ON MALAYSIA Day today, thesundaypost is happy to feature Professor Pierce Chow who was born in Kuala Lumpur but grew up Sarawak and who has just been honoured — among some of the best talents in Asia Pacific — with the National Medical Excellence Award (NMEA), an initiative of the Ministry of Health Singapore, for excelling and contributing significantly to the field of medicine.
Chow, a former Josephian and also a scout, is the fifth recipient of the Outstanding Clinician-Scientist Award, the first non-Singaporean to be so honoured.
The award is in recognition of his contributions to clinical and translational research in hepatocellular carcinoma, the third most common (liver) cancer in Asia.
His studies and findings have helped improve the care and management of patients afflicted with the disease.
Chow is now a senior consultant in the Department of General Surgery at Singapore General Hospital and a visiting senior consultant at the National Cancer Centre in the city state.
He is also a professor and course director at the Duke-NUS Graduate Medical School.
Below is an email interview Chow had with Phyllis Wong.
Q: Please tell us a bit about your background and some memories of Sarawak.
A: I was born in Kuala Lumpur but my family moved to Sarawak when I was five and I grew up in Kuching until I left for further studies in Singapore.
In my mind’s eye, Sarawak was very beautiful. I remember the Matang waterfall where we used to swim, the beach at Sematan, the sunset at Santubong and the Wind Caves at Bau.
I went to a great school (St Joseph’s). It was a wonderful place to grow up in.
Q: Why did you choose to work in Singapore and not come
back to your hometown in Sarawak? How do you view the brain drain problem in Sarawak?
A: I wanted to do medicine but there were limited places in Malaysian medical schools for non-bumiputras back then. My family did not have the means to send me to medical schools in the west. The medical school in Singapore, however, has a very good reputation, so I went to do medicine at National University of Singapore (NUS).
All NUS medical graduates were bonded (then and now) to the Singapore government and clearly, I would not have had the funds to buy myself out even had I wanted to.
In any case, I wanted to specialise in surgery and was accepted into a training position — it was as competitive then as now.
I did well in my post-graduate professional exam and my mentor encouraged me to do a PhD which I did.
After completing surgical training, I was awarded a Singapore government-sponsored fellowship for further training in HPB surgery and liver transplantation in Australia which also carries a bond.
It did not matter to me then because I had already married and have a family in Singapore. My wife is Singaporean.
In the meantime, my mother had passed away and there was no longer a home in Sarawak. In summary, I would say there was an absence of opportunities for me in Malaysia back then and the meritocratic system in Singapore filled the void.
I believe the same situation applies to many Malaysian professionals now working in Singapore.
Q: Why did you choose clinical and translational research requiring long hours and commitment which is usually not taken up by medical doctors?
A: As with many other doctors, I entered medicine with the idea that I wanted to help sick people — as many sick people as possible. With the maturity that comes after a few years of working, one gets to realise that while the impact of an individual doctor may be great on the specific patients that he encounters, his impact, on the whole, is limited.
To have impact on a larger number of patients, one really has to go beyond that and look into better ways of treating diseases — and that’s where clinical and translational research comes in.
A basic scientist working at the bench may make fundamental discoveries that will have substantial impact further down the road.
But the clinician-researcher doing translational and clinical research can achieve much more immediate impact.
There is, of course, no necessity for a clinician to do research and it’s a hard life to meet two demanding schedules. If one has the aptitude for research and the opportunity to do it, then the existential question would be should one take this on or the easy path to private practice.
To take on research means there is opportunity cost and one has to be prepared that research projects can fail and that research is inherently much more Darwinian than mere clinical work. Each of us has only one life. I suppose we should seek the most meaning out of it.
Q: How do you juggle between being a clinical researcher, a doctor and a medical teacher?
A: Although the three activities are aligned and centre on the patient, it’s not easy.
Having a supportive academic environment helps but the reality is that even with the best environment, only very few in every cohort of doctors will take this path. To do well in all three, one ends up working much longer hours and into the weekends.
Work and life become one and the same. Well, it has been said if you enjoy your work, then it ceases to be work. But there will still be timelines and datelines and the burning of midnight oil. It helps if you don’t need much sleep!
Q: In the course of collaboration with researchers in the Asia Pacific region, how do you look at the medical advances in these countries, especially in comparison to those in Malaysia?
A: In terms of economic development and technology (including medical technology), Asia Pacific is extremely heterogeneous. In medical infrastructure and development, some parts are first-world — South Korea, Hong Kong, Japan, Singapore. In many other countries, things are very rudimentary. I would place Malaysia in the intermediate group.
The immediate concern is still to provide adequate medical care to the entire population and it’s difficult to both create and sustain centres of excellence in isolation.
Things are very challenging when it’s difficult to keep doctors in institutional practice because of poor policies and remuneration.
Q: You have been known to be very accomplished in liver cancer research. Why liver cancer?
A: The direction one takes in life is often a combination of interests and opportunities. The liver is a fascinating organ — do you know it’s the only organ in the human body that regenerates to any extent?
The sub-specialty of Hepato-Pancreato-Biliary (HPB) surgery was just being developed in the hospital at that time and I came into contact with patients with liver cancer.
Liver cancer is particularly common in Asia Pacific, and most patients were diagnosed only when in advanced stages of the disease (they still do). There was not much that we could do for many of them back then. Death can come in a short time. It seemed especially important we do something for these patients.
Q: Why is liver cancer often detected late? Who are those in the high risk group? Any advice on how to lower the risk of liver cancer.
A: The liver is an internal organ and normally one can neither see nor feel it. By the time there are symptoms, the disease tends to be in at least the intermediate stage. However, there are specific high risk groups although as with any cancer, no one is risk-free.
The most important risk group in Malaysia is the chronic Hepatitis B carriers. The most important way to lower the risk of liver cancer is, thus, to undergo immunisation for Hepatitis B. If one is already a carrier, then it is important to go for six-monthly surveillance with ultrasound and a blood test for the cancer marker alfa-feto protein.
Q: What are the latest breakthroughs in liver cancer research?
A: It’s increasingly clear to those of us involved in liver cancer research that this is a very heterogeneous disease. Many of our current practices are based on the assumption that the disease is relatively homogeneous. We are currently collaborating with a French group to look at the molecular sub-groups of this disease. In time to come, we could hopefully plan each patient’s treatment based on the intrinsic molecular biology of his particular tumor type.
In the meantime, physical ablation of the cancer remains the most important treatment and surgery should be considered whenever possible. We are currently conducting a large multi-national clinical trial on internal radiation therapy for patients where surgery is not feasible.
Q: What does winning National Outstanding Clinician Scientist Award mean to you?
A: There is a lot of satisfaction that my research has been benchmarked and ranked and not found wanting. It is also a testament to my friends and scientific collaborators, both in Singapore and Asia Pacific who have subscribed to my scientific ideas, often without counting their personal costs. I suppose winning this award does encourage me to go further.
Q: What other awards have you received over the years?
A: I had some early success winning the Chapter of Surgeon Gold Medal in 1994 at the conjoint M.Med/Royal College of Surgeon of Edinburgh examination and the Young Surgeon Award for my research into liver blood flow and regeneration the following year. These were followed by a number of other awards over the years, including the Clinician-Investigator Award in 2010.
Other than academic and research awards, the other awards that I am particularly proud of are the Outstanding Educator Awards in 2009 and 2010 and the Pioneer Award in 2012 from Duke-NUS Post-Graduate Medical School where I am one of the course directors.
Q: Where will you go from here?
A: As far as the scientific and clinical understanding of liver cancer is concerned, we are only at the beginning. A door has been opened and there is a lot more to do beyond that door.
Q: Any word of encouragement for the young ones in Sarawak?
A: One should follow one’s dreams. It does not matter where you come from or how challenged your background may be. Although the road can, indeed, be very difficult, if your dreams are altruistic, you will tend to find unexpected help along the way. Altruism is a quality recognised by all.