Biomedicine in Singapore #2.
A couple of months ago I got very interested in this blog written by a NUS medical student who was complaining how teachers in the SOM treat students from Duke GMS better and always attempts to belittle them. Some of the points that he raised are relevant in the discussion today.1) Is developing research important to biomedicine in Singapore?
The answer is YES, regardless of the angle you are looking at it. I have addressed the industrial point of view; I will have to address the clinical point of view too.
I don't know if it is prevailing or not, but that guy above gave me the idea that many students in NUS SOM do not believe that research is necessary and is a digression, a waste of resources, and it is just the 'politically correct thing to do'.
How interesting. If doctors in Singapore are like that, Singapore will forever be playing catch-up - we will never lead. We can continue to dream about becoming a biomedical hub; when techniques that are used in Hopkins are unheard of in Singapore, that Sultan from Saudi Arabia will choose to go to Baltimore instead of Singapore and the goodness-knows-how-much from him (he was happy because we gave him good care) which became a new building for paediatric patients and an endowment fund for purchasing equipment and giving scholarships to needy students will belong to Baltimore, not Singapore.
If we are content in running an efficient medical system for every Singaporean, it's fine if we just keep playing catch-up. But if we are trying to develop this whole thing into an industry to sustain Singapore's economy in addition to being a service to all Singaporeans - I'm sorry you guys will just have to work harder, or just learn to work with us.
Currently clinical research and translational research is not managed by A*STAR - they come from the MOH research institutes such as NCC, NHC, NNI, NSC etc., in collaboration with the hospitals. Some clinical trials are also done in these sites - A*STAR does not manage these trials also. These research centres are not big, the studies that they do are not significantly world-class, but they are doing relevant work. Other than getting money from MOH, research groups from these places can get additional funding through direct NRF grant calls, which A*STAR groups are not eligible for. Recently NRF has just given out 4 $10,000,000 grants for cross-disciplinary collaborative projects aimed at studying significant clinical problems. They have given a couple of these grants in the previous years as well.
2) Though what kind of research should Singapore fund? Since I have established that Singapore's biomedical initiative is economically driven, the natural conclusion is that Singapore should fund research that will have a higher likelihood of generating returns. Indeed this is NRF's policy. Read:
CRP proposals should demonstrate the following:
i. High quality cutting-edge science;
ii. High likelihood of building up research infrastructure and capabilities in
Singapore;
iii. Competent team consisting of individuals with credible track records;
iv. Excellent execution of individual projects which form a coherent
programme; and
v. High potential to generate economic and societal benefits to Singapore by
creating new industries or advancing existing industries.
National Research Foundation - Competitive Research Programme. Note: only groups based in Singapore are eligible for NRF funding.
This is only one of the couple of funding schemes that NRF has. For more information check out their website - even I am not completely aware of everything that they have.
With limited resources, it is apparent that Singapore should focus on strategic areas that we can eventually develop into a strong capability. Institutions overseas have key strengths too - Hopkins has key strengths in biomedical engineering, urology, pancreatic cancer, neurology and neuroscience. However, focusing on key strategic areas does not mean a neglect of the basic sciences - all these areas of research are heavily multidisciplinary and expertise from all levels is necessary. Of course, it should be harder for a research group that focuses on rice genetics to get funding here, but people dealing with transcriptional silencing of tumour suppressor genes (this is such hardcore molecular biology that I, despite being a basic science person, am trying to stay away seriously) should be able to get funding.
An important consideration should be - whether or not the research group is able to contribute to the technical story and the translational efforts the larger key strategic group is putting together. It will also depend on how the research group is able to sell their projects - it is the same everywhere.
(Sometimes it is hard to sell new ideas to the older generation of administrators in Singapore. I had an interesting (well not so much when I am doing it) experience trying to persuade a NUS/A*STAR dean/director that physician scientists are now a necessity in bringing people from multiple disciplines together to produce useful research - there is a reason why the NIH started the MSTP scheme in 1974 (is this even a NEW idea?!!) and they do not plan to end it anytime soon. A friend of mine had another experience persuading experts - not from Singapore but from Cambridge UK this time - that computational models are important and useful in future biomedical research and it didn't turn out well. Well for the latter I have already taken it for granted because I have seen such models working in many people's (and to some extent, my lab's) research in Hopkins...)
3) Research will only benefit Singaporeans if it can translate into jobs, better healthcare, and economic growth. Thus, translation and commercialisation is necessary - it is a reality that no one can escape from. However, I must emphasise that such a translation is NOT as straightforward as people might hope - research -> new pills and medical equipment that we can sell to earn money; research -> new clinical procedures that will have a 10% higher chance of curing my cancer. Looking at it in this way is overly simplistic and unrealistic.
A*STAR does have a commercial branch dealing with this process - it is called Exploit Technologies. EDB people have the resources to help us do that too, and there are also local companies dealing with development and running trials, albeit not at a large scale - they include S*BIO and Merlion Pharmaceuticals.
However, the key here is physicians. Drug trials, new medical equipment, and new clinical procedures need to be run by physicians. These physicians need to work together with the key strategic groups that I have mentioned before, know what the groups are doing, be willing to contribute ideas, time and effort, must be able to recruit patients, and must be able to network with other hospitals in the region or even as far as hospitals in East Asia to make the whole development scheme viable.
Hopkins oncologists can refer patients to Duke for trials if they are willing to. Can SGH refer patients to Queen Mary for trials even if the patient is willing to? As far as I know, I don't think so, and I don't think most doctors here are interested, and they may even criticise me for being too ambitious, risking the lives of patients - and they believe that only a messed-up privately owned medical system in the US can support such ideas.
I don't think so. It all comes down to whether we can design our system in a way that is clever enough to not compromise healthcare to common Singaporeans but also reap the benefits of a private medical system. I won't go into details here - it is running too long.
Okay conclusion:
1) To develop a biomedical industry, Singapore needs to develop research capabilities.
2) Singapore needs to form multidisciplinary strategic interest groups, each with a clear focus - to a certain extent that is what we are doing now.
3) If Singapore is serious about making biomedicine the industry of the future, we need to produce some doctors who have the foresight and ability to invest their efforts in the initiative.
4) Foreign experience is definitely needed at the time being, until our universities are capable of producing talents that can sustain the industry independently. They can't do that yet.
Developing biomedicine runs a high risk. However, nothing is risk adverse, and we can't afford to do nothing and continue to rely solely on manufacturing, finances and petrochemicals - stagnating is a sure way to kill. However, a high level of transparency and accountability should be made available, and in this light the biomedical industry is doing way better than GIC and Temasek Holdings already.
If properly managed, Singapore can become another Cambridge MA. It will take one generation at least - it takes a long time to change people's mindsets and change educational culture, especially if those people are all established experts. It might require people like us to go in to create a storm. I would be happy and proud if I can be part of this successful effort!
And in the upcoming General Elections, vote wisely! Use your brains! I will start talking about it soon...
Labels: Policy and Politics
