New Delhi, April 19: More than half of India's 579 medical colleges and teaching hospitals did not publish a single peer-reviewed research paper over the past decade, according to a bibliographic analysis that some doctors say highlights a worrying lack of interest in research.

The analysis by a team of Delhi-based doctors has found that only 25 medical institutions accounted for over 40 per cent of the medical research output between 2005 and 2014. And 332 (57 per cent) institutions did not generate a single research publication during this period.

The states with the largest numbers of private medical colleges are the worst performers. Seventeen (74 per cent) of Kerala's 23 medical colleges, 24 (73 per cent) of Tamil Nadu's 33 colleges, 25 (58 per cent) of Maharashtra's 43 colleges and 17 (41 per cent) of Karnataka's 41 colleges had no research publications.

"These findings support long-standing suspicions that for many private colleges in the country, medical education is just a business," Samiran Nundy, a senior gastrointestinal surgeon at the Sir Ganga Ram Hospital, New Delhi, who led the analysis, told The Telegraph.

Several states with fewer medical colleges and a higher proportion of government colleges also fared poorly in research. Seven of Bihar's 10 colleges, three of Bengal's 10 colleges, and four of Rajasthan's 10 colleges also had no research output through the decade.

Nundy and his colleagues Samrat Ray and Ishan Shah used a global research database called Scopus to measure the research output from 316 colleges registered with the Medical Council of India (MCI) and 263 teaching hospitals that provide training leading to postgraduate qualifications approved by the National Board of Examinations (NBE).

Their bibliographic analysis was published today in the journal Current Medicine Research and Practice.

"While the overwhelming burden of patients is often proffered as an excuse for the lack of research papers, the real reason is more likely the lack of guidance and role models," said Nundy. "We find some of the institutions that draw the largest numbers of patients also were among the top in research publications."

They found that 25 institutions had generated over 100 research publications each year, and accounted for 40 per cent of the research. The top five MCI-registered institutions with the highest number of publications are the All India Institute of Medical Sciences, New Delhi, the Postgraduate Institute of Medical Education and Research, Chandigarh, the Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, the Kasturba Medical College, Manipal, and the Tata Memorial Centre, Mumbai. The college in Manipal is a private sector institution.

The top five in research output among the NBE-registered institutions are the L.V. Prasad Eye Institute, Hyderabad, the Sir Ganga Ram Hospital, the P.D. Hinduja Hospital, Mumbai, Indraprastha Apollo Hospital, New Delhi, and the Aravind Eye Institute, Chennai.

Doctors who were not associated with the analysis say the absence of publications from over half of India's teaching medical institutions is not surprising but should be a cause for worry. Every postgraduate medical student in a college or in a teaching hospital is expected to generate a thesis as part of the coursework.

"This analysis raises questions about the value of the obligatory thesis," said Harshpal Singh Sachdev, a former professor of paediatrics at the Maulana Azad Medical College, New Delhi, and now a senior consultant at the private Sitaram Bhartia Institute of Research.

"Either the standard of the thesis does not lend itself to a research paper, or the student and the supervisor are probably producing the thesis because of the necessity, without any interest in publishing it as research," said Singh who was not associated with the analysis.

The paucity of research has implications for patient care, some doctors caution. "Teaching, research, and patient care go together," said Krishan Lal Gupta, professor of nephrology at the Postgraduate Institute of Medical Education and Research, Chandigarh. "When you do research, you're forced to read what others have done earlier, learn about the latest developments - such activities influence patient care," he said.

Nundy said the scenario in India sharply contrasts with that in the UK and the US where not a single teaching medical institution would have no publications over a period of a decade. The analysis has also shown a significant difference in the number of publications by top institutions in India and the US.

The annual research output of the Massachusetts General Hospital, for instance, is 4,600, which is about four times the output from AIIMS, which produced about 11,300 research papers between 2005 and 2014.