Lee Wei Ling's take on biomedical research in Singapore

Posted here for archiving purposes; Lee Wei Ling is LKY's daughter.

Taken from Sammyboy's forums:

Nov 4, 2006

What ails biomedical research in Singapore

By Lee Wei Ling, For The Straits Times

BILLIONS of dollars have been poured into our biomedical research drive and more billions are to follow. How can these monies be best utilised?

The strategy of attracting foreign stars and then letting them decide for themselves what areas of research to engage in has its problems. It would be difficult to persuade many of the very best foreign researchers, at the peak of their careers, to leave their homes in the West where they have their own research team and funding.

It is an approach where success depends too much on chance, and the areas of research would be very diverse, depending entirely on the researcher we are able to persuade to come to Singapore. If the present approach is followed without modification, a coherent body of research and success in a series of related fields is unlikely to develop.

In my view, a more rational approach will be to identify niche areas unique to the Singapore population or where we already have a competitive advantage. Examples include hepatitis B, primary cancer of the liver, stomach cancer, systemic lupus erythematosus (more often known as SLE or lupus) and other autoimmune disease (where the body's immune system attacks the body's own organs), and the pattern of strokes and head injury.

In point of fact, Novartis has just won approval from the US Food and Drug Administration for a new drug called Telbivudine that can be used to treat chronic hepatitis B. The clinical trial for this drug was a large multi-centre study, in which Singapore was involved but wasn't the lead investigator.

Whoever it was in Novartis who initiated the trial certainly understood 'niche'. With 5 per cent of ethnic Chinese being hepatitis B carriers, this niche translates into millions upon millions of patients. This is what I mean by niche areas versus the shotgun approach we have adopted in Singapore.

Again, head injury is common worldwide and a major cause of loss of life and cause of permanent disability. However, it is not a glamorous research topic and only 10 major centres worldwide are doing serious research in it.

At the National Neuroscience Institute, we have a good track record of head injury research and a comprehensive programme from molecular to bedside, from the acute stage to rehabilitation. We should target our research on these areas where not only is it relevant to Singaporeans, but we also have an advantage over foreign countries with much more advance research facilities.

We should learn from our experiences and recognise the big picture that this little red dot cannot compete for talent (or output) with giants in all areas of biomedical research.

Our strategy must be to encourage local researchers and provide for greater interaction between them and foreign researchers. Much more can be done to address the needs of local researchers and make them feel that they are an integral component of our biomedical drive. Some small steps have begun in this direction but too few and too small.

We should be more focused in finding our niches, then attract the appropriate foreign talents while nurturing our own talents at the same time. Once in a while, a foreign researcher may come with his own agenda. The Simon Shorvon saga is a good illustration. He abused the Singapore system by random manipulation of the patients' medication without seeking their proper and informed consent.

Simon Shorvon tried his utmost to rapidly complete this unauthorised part of his research where he treated Singaporeans as subjects from a Third World country who can be easily manipulated. What he was doing was very dangerous to the patients. He was unable to complete his research here, because he was exposed.

He and some others subsequently collaborated with Duke University in a similar field but only on the genetics of metabolism of anti-epileptic drugs with appropriate patient consent. Significantly, the part of the research with random manipulation of the Parkinson's patients' medication appears not to have been done.

Another area where we could improve is to form a lead agency to coordinate and identify areas for which Singapore research can truly excel without duplication and wastage of resources. This would create focus within our national strategy to leapfrog onto the world stage of medical and scientific excellence.

The current state of affairs emphasises funding in multiple areas for which there is no coordination and perhaps even outright competition between different groups doing very similar research. One could argue that this is also the case in the US and other advanced countries. However, that does not make it right or appropriate for all countries. Smaller countries with limited resources have to be more focused on how those resources are used.

The competition is for the sake of being the first to make the discovery, to revel in the fame and glory, to benefit financially from any patent that may follow the discovery. The competition is not for the benefit of patient care. The advanced countries can afford the wastage but this little red dot cannot.

An important issue is whether Singapore can produce enough researchers in the life sciences.

According to one newspaper article, it was in 2002, when the National University of Singapore had barely begun producing its own life science graduates, that Mr Philip Yeo, chairman of the Agency for Science, Technology and Research (A*Star), famously rattled those undergraduates when he said they would be qualified only to wash test tubes.

Four years on, armed with bachelor's degrees, some of these graduates are learning the truth of his words the hard way. Many from the first cohort have ended up in junior research positions or manufacturing and sales jobs in the industry - positions that do not require a life sciences degree. Others find themselves completely out of the field.

According to the industry's annual reviews compiled by A*Star and the Economic Development Board's biomedical science group, an average of 1,000 new jobs were created annually for the past five years. Last year, there were 10,200 manufacturing jobs in the industry, almost doubling the 5,700 jobs created in the then-fledgling sector in 2001. By last year, EDB had targeted the number of such jobs to hit 15,000.

But the booming figures mask a Catch-22 situation: The current shortage of PhD holders in the biomedical sciences cluster is hampering Singapore's bid to attract multinational companies to move their high-end research projects here. Without a PhD, most of Singapore's life sciences graduates are qualified to work only as research assistants.

The coming Graduate Medical School will not solve this problem. It will produce doctors chosen from graduate students who apply. The cut-off score of MCATS (a test used to weed out or select medical students, the medical equivalent of SAT) is higher than that for Duke University itself. But that does not surprise me. Singaporeans are exam smart. Many of our Raffles Junior College students achieve near-perfect SAT scores.

The crucial question in my view is whether the four-year curriculum with one year dedicated to research can produce good researchers. Certainly they will not have the research experience of PhDs and their clinical skills will probably not be as good as those of our current NUS medical students who have three years of clinical experience.

One could argue that they will all be doing translational research, where their background in clinical medicine allows them to know what is relevant in translational research. (Translational research is that which brings the findings from the laboratory to the patient. If drug X works in controlling epilepsy in lab rats, translational research investigates if drug X will reduce seizures in epileptic patients.)

But I worry that we may end up producing half-baked clinicians and half-baked researchers after what is a very expensive experiment. Even in the US, Duke is the only medical school with such a programme. It is reported to have the highest number of students pursuing a career in research in biomedical sciences after graduation. Many of them have gone on to lead and drive R&D in the life sciences.

However, Duke draws from a much bigger talent pool. I am not sure if the graduates of Duke-NUS Graduate Medical School in Singapore will be capable of the same.

The writer is director of the National Neuroscience Institute.