Wednesday, Sep 24, 2014Wednesday, Sep 24, 2014
Opinion
 
Wong Tien Yin, For The Straits Times

Let research loop back to patient care

Singapore can learn much from the US experience when it comes to integrating academic research with improved health care.

Published on Jun 27, 2014 3:29 PM
 
-- ST ILLUSTRATION: MANNY FRANCISCO

In 1987, Mr Philip Yeo, then chairman of the Economic Development Board, went to the United States as an Eisenhower Fellow.

His observations of the R&D scene there shaped his vision for the establishment of the Agency for Science, Technology and Research, or A*Star, and the foundation of Singapore's biomedical sciences initiative.

Established in 1991, A*Star is a statutory board that fosters scientific research and talent to promote a knowledge-based Singapore.

Last year, I was privileged to be selected as one of Singapore's Eisenhower Fellows to spend seven weeks in the US. As a physician and scientist, my aim was to look out for lessons to shape the future of Singapore's health-care ecosystem.

Singapore already has a strong reputation for high-quality, cost-effective health care. Yet the country is faced with significant challenges, including ageing, chronic diseases and increasing health-care costs.

How can Singapore use the biomedical research innovation that it has built to provide better care to patients and thereby create Singapore Medicine 2.0?

During my fellowship, I visited 10 cities and 30 hospitals, universities, and research institutes. I met doctors, academics, scientists and CEOs. This is what I learnt:

Academic centres shape innovation and care

AN ACADEMIC medical centre (AMC) is a university-hospital partnership that has a triple mission: patient care, research and teaching. In Singapore, we currently have two health-care clusters that function as AMCs. They are the SingHealth/Duke-NUS partnership in Outram, and the National University Health System at Kent Ridge.

Among the major AMCs that I visited in the US are the Harvard-Massachusetts General Hospital system, the Mount Sinai University Health System in New York, the Stanford University Medical Centre, and the Duke University Health System.

For decades, these AMCs have provided new understanding of how diseases develop. They have also discovered new treatments and methods of prevention that are now widely practised globally.

However, the most useful lessons for Singapore come from an unexpected place: the University of Pittsburgh Medical Centre (UPMC), Pennsylvania.

This AMC was developed in the 1970s, and has done very well in a short span of time. Prior to 1970, the economy of the Pittsburgh region was dominated by coal and steel mining. Today, thanks to a strong university-hospital partnership, it is a hub for health care, education and innovation.

How did they do it? It started with a vision and commitment from the two partners - the hospital and university - to help each other succeed in a single mission of "research-based patient care".

By providing access to patients, the hospital helped the university do better at clinically relevant research. This research in turn helped improve patient care within the hospital, thereby strengthening the reputations of both institutions.

The hospital-university partnership became attractive employers for top-notch doctors and researchers from around the country. It also started winning large research grants.

Young clinician-scientist stars, the hybrid talents that help translate biomedical research into clinical care, started flocking to Pittsburgh. This sustained the system and attracted even better physicians. And all the while, patients and the community benefited from getting better care.

An example is the work of UPMC's transplant pioneer, Professor Thomas Starzl. He was a surgeon who first used anti- rejection drugs to make liver and other human organ transplantation possible.

UPMC's Starzl Institute has since saved thousands of lives, and attracted many aspiring young surgeons to train and join UPMC as faculty members.

Pittsburgh is now known as the "transplant capital of the world".

This virtuous circle revolves around the commitment to treat success in research and success in clinical outcomes as inter-dependent outcomes. This is actually easier said than done.

Initial commitments might waver under the pressure of short-term returns, the tendency to protect one's own turf, or the (mistaken) belief that research in health care is "optional", and only when economic times are good.

In Singapore, our emerging AMCs need to be similarly nurtured and supported as the focal point of Singapore Medicine 2.0. It is difficult to create a fully functioning virtuous loop when there are more immediate strains in our health-care system.

But doing so needs to be our priority if Singapore Medicine 2.0 can ultimately create better long-term outcomes for patients and the community.

Develop a diversity of talent in system

WHEN I met Professor Cherry Murray, dean of engineering at Harvard, I was surprised at the unconventional route through which she had landed the job. With only 80 academic papers, she is less well-published than most of her faculty.

However, her curriculum vitae is different. Prof Murray started out in academia but spent many years successfully leading R&D teams at Bell Labs before coming back to her position as dean.

By appointing her, Harvard showed a healthy disregard for academic excellence, narrowly defined.

Singapore's health-care institutions typically follow conventional understanding in hiring and promotion. This excludes people who have had less conventional careers but who could contribute greatly to the success of innovation.

Prof Murray's case prompts reflection on how good we are in Singapore at rewarding and cultivating a diversity of talent, and how this has an impact on making Singapore Medicine 2.0 a reality.

To bring innovation into our health-care system we need a diversity of talent.

We risk losing talented people and invaluable contributions when holding too rigidly to a "one size fits all" approach.

Can we be bolder in supporting diverse and talented people who can bring innovation into our health-care system?

Engage the public as a stakeholder

THE calibre of Singapore's health-care system and our biomedical research is already high. However, compared to the US, we have a long way to go in building a legacy and tradition.

Take for example the famous Ether Dome at Massachusetts General Hospital (MGH), where general anaesthesia was first administered in 1846. Imagine its significance for health-care workers at MGH, and those who enter the hospital as patients, or even those who visit the Ether Dome as tourists: they feel part of a lasting legacy.

I am not suggesting that Singapore can create a similar history immediately. But Singapore can learn from how American AMCs work to create, treasure and sustain a legacy in the present day. They do this through a culture of gratitude, and of sharing this with the public as a stakeholder in their health-care, research and teaching journey.

In the Boston subway, I saw an advertisement that Harvard offers free science seminars to the public: "No prior knowledge necessary."

Imagine such a poster on our Singapore MRT! In other poster ads, hospitals and universities advertise themselves as change-makers in science and medicine, informing the public about new treatments and approaches they are working on. The broad dissemination of the goals and achievements of biomedical research helps maintain public engagement in these institutions and what they stand for.

In building Singapore Medicine 2.0, we should take seriously the role of public engagement and the need to instill a sense of ownership among not just those working in the sector, but also the general community. We need to create that gravitational pull that makes young aspiring Singaporean doctors, researchers, patients - and indeed any curious individual - want to inherit and further the legacy.

As a physician and scientist whose career unfolded against the backdrop of the biomedical sciences initiative, I believe that developing three effective strategies is the way towards Singapore Medicine 2.0.

Singapore should build AMCs that bridge hospitals and universities which are sustained by a virtuous loop between better patient care and research outcomes. The country should develop a diversity of talent and, finally, engage the public as a key stakeholder in the health-care innovation journey.

Dr Catelijne Coopmans, fellow and director of studies at Tembusu College, NUS, contributed to this article.

Wong Tien Yin is professor and vice-dean, Duke-NUS Graduate Medical School, National University of Singapore (NUS), and deputy medical director of the Singapore National Eye Centre.

stopinion@sph.com.sg

Background story

To bring innovation into our health-care system we need a diversity of talent. We risk losing talented people and invaluable contributions when holding too rigidly to a "one size fits all" approach.