Prioritising research — think global and act local

DR Goh Pik Pin has been director of the Clinical Research Centre (CRC) for two decades (since 2010).

She has never been more excited than when research was placed under National Key Economics Areas (NKEA) of Entry Point Project 2 (EPP 2) in 2010.

Since then, 30 clinical research centres have been set up across Malaysia where there is a renewed interest in medical research.

With doctors committed to research despite the lack of funding, Malaysia has a bright future as a destination not only for clinical research but also pioneering research.

thesundaypost recently met Dr Goh for a Q and A interview in which she stressed the importance of research in keeping Malaysia on course to achieving its vision of becoming a developed country by 2020.

Dr Goh Pik Pin

Q: Why is it important for doctors to be involved in clinical research?

A: From the patients’ perspective, we do clinical research to discover more effective treatments and improve patients’ treatment. The ultimate aim is to provide a good quality of life.

From the perspective of healthcare providers, research helps save costs. When more effective treatment is available, there will be less complication. Patients will have shorter stays in hospitals which, in turn, save money.

From the country’s perspective, research can improve its wealth by bringing in investments from pharmaceutical companies which will set up offices and labs here, thus providing job opportunities.

 

Q: How do you describe the general development of research in Malaysia?

A: The National Medical Research Registry, set up by the Ministry Health (MOH), is a web-based platform for registration of research protocols. It receives about 1,000 protocols every year. There are about 4,000 clinical specialists under the ministry. With 30 clinical research centres in all major MOH hospitals across the country, we are seeing increasing numbers of medical personnel doing research. This is an exciting trend.

The present scenario came about after Prime Minister Datuk Seri Najib Razak’s emphasis on research — by listing it as one of the national agendas. And placing clinical research under National Key Economics Area of Entry Point Project 2 shows our country is serious about medical research. Furthermore, budget has been allocated to improve facilities such as labs and research equipment. The government support is encouraging. Resources have been channeled into research, human capacity building and training.

Although we see an increase in the number of people involved in research, compared with developed countries such as Japan and Korea, we still have a long way to go. Observers from other countries have, however, commented we are moving towards the right direction.

We are seeing positive growth but there are also gaps to fill and areas to improve. Presently, we don’t have enough scientists in research labs — we don’t have trained people working on early phase research. We also don’t have many well-equipped research labs. We lack statisticians and IT experts as well.

Hopefully, with increasing awareness and government funding, we can get more young people to do research. Young people must realise there are many things besides being a medical doctor, a pharmacist or a nurse.

A medical staff can only attend to one patient at a time but a researcher who can come up with a cure, saves millions of lives at a time. Young people must learn to see that.

 

Q: Is there enough funding for research in Malaysia?

A: The government is giving funds through the Science, Technology and Innovation Ministry (MOSTI). But as a country, whatever has been given is not enough.

Malaysia only spends slightly over two per cent of GDP on research while the US allocates over 20 per cent. So there is still room for improvement but unfortunately, as a developing country, the government needs to spend more on other things such as infrastructure and education.

Research needs money. As doctors in research centres, we need more funding, so do academicians in universities.

The government through MOSTI has been giving a lot more to academic institutions but not enough to the Health Ministry although we also do a lot of research for our patients. Now, we are working with MOSTI on the possibility of giving us more research grants.

If Malaysia were to achieve its vision of becoming a developed country in 2020, it would have to spend more on research and development (R&D) which is one of the parameters to determine whether Malaysia can be called a developed nation.

 

Q: What target has CRC set to help Malaysia achieve Vision 2020?

A: We have set up a key performance index under NKEA whereby Malaysia must, by 2020, do 1,000 clinical trials through industrial sponsored research on drugs and medical device. This is the target. For this year, our target is 224 clinical trials and as of August 2014, we have achieved 149. If we continue at this rate, by 2020, we can achieve 1,000 per year.

 

Q: You are confident the target can be achieved. Why?

A: The pharmaceutical and medical device industry can see the potential of Malaysia and I’m confident because Malaysia is very unique.

First, our country has seen the importance of research and is making efforts to make it a national agenda. Our prime minister believes research is important and has been encouraging other countries to come to Malaysia to do research. Not many countries are doing that.

Secondly, there are many committed doctors and nurses in Malaysia who are trained and speak English. So Malaysia can be a preferred destination for many pharmaceuticals because they will not need translators.

Thirdly, drugs may react differently to different groups due to genetic differences. Malaysia has patients from different ethnic groups who can be easily available for clinical trials. This is one of the good things Malaysia can offer.

Besides, Malaysia has good infrastructure and efficient international flight connectivity. All these are crucial for research. Furthermore, we have good regulations to ensure our research is of good quality.

Then there is also a high number of Malaysians suffering from non-communicable diseases such as diabetes or hypertension, especially diabetes where one in five people has the affliction.

These diabetic cases form a big pool of patients pharmaceutical companies can tap on. What’s most important is our patients are still not in trials and therefore, are potential trial patients.

Compared to Singapore which has a total population of only five million with many of their patients already involved in research, Malaysia with its 29 million population has a huge advantage.

A patient cannot be involved in more than one research. He can’t take Drug A in one clinical trial and then take Drug B in another. Countries like Singapore are already saturated.

With the advantages and strengths Malaysia can offer, I’m confident we can achieve our target. What we are lacking are opportunities from pharmaceuticals. So what we must do is promoting Malaysia to these pharmaceutical companies — mainly in the US and UK. We need to let them know where and who we are.

 

Q: While we are encouraging clinical research, what kind of protection are we offering the patients?

A: Research is the most regulated activity because protocols have to be approved by the Institution Review Board (IRB) Ethics Committee. The function of the Committee is protect the rights and safety of research subjects by examining protocols, investigators as well as research data and statistics.

Besides the approval of IRB Ethics Committee, patients will have to read and understand a document called patient information sheet, written in layman’s terms, and sign an informed consent form. No one can conduct clinical trials without giving patients a full explanation and obtaining their consent.

And for a molecule (the product before becoming a medicine) to be tested on patients, it has to go through another committee — National Pharmaceutical Control Bureau under Pharmacy Division of MOH.

The Committee will make sure the molecule is safe before approval is given for clinical trials. So basically, clinical trials are very well regulated through the protection provided by these two regulatory bodies.

And any adverse events during the research process are recorded and reported to the IRB and sponsors.

With all these regulatory requirements in place, patients are always well protected.

 

Q: What is the percentage of Malaysian medical staff who are involved in research?

A: It’s very difficult to give an absolute number because as doctors, most times, we are involved in some kind of research. Furthermore, research does not only involve doctors, pharmacists and nurses but also others such as statisticians and IT personnel.

Research is team work. So we can’t really give an exact figure even though there is registration of research protocol and publication. In an article published in a scientific journal, four names may be stated as authors but in reality, many more are involved behind the scene.

Presently, we have seen an increase in the number of doctors, pharmacists and other healthcare providers involved in research because we have set up a clinical research centre network across the nation.

 

Q: How many clinical research centres are there in Malaysia — and how many in Sarawak?

A: There are 30 MOH hospitals with clinical research centres where facilities, consultation and guidance in writing protocols are provided. In this way, the government is hoping to encourage doctors and nurses to do research.

The setting up of the Clinical Research Centre will form the backbone supporting research. Of the 30 clinical research centres, three are in Sarawak — at the Sarawak General Hospital, the Sibu General Hospital and the Miri General Hospital.

 

Q: What have been the areas of focus for Malaysia medical researchers?

A: These depend on areas of concern in individual states. Each state, with its own uniqueness, faces different challenges. We should focus on areas where we have comparatively more patients. For example, in Sabah, it is malaria and here in Sarawak, it is hand-foot-mouth disease (HFMD).

The research each state prioritises is one that matters to the people most. So if I were in Sarawak, I would be most concerned about HFMD, and most likely, the research focus will be on HFMD.

Researchers will always be focusing on what is relevant to the whole state. And for the country, the focus will be on obesity, diabetes and hypertension.

We are a tropical country, so it’s natural we focus on diseases prevalent in tropical areas. This is what we call low hanging fruit. We cannot expect the US or UK to do the research for us as they don’t have the cases. What areas to prioritise on for researchers? The principle is — think global and act local.

 

Q: In what areas have our researchers achieved outstanding results?

A: Malaysia is now famous for research on malaria conducted in Sabah. The research by Queen Elizabeth 1 on plasmodium knowlesi malaria yielded wonderful results which have greatly reduced deaths caused by the disease.

The researchers involved published many papers. Their research has caught the attention of the London School of Tropical Disease and Hygiene and three million pounds was given to support their research.

The team has also been invited by the American Society of Tropical Diseases to conduct a symposium in the US this November. I would say the malaria research has caught the attention of the world. We are very successful in that.

Next is dengue. Researchers of the disease have also published papers – and their works have attracted a lot of attention as well.

Our cardiologists in Sarawak are also doing quite cutting edge research on cardiovascular diseases, especially heart attack. There is also research on bio-markers to determine which patients group is more prone to cardiovascular disease.

In Sibu, the focus is on paediatric studies, mainly autism where many papers have been published.

Years ago, Prof Dr Mary Jane Cardosa and Dr Ooi Mong How discovered enterovirus 71 (the virus causing HFMD) which led to compulsory vaccination for newborns in Sarawak — and not other states. This was a great breakthrough and the impact is still felt today.

 

Q: How has Sarawak performed in terms of medical research?

A: I can only talk about research carried out by government hospitals. We have very good hospitals in Sarawak and one of them is the Sarawak General Hospital (SGH).

It is one of the most active in research among the hospitals. The number of publications from this hospital is very high. Now, with the setting up of the SGH Heart Centre (at Kota Samarahan), good cardiovascular research has been conducted with doctors such as Senator Datuk Dr Sim Kui Hian and Dr Alan Fong.

Besides SGH, there is also Sibu Hospital where Dr Toh Teck Hock is conducting paediatric research and in Miri Hospital, ENT surgeon Dr Doris Evelyn is heading the commission of ENT research.

Sarawak is rich because the state has three CRC hospitals which have the human capacity to do research.  Sarawakian doctors are very special. They are very committed, sincere and hardworking. They are passionate about what they are doing. This is to me a plus point.

Your diverse ethnicity is another plus point. If pharmaceutical companies are coming, not only can they find Chinese, Indians and Malays but also perform clinical trials on small minority groups to learn about their genetic profiles and things like that.

 

Q: In terms of research, what do you think should be the direction of Sarawakian researchers?

A: Floral and fauna. The state government has been funding research on Sarawak’s floral through the Sarawak Biodiversity Centre. The government should continue to invest in it and hopefully, we can come out with an effective cure for some diseases with some of our herbal plants.

But this is a long journey. From plants to medicine may take up to 15 years and drug discovery involves a lot of money. I understand studies are now being conducted on the Bintagor Tree for its anti-HIV effect.

So for Sarawak, I hope more scientists will look into its floral and for doctors, they can continue to do research that matters — one that will help produce better outcome for patients and improve treatment.

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