Clinical research in Latin America: obstacles and opportunities

Abstract

Historically, most clinical research has been concentrated in developed nations. This trend is obvious from the geographical distribution of clinical research publications; most of the publications and the research itself come from North America and western Europe [1,2]. Nevertheless, the presence of clinical research in Latin America and other developing nations has been growing recently, mainly because of cost effectiveness, good patient recruitment and enrollment capability, the emergence of research regulatory agencies, improved ethical oversight of research, growth of the market size in developing countries and thus research capacity. In addition, the outsourcing and globalization of clinical research from contract research organizations is an important phenomenon that has promoted some research in areas that lack the tradition of clinical trials [3]. In fact, research centers in Asia, eastern Europe and Latin America are increasing in number and growing in capacity. Latin America is composed of 20 countries from Argentina in the south to Mexico in the north, with a combined population of more than 590 million people who mainly speak either Spanish or Portuguese. One characteristic that marks Latin America is the great income heterogeneity between and within countries, which also contributes to the heterogeneity of research capacity in this area. Brazil, Mexico, Chile and Argentina are the main players in this scenario, but total research production is still low. No more than 2% of global research is produced in Latin America, and Latin American countries invest no more than 1% of their GDP in health research [4,5]. One important challenge is how to measure research capacity. Several methods have been proposed, including measuring the number of full-time researchers, PhD students, laboratories, patents or publications. Each method has its limitations. In a study we have just conducted, we chose to measure the number of publications from Latin America that have appeared in high impact journals over the last 11 years [Coronel E, Halstead D, Fregni F. Unpublished Data], as this would be the ultimate goal for high-standard clinical research. We found that only approximately 0.4% of the all the articles we analyzed came from Latin America, with Brazil being the main contributor, and that 2.2% of all the articles involved collaborations between Latin America and other countries. Although changes in clinical research capacity may take decades to translate into changes in publications, these numbers are still very low. The purpose of this article is to identify the main obstacles that contribute to this poor situation of clinical research in Latin America, while at the same time pointing out the potential opportunities for growth in this field.