ad Astra • Volume 2, Issue 1, 2003 • Viewpoint
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