Initiative for capacity building in academic psychiatry in India: The E-Journal Club of the Indian Psychiatric Society.

The previous issue of the Indian Journal of Psychiatry carried an editorial[1] which observed that India does not have adequate psychiatric manpower, that there are few psychiatric centers in the country that are strongly oriented toward academics and research, and that, in consequence, many psychiatric centers with an interest in research may not have the necessary skills to demonstrate or create excellence in research. The editorial[1] further observed that sustained exposure to good quality research in high ranking journals, combined with the development of the ability to critically evaluate a study and its place in the field, are together necessary to drive the desired improvements. The editorial[1] referred to an initiative that was in the pipeline at the time of writing. This initiative sought to develop an e-platform for discussing and imparting training in research-related issues in the field of mental health and the allied neurosciences, linking postgraduate and academic psychiatry departments across the country.

We are delighted to announce that, during the second week of March, 2015, the E-Journal Club (eJCIndia) initiative was successfully launched by the Task Force of the Indian Psychiatric Society on Psychopharmacology, along with the Task Force of the Indian Psychiatric Society on Workshops and Training, and with the support of the Department of Psychopharmacology at the National Institute of Mental Health and Neurosciences, Bengaluru. As of the first week of April, 2015, the e-group already has nearly 200 members, comprising postgraduate students, postgraduate teachers, and psychiatrists who are interested in academia even though their practice is not part of an academic environment.

The eJCIndia group has completed several activities. The first activity presented an extract from the results of a meta-analysis[2] and invited the membership to comment on whether they would alter their clinical practice based on a highlighted statistically significant finding. After discussion, an answer was provided that explained concepts in meta-analysis, aspects related to schizophrenia rating using the Positive and Negative Syndrome Scale (PANSS), and the clinical significance (as distinct from statistical significance) of a difference in PANSS ratings.

Another activity sought to stimulate critical thought by examining paradoxes in the pillars of homeopathy, a school of treatment that enjoys popularity in India and elsewhere. Homeopathy considers that the administration of a diluted dose of a substance that produces a symptom will treat that symptom when that symptom occurs as part of an illness; the greater the dilution, the greater the efficacy of the treatment. It was discussed that the water that we drink has, in the past, come in contact with thousands of chemicals. This water, to use a concept in homeopathy, will therefore contain “memories” of those chemicals. Hence, water should be therapeutic for every disease! Alternately, how do we know that the memories in the water that we drink won’t cancel out the memories of the homeopathic medicines?

Then, what about the solvent that was used for the dilution of the homeopathic treatment; that would also have previously come in contact with plenty of substances with therapeutic or adverse effect potential, resulting with the potential to interact with the homeopathic substance(s).

Finally, what about the air that we breathe; does that have homeopathic potential or does the magic only work for what goes into the belly? With regard to the validity of case reports that are adduced to testify to the efficacy of homeopathy, the obvious refutation is that case reports are only evidence that something (e.g., efficacy of a treatment) can happen, and not that something (e.g., generalization to the population) will regularly happen. Besides, case reports cannot eliminate the possibility of placebo mechanisms.[3]

Subsequently, there was a detailed and painstakingly critical appraisal of a randomized controlled trial published in this very journal.[4] There were several offshoots from the discussions, mostly about issues related to rating scales, and statistical techniques ranging from the Mann–Whitney test to multivariate analysis of variance.

The success of this initiative will depend on the enthusiasm of the group moderators, and of senior academicians who are invited to conduct scheduled group activities. More importantly, the success of this initiative will depend on the participation of the membership. Besides random enquiries and conversations, which are encouraged in the group, it is planned that, at least once a month, a journal article will be posted and a group of students, such as from a single department in an institution, will summarize and critically analyze the article. This will be followed by questions and discussion among the membership of the group, moderated by the initiator of the activity. Thus, this e-activity will mimic what happens in a live journal club meeting.

Word about this activity needs to reach postgraduate students and academic psychiatrists across the country; unfortunately, there is no assured way of ensuring that this occurs in a systematic manner. The group has already been publicized in the e-group of the Indian Psychiatric Society, and it is hoped that the additional publicity provided through this editorial will further improve awareness. Last but not least, it is hoped that participation from the membership will continue to be good. Unless the target audience, for whom this group was created, stays involved, no amount of enthusiasm from the prime movers will be of benefit.

Readers desirous of participating in this initiative should send a blank e-mail to eJCIndia-subscribe@yahoogroups.com; they will then need to follow the instructions that they receive in a return mail in order to be added to the mailing list of the group.