All matters connected with international cooperation are handled by Office of International Relations, Promotion&Develepment Projects, which is supervised

by the Rectors Office for Strategy and International Cooperation.

The Lifelong Learning Programme ERAS !S "!PA#E International cooperation

he !niversity sees the development of international cooperation as e"tremely important, and is very successful in that field. he #edical !niversity of $da%s& cooperates with many centers in 'urope and the world as part of intercollegiate and intergovernmental agreements, initiatives and programmes of the '!, thematic networ&s, and membership in international organi(ations, )oint *Sc and +h, studies, the e"change of academic teachers, )oint publications and numerous science conferences and symposiums. Since -../ the !niversity has actively participated in the SOCRA 'S0'rasmus +rogramme. 'ach year a growing number of students of medicine, pharmacy and biotechnology are sent to 12 partner universities in the '!. he !niversity accepts an increasing number of foreign students, who complete part of their studies in 'nglish at our college. he #edical !niversity of $da%s& participates in the 3eonardo da 4inci, C''+!S, 5!+AC' programmes as well, than&s to which our students and young scientists travel abroad to complete part of their studies, wor& practice or research wor&. Appreciating the importance of the regional side of 'uropean cooperation, he #edical !niversity of $da%s& is a co6founding member of the *altic Sea Region !niversity 5etwor&, coordinated by the !niversity of ur&, 7inland. he A#$ ta&es part in the wor& of regional organi(ation Scan*alt, whose aim is to support the initiatives for the development of technology transfer, in the fields of medicine and biotechnology, in the *altic Sea region.

International cooperation to promote a$vances in me$icine

$ha(wan *utrous Author information 8 Article notes 8 Copyright and 3icense information 8 #edical and scientific researches in the last few years have become increasingly global, cross6 national, cross6cultural, and collaborative. oday, one fifth of the medical and scientific papers have international coauthors. his reality is a reflection of globali(ation of modern day life and easy communications and movement of health professionals and patients. International collaboration is emerging as a norm and is an accepted form of current research environment. It is strongly encouraged by funding agencies. he sheer volume of international collaborations has been increased substantially during the last 29 years.:-,2; his increase is also noticed in the number of internationally co6authored papers between the developed <usually referred to in political )argon as the =5orth> and developing and emerging countries <usually referred to as the =South, for e"ample, India and *angladesh, #e"ico and *ra(il, China and +a&istan>. ,espite its late start, China has published many collaborative papers with most Asian countries and also with the 5orth, confirming the effectiveness of China?s current open6door policy. +apers resulting from international collaboration appear in higher6impact )ournals and are cited more often than papers that are the

outcome of local research.:@; Chen et al.:2; reported that only A.1B of the papers appearing in )ournals with an impact factor eCual to or greater than D were published by the local authors during the study period in aiwan <-..962991> compared to -@.EB of the publications that had international collaboration. aiwan?s researchers collaborated with AE countries, with the greatest share from !SA <E...B>. Although the ma)ority of collaborations are mainly between the 5orth and the South, only one fifth are South6South collaborations <collaboration between developing countries>.:1; Fowever, ma)ority of these collaborations are still disorgani(ed efforts, and they vary according to the centers and universities they are originating from. here are no coherent international collaborations, and many failures have been reported. Ge can summari(e the patterns of collaboration as followsH -. Short6term pro)ect6oriented collaboration, where a few centers in different countries are wor&ing together for one pro)ect. his is often controlled by the availability and the policy of funding agencies. 2. 3ong6term collaboration, forming an =alliance between research organi(ations who share the same interest. here are no rules to govern these activities, which are carried out on an ad hoc basis. It is most li&ely to happen amongst people who have trained in the same center or are sharing the same interest. @. Organi(ed international collaboration, which is usually initiated by centers of e"cellence trying to find new research <and may be commercial> opportunities in a promising emerging mar&et. Ge are seeing an increase in this form of collaboration, where centers of e"cellence in the developed countries are opening research offices to facilitate and enhance continuous collaborations. hese centers are targeting opportunities in many developing countries such as the #iddle 'ast, China, and Southeast Asia.
4.

he large, learned scientific societies are now an accepted platform of international collaborations. American horacic Society is an e"ample. It attracts delegates from all over the world, and it has become more international than =American. he 299A American horacic Society conference in San 7rancisco was attended by over -E,999 people from .9 countries. !nfortunately, most of the sponsorship and attendance is governed by commercial interest of the pharmaceutical companies rather than scientific motivation and need. here is also a trend emerging whereby these regional societies are forging a very close scientific collaboration with each other, for e"ample, the close association of American horacic Society and 'uropean Respiratory Society, which results in many combined guidelines and e"pert documents. #any such collaborations are present in the genetic field of infectious diseases,:D; but most are in infant stages and need further support and funding. Respiratory ,iseases <$AR,> httpH00www.who.int0respiratory0gard0en0I and Global Strategy for Asthma Management and Prevention httpH00www.ginasthma.com0.

