First, a decade of
investment developing the life sciences in the Biopolis has laid a
strong foundation for biomedical research in Singapore. There are
now more than a thousand PhDs actively working on various aspects of
basic biomedical research, many of them of first-world standard and
at the cutting edge. But to deliver greater value from basic
research, it has to be translated into actual clinical
applications. Bench research on animals has to be turned into
better treatment protocols, therapies, diagnostic kits, or even
drugs and devices, to benefit patients. Rather than having our
researchers in Biopolis partner foreign clinicians in foreign
hospitals, we should promote such collaboration in translational and
clinical research (TCR) with our local hospitals instead. Indeed,
our international scientific advisors have strongly recommended that
Singapore invest in TCR to close the missing gap between bench and
bed.
Second, a strong
clinical research environment will support our philosophy to
emphasizing a knowledge- and evidence-based approach to healthcare.
This will raise the standards of medical care for Singaporeans and
help manage medical inflation by identifying more effective ways to
deliver care. Our system is already highly productive in terms of
service delivery, and there is little scope for major cost-cutting
within the present approach. Breakthroughs in cost management must
come from applying knowledge.
Third, supporting
clinical research and knowledge-driven care will help to draw and
retain top doctors and medical talent within our public hospitals. I
think anecdotally, you have heard this many times both from our own
doctors who are interested in research as well as the newly
recruited doctors from overseas whom we managed to persuade them to
return to Singapore. Inevitably, all of them mentioned that there is
a change in environment or at least they perceived that there is
change in environment.
But I think there is
more than perception and that it is real. This is an important point
for our clinicians. By meeting clinicians’ aspirations for
scientific discovery, they can develop professionally and be more
intellectually engaged in their work. We therefore hope that
participation in research programmes will help reduce the brain
drain of our doctors to the private sector and to other countries.
In short, clinical
research is a way to grow our medical capabilities and maintain our
status as a regional medical hub. It will differentiate us from our
neighbours. Our competitive advantage has to be based increasingly
on better knowledge and stronger skills, grounded on scientific
research.
Responding To
New Policy
But we must be realistic
in our ambition to pursue clinical research. Demand for research
funding is bottomless and we can never hope to match the US budget
for clinical research.
Nevertheless, we have
committed a significant $1.55 billion, which to us is a lot of
money. For years, we hardly get a few millions. Now at least, there
is slightly more than a billion for the next 5 years. I have no
doubt that very soon it will be more than $1 billion for the next 5
years of programme.
With this larger
investment comes the need for more strategic management of, as well
as accountability to the public for, the use of these funds. We
should only fund high quality, competitive research that will
deliver concrete results in improving healthcare for Singaporeans.
We must ensure that only the best proposals are funded.
The old scheme where MOH
gives out block budgets to individual centers on the basis of trust
that you will spend the money well, I think those days are gone.
When it is a few million dollars, we can afford to take the risk.
But when you start talking about spending a couple of billion
dollars, I think that causal informal approach to research fund
distributions can’t work. We need proper research grant
applications, have them peer-reviewed and subject them to contest.
Whoever has the best ideas will get the money.
Hence, it is paramount
that we build in competitive peer review mechanisms into the grant
allocation framework. In addition, we should maximize our returns
through better coordination and integration to reap synergies. We
must not waste resources through silly duplication particularly
where facilities are on the same campus.
My office is within the
Outram Campus. I worry when I see Duke next door building up, much
of it funded by Singapore taxpayers. And at the other side, we have
SGH’s specialty centers. All want to build their own research
laboratories and so on.
Let us think through
carefully with each campus on what we can share. At the end of the
day, money comes from taxpayers like you and me. For big ticket
items where Singapore can only support one, we subject both campuses
to contest and we decide where we want to put this facility.
38. Where we can have
two, we will build one each. But within each campus, let us
cooperate and coordinate and not duplicate because there just isn’t
enough money to go round. For every hundred million dollars we save,
we could fund so many more scientists, clinical