Current research ethics frameworks – including the Belmont Report, Declaration of Helsinki, and Canada’s TCPS 2 – require favorable risk‑benefit balance, informed consent, and justice. Yet none mandate a systematic review of operational feasibility: recruitment access, team capacity, realistic timelines, or site approvals. As a result, participants are enrolled in studies that are predictably infeasible, bearing risks for no potential benefit. This is not an administrative oversight; it is an ethical failure. Health policy must now require that every ethics review include a light‑touch operational feasibility check – not as a bureaucratic detail, but as a core protection for participants and a safeguard for public trust in research. The cost of delays in clinical trials can be as high as ​$8 million/ day in west, while the investment on ensuring operational integrity is expected to be much lower with the right use of resources, technology and building recruitment networks. Details

Our analysis on economic impact of smog for winters 2023 in Pakistan, indicated towards a loss in millions of dollars for government in managing additional respiratory diseases burden in smog months (end of 2023 and early 2024 winters, with AQI in very unhealthy range), all funded through Sehat Sahulat Program. This analysis was presented in APPIC conference in Vancouver, 2024 by our team. 

There are many reasons to the recent rise in seasonal smog. One major contributor to this is rice stubble burning, which has been increasing with the rise in food demand and crop quantity. This leaves farmers with more stubble to clear rapidly before planting wheat. In past, the stubble was manually cut and sold to be used as animal fodder. In recent years the changes in crop quality, and rising demand of basmati rice, the quality of stubble/ fodder value has decreased. The lack of demand of fodder means lack of incentive for farmers to cut it manually and burning has become a fast, though harmful, solution. For government, investing in Happy Seeder machines, which cost around $15,000 per unit, and employing contractors to operate in all rice fields could save the government millions of dollars in healthcare costs tied to smog-related illnesses. We advocated for the cause on different platforms. Our messaging gained effective uptake and one agency working as think tank for ministry of health in the domain of environmental health reached out to us inviting collaboration. Later in the same season, notable steps were taken by Punjab government for smog. The following year (2025), Pakistan’s annual average PM2.5 levels dropped from 73.7 μg/m³ (2024) to 67.3 μg/m³ (IQAir data). While many factors influence air quality, our campaign contributed to raising public and stakeholders' attention during this period.

(Article in publication phase)

A report was prepared by Dr. Bushra Anwar in partnership with APPNA MERIT in the year 2022. The information was gathered from APPNA webinars, and discussions with stakeholders from Pakistan, & utilizing various online and offline resources. The primary goal was to formulate a white paper for Pakistan clinical research strategy. The report outlines the current landscape of the global clinical trials market, with particular emphasis on South Asia and Pakistan. It evaluates the clinical research sector in Pakistan through a relevant analytical framework, identifying strengths, opportunities, weaknesses, and threats. Additionally, it offers policy recommendations tailored to each aspect of the framework.

An updated version of this report was developed in 2024, in collaboration with ACRP Ambassadors Club Pakistan and APPNA, its printed copies distributed in 1st Clinical Trial Summit Pakistan 2025, and later published on website of Drug Regulatory Authority of Pakistan in July 2025. This report is revised annually to provide the most current information and to propose a strategic roadmap for enhancing clinical research activities in Pakistan by leveraging our strengths and addressing our challenges.