Box 1. Other “Prakash” Opportunities

We believe that Project Prakash is just one instance of many compelling opportunities to merge science and service. These “Prakash” Opportunities promise to bring light into people's lives and simultaneously illuminate fundamental questions in science. Here are a few examples.

Educating illiterate individuals and seeing effects on brain: A third of the global population is illiterate [13]. Illiteracy affects not only the individual but also society. Providing education to illiterate individuals will help improve their life prospects while also presenting an opportunity to study changes in various aspects of cognition and their neural substrates.

Providing treatments for other childhood disabilities and studying outcomes: The prevalence of childhood disability has increased significantly in the last few decades [14]. Rudimentary interventions are available for some disabilities, such as sensory impairments, speech impediments, epilepsy, and autism, which improve children's ability to interact with their world, Nevertheless, they are far from perfect. Providing children the best available treatments is a great opportunity to study treatment outcomes as well as learning and plasticity mechanisms in the brain. Such studies can help determine how the interventions themselves can be improved.

Feeding malnourished children and probing effects on brain structure and function: Severe malnourishment is responsible for the deaths of 5 million children every year [15]. Infants born underweight are at risk for learning disabilities, mental retardation, blindness, and even premature death [16]. By providing nutrition to chronically malnourished individuals, we have the opportunity to improve their lives while also examining how the brain responds to this intervention at different points in the developmental trajectory. For instance, imaging techniques can be used to determine if improved nutrition results in changes in brain volume and connectivity. The inclusion of scientific assays can, in turn, enhance the ability to monitor the effectiveness of nutritional interventions.

Providing medical screening and detecting low-penetrance disease susceptibility genes: Many conditions, like various kinds of cancer, are likely to arise from several low-penetrance genes rather than a single high-penetrance mutation [17],[18]. The discovery of these genes requires large numbers of well-characterized patients. This scientific need is perfectly complementary to the humanitarian need for increased disease screening in densely populated developing nations. The large family structures in many of these societies, and hence the availability of genetic data across many relatives, can greatly facilitate gene discovery.

Box 2. Notes of Caution

As appealing as it sounds to combine science with humanitarian efforts, there are potential pitfalls to this approach. These include implementational challenges as well as broader issues of ensuring that research creativity is not stifled.

Financial support: A project based in a foreign country, whose immediate beneficiaries are individuals of that country, might be seen as beyond the ambit of a national funding body. We find that, on the contrary, funding agencies are very supportive of Project Prakash because they see that the results are likely to transcend national boundaries. More generally, funding risks are ameliorated if the anticipated scientific gains are likely to be significant and not geographically specific.

Support from the research community: A project with a service component might be seen as a distraction from our obligations to publish papers, obtain grants, and fulfill the requirements for tenure. Our experience with Project Prakash has been overwhelmingly positive, however: researchers generally share a desire to affect people's lives, even though this motivator can be lost in the shuffle of grant deadlines and paper submissions. We feel that there is widespread support for research programs tailored to a humanitarian cause that also addresses important scientific questions.

Support from society at large: A project that merges science and service risks being misinterpreted as exploitative or disrespectful of cultural and religious traditions, especially in developing countries where there is greater resistance to science-based interventions due to competing religious, cultural, or community beliefs. This very real danger must be countered with clear communication between scientists and society. In Project Prakash, we find that counseling parents, a frank description of the project's objectives, and a few local non-scientist champions whom the patient population can relate to, are often necessary and sufficient to address this concern.

Maintaining high quality of research: Many researchers can attest to the challenges of working with children and patients. For instance, densely sampled longitudinal studies are logistically complex. The histories of the participants are highly variable, sometimes making group level analyses difficult. Such hurdles may be exacerbated in a developing country but can provide a useful spur to designing experimental protocols that are resilient to the circumstances. Some unavoidable experimental compromises may be tolerable as long as they are accurately reported and do not hinder the interpretation of the results.

Draining resources from other deserving avenues of research: The desire to tie research to societal benefits should not diminish our ability to pursue more “blue-sky” projects. The scientific value of any project must be evaluated dispassionately. Are the likely scientific advances significant enough to merit the investment into the project? If the answer is affirmative, then all else being equal, a project that has a simultaneous beneficial impact on society may be more deserving of support than one that does not.

Maintaining ethical standards: Linking the provision of service to scientific gains may result in a conflict of interest, transforming service into exploitation. Safeguards against exploitation include avoiding a quid-pro-quo arrangement between service provision and study enrollment. All individuals who need intervention, not only those who fit the scientific inclusion criteria, should be treated. This has been a guiding principle for Project Prakash, which has treated not only congenitally blind children but also those with late-onset visual impairment. Also, independent institutional review boards must provide oversight to ensure participant welfare.