1.  Introduction

The National Institute of Biomedical Genomics (NIBMG), as enshrined in the Cabinet Note for its establishment which was approved by the Union Cabinet, is committed to generating basic genomic evidence underlying human health and disease and exploiting the evidence for reduction of public-health burden in India, not only within the precincts of NIBMG but also by promoting and implementing the principles and practices of biomedical genomics in hospitals, medical schools and other relevant institutions.

            For NIBMG to ensure that biomedical genomics research carried out in the country relevant to the health needs of the nation, and to sustain and increase the footprint biomedical genomics in India and globally, it is imperative that (i) scientists of NIBMG choose and work on problems that are of relevant of national health needs, and (ii) clinicians engage in basic and translational research in a bigger way than at present.  In other words, concomitant with the establishment of a national institute on biomedical genomics, to ensure a national and international impact of biomedical genomics, clinicians and basic science researchers must engage closely with each other, and clinicians must engage in research within their own community in a bigger way.  NIBMG has a national responsibility of promoting and nurturing both these essential requirements.  Otherwise NIBMG will remain yet another institution in India without any major impact on national health needs, and biomedical genomics will not get a jump-start; thereby defeating the purposes for which NIBMG was established.

2.  Why Expand to Hospitals and Medical Schools, and not Confine to NIBMG?

            The principal reasons are:

(a) For clinicians to not merely remain as suppliers of biospecimens derived from patients to researchers of NIBMG and other institutions, and to not work on problems identified by other researchers, they must be given independence and platforms to exercise their independence.  “Independence” in terms of (a) defining the health problems that require solutions using genomic approaches, (b) carrying out work to identify a disease/health phenotype more deeply that in presently done, and (c) generating the basic genomic evidence pertaining to the phenotype.  The proposed Biomedical Genomics Centres (BMGCs) will provide this “independence” to clinicians on their home turf, so that they can exercise their intellect and skills without the burden of being overseen on a daily basis, which will improve the relevance and quality of research on biomedical genomics in India.

(b) Hospitals and Medical Schools are where all the actions that are relevant to biomedical genomics take place.  These are the places where patients come, where detailed tests (biochemical, imaging, etc.) are carried out to determine the cause of a patient’s disease, and records of these tests and diagnoses are maintained.  Thus, these “places of action” are the best places to provide frameworks for clinicians and basic scientists to engage in identifying health/disease “phenotypes” that require solutions.  The proposed BMGCs will provide such institutional frameworks.

(c)  One of the major impediments to impact-oriented success of biomedical genomics has been that – most often – a basic scientist working on a disease has never seen a patient with the disease.  Most basic scientists have never visited wards of hospitals to identify problem-areas that require solutions.  The trend persists.  Most Research Fellows currently enrolled in PhD programmes and engaged in biomedical genomics research have never held any serious discussions with clinicians “in situ”, that is, where patients are diagnosed and enrolled.  BMGCs, created on the campuses of hospitals and medical schools, will be appropriate remedial platforms, with the intended fallout of improvement in relevance, quality and impact of biomedical genomics training and research.

(d) The BMGCs, as institutional platforms, will be so empowered that after having identified relevant health/disease “phenotypes”, the clinicians can carry out the initial phases of genomics research to generate the basic evidence of genomic underpinnings on the phenotype.  The relationship between a BMGC and NIBMG will be so defined, through an appropriate MoU, that NIBMG’s technology platform resources will be available to a BMGC to enhance and value-add to the basic genomic evidence generated by a BMGC.  This will help ensure globally competitive research in biomedical genomics.

            In sum, a BMGC will be a platform for clinical scientists to carry out research in genomics  with “precisely defined”  disease phenotypes , including events resulting from administration of relevant drugs, drawn from the patient population of the Medical School  and to return back to the patients with genomic  solutions for improved diagnosis , management  and prophylaxis.  In addition, through the organization of workshops and CME courses on biomedical genomics, with the eventual goal of initiating a DM/DNB programme on Medical/Clinical Genetics, a BMGC will foster capacity-building that is sorely lacking in our medical profession.