5. International cross6border activities such as the $lobal Alliance Against Chronic

E. A growing interest towards conducting clinical trials and involving developing countries, where commercial organi(ations, in particular, pharmaceutical companies, are becoming increasingly active in this field.
7.

here is an increasing trend of establishing an eCual partnership with scientists from both the 5orth and the South. 7or e"ample, we have noticed the need to collaborate in =pulmonary vascular disease on a global scale. his condition started to attract attention, and more patients were diagnosed as therapies started to be available. Although the condition may affect less than -D9,999 people in the west, it is far more common in the

developing world <with an estimate of more than 2D million people> because of the other etiological factors which are not seen in the western environment. !nfortunately, the commercial power in mar&eting drugs has helped in shaping the condition to the e"tent that it only reflects the interest of a few in the 5orth and hinders progress of the many. his situation prompted the formation of a virtual institute for pulmonary vascular diseases, <www.pvri.info>, which includes eCual partnership of e"perts and researchers from the 5orth and the South. /. Collaboration as a result of the growing global health threats, including climate changes, AI,S, tuberculosis, malaria, chronic obstructive lung diseases, and the easy spread of these conditions, as we have seen recently with avian flu. his ma&es the collaboration between nations for research and e"change of &nowledge and information not only a lu"ury but a necessity. International Research Corporation has always helped scientists to &eep abreast of international science and share e"pertise and resources:E; which enhance the scientific community and in6 house training. It benefits both the health care system and the population as it may provide new treatments which are probably not already available in that country. It also helps in building up of research capacity and has direct economic significance. Some governments are already beginning to pay premiums to become hubs in the global e"cellence networ&. It remains to be seen whether this development will produce significant changes in the world research capacity. he benefits have also been reflected in the developed countries.:1,A,/; 7or e"ample, the new policies in the !nited Jingdom which are led by primary health care have resulted from international health policy based on the e"periences of many developing countries over the past @9 years.:/; he increasing collaborations on human sub)ect research have crossed international borders and created a number of issues and raised various Cuestions, particularly in the developing world. hese include ethical, cultural and ethnic issues. he proportionally heavy burden of diseases, particularly infectious diseases, and other environmental factors may affect the results of the studies. he underlying conditions prevalent in the study area may not necessarily apply to the conditions in other countries. 7or e"ample, in chronic obstructive lung disease, smo&ing is the most common cause of this condition in the westI the cause may not necessarily be the same in India, where it could be due to coo&ing fumes, for e"ampleI or due to sandstorms in countries such as the #iddle 'ast or Sub6Saharan Africa. 7urthermore, the presence of a core infection may change the pathophysiological milieu of the disease, which may result in a different response to the treatment or to the immunological or the pathophysiological reaction, which ma&es it difficult to translate the results to the western developed world. he ethical issue is the most important issue involved in cooperation with the developing world. his is a very comple" sub)ect, and it was reviewed by 4armus and Satche and others.:1,.6--; Although many studies claimed that they adhere to the international guidelines, it is important to consider the details of these guidelines, the socioeconomic and cultural structure of the country. In response to this reality, international organi(ations started tas& forces to guide doctors and investigators in the comple" world of human sub)ect research. $uidelines were produced, including the declaration of Felsin&iI International 'thical $uidelines for *iomedical Research Involving Fuman Sub)ectsI:-2; the guidelines of $ood Clinical +racticeI and the guidelines from the International Conference of Farmoni(ation httpH00www.ich.org0. here are also specific guidelines regarding certain diseases or conditions, such as epidemiological studies, genetics,

biomedical and pharmaceutical trials. Clinical practice guidelines are regarded as powerful tools to achieve effective health care. Although many countries have built up e"perience in the development, appraisal, and implementation of guidelines, there has been no established forum for collaboration at an international level. In an effort to partly resolve this issue, in 2992 the international $uidelines International 5etwor& <$I5> was formed httpH00www.g6i6n.net0. his networ& aimed at promotion of systematic guideline development and implementation which =seeks to improve the quality of health care by promoting systematic development of clinical practice guidelines. here are also other similar organi(ations aiming to develop, teach, and promote evidence6based health care and provide support and resources to anyone who wants to ma&e use of these, such as O"ford Centre for 'vidence6based #edicine httpH00www.cebm.net0. 7unding is a big issue which needs to be considered seriously considering that more than .9B of the world?s =potential years of life lost <+K33> belong to the developing world, but it attac&s less than -9B of global research funds.:-@,-1; Indeed, current funding, averaging around !SL 29,999, is too low even to ensure that a single country?s research is successful.:-D; Although there are increasing funding opportunities, mainly via philanthropic organi(ations, some 5$Os, and even governmental organi(ations, the sheer problem is so huge that more is continually needed. Ghile minimum research capacity may e"ist in many developing countries, the fact that lead institutions, as well as study countries, are concentrated in a handful of centers attests to great disparities in research capacity. #echanisms must be introduced to ensure investment in a research capacity, particularly infrastructure research capacity such as research nurses and research associates.:-E; Careful consideration of the cultural, social, and intellectual properties of the developing countries has played a part in maintaining a successful research partnership. +atenting of biological materials, including plants, animals, and even discoveries, made in the developing countries, whether due to e"isting &nowledge of the local and indigenous people or by considerable input from local researchers, is becoming a &ey issue of contention between multinational companies and health care campaigners and other campaigners <usually referred to by the negative term biopiracy>.:-A; As a general rule, the sponsoring agency should agree in advance of the research that any product developed through such research will be made reasonably available to the inhabitants of the host community or country at the completion of the research. he potential for clinical research to e"ploit populations has raised much concern recently. It is advisable that collaborators must enter into partnership, which means that researchers must engage the population in development and evaluation of, and benefeting from the researches.:-/,-.; 3astly, the developing country must be empowered to participate in debate and decision ma&ing about priority setting for research collaboration. A good starting point for this is for countries in a specific region to start to collaborate to tac&le common regional health problems.:-.; In conclusion, research collaboration is an enormous and powerful tool which provides mutual benefits to all parties. It needs careful planning and considerable thought to the diversity of the human society. he 5orth6South collaboration can be strengthened by promoting further involvement of countries such as $ermany, 7rance, *elgium, and Spain in funding, supporting, and leading research in developing countries. $o toH

%ootnotes

So&rce of S&pport' 5il #onflict of Interest' 5one declared. $o toH

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