Knowledge can flow from developing to developed countries

Editor—I am pleased that this issue of the BMJ explores the many aspects of research in developing countries. The first thing that comes to mind on this issue is how developed countries can teach developing countries, but few people realise that the flow of knowledge can sometimes be reversed. Developed countries can learn and benefit from research in developing countries, particularly from research on infectious diseases and alternative treatments.

More international travel has led to a resurgence of infectious diseases and to a rapid spread to developed countries of diseases that used to be exclusive to the developing world. The emergence of HIV infection has warned us about the global threat of new infections, which are more likely to start in developing countries.¹ Research and surveillance on infectious diseases are most effectively done in areas where the diseases are common. Early communication and attention to this epidemiological information from developing countries can prevent potential global disasters.

The different needs and healthcare settings in developing countries often stimulate new treatment methods, some of which can be more cost effective than established practices in developed countries. Directly observed therapy, short term (DOTS) for tuberculosis was shown to be effective in Africa and Asia in the early 1950s and has been the standard method of treatment in Hong Kong since then. It was only in 1993 that the US Centers for Disease Control recommended it be considered for all patients with tuberculosis.² Earlier adoption of this research evidence might have prevented some of the deaths and multiple drug resistance associated with tuberculosis in many developed countries in recent years.

Traditional medical practices in developing countries can be a treasure box of alternative or complementary treatments for people in developed countries. Research on the effectiveness of acupuncture has made it a standard treatment in many developed countries. Qing hao su, a Chinese herbal medicine, has been proved to be an effective and safe treatment for malaria.³ Trials of many Chinese herbal medicines for the treatment of HIV infection and cancer are currently under way.

The lack of advanced technology and sophisticated equipment may limit the quality and scope of some research in developing countries, but a lot of knowledge can be acquired through careful observations and innovative ideas, which do not need a lot of money. Mutual exchange is a more satisfying process than one-way transfer of knowledge and resources. Developed countries will get more in return for their investments in research in developing countries if they are more receptive to findings from these countries.