Among the insights revealed by the topic modelling of MDR-TB were the apparent lack of research interest in the topics labelled as Operational research/public health and Diagnostics. Below are my own perspectives of why these topics may have been neglected thus far.

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Lack of industry involvement

One often cited reason for the low funding is the lack of industry involvement, which is not just a problem for TB diagnostics or operational research, but for the field of TB research as a whole (see WHO Policy paper). TB is not a disease that provides a good return on investment, and TB diagnostics or operational research even less so. The remaining allocation of funding comes from public funding resources which are limited and therefore is prioritized towards fields that are traditionally tried and tested for their ability to solve health problems such as drug therapy and vaccines.

Unpublished research for IP reasons

Particularly for the field of diagnostics, much research is currently being conducted in private biotech companies (as can be seen in FIND’s TB diagnostics pipeline). These companies may have an interest in withholding publication due to IP issues. Furthermore, research and testing of the diagnostics in the field by third parties may be limited until the device has been officially released and already available on the market, further contributing to the lack of publications in this area.

Lack of interdisciplinary mindset among scientists

The fields of operational research and diagnostics have one thing in common: they both require cross-disciplinary involvement.

For operational research and public health, input from the social sciences are necessary in order to make sense of the complexity of the human and societal challenges that make up a large part of the MDR-TB issue. Most scientists and clinicians are not trained in qualitative methods and may furthermore not understand the value of such enquiries.

In the case of diagnostics, the involvement of technology requires a different set of toolkits from that used by basic scientific researchers. These toolkits employ a different set of skills that are usually found in design and engineering, and not in molecular or clinical research. Such skills require an innovative mindset that includes rapid prototyping and failing in order to learn, all skills that are not part and parcel of the traditional scientific training. The unfamiliarity of scientists with these working tools naturally funnels most researchers away from this field into more traditional fields like treatment or vaccine development.

Lack of incentive to tackle complex problems with no reward

The success of medical breakthroughs such as the development of the polio vaccine or discovery of penicillin has resulted in the paradigm that singular achievements are responsible for solving major health challenges.

This has resulted in a culture of incentivizing singular breakthroughs by awarding prizes to individuals such as the Nobel or Lasker awards, amongst many others.

Subjects such as operational research therefore do not inspire the imagination of most researchers due to the lack of prestige and potential for major breakthroughs.

Thus the problem of low research output in the field of operational research is as much a problem of funding scarcity as it is an issue of scientific culture amongst researchers and institutions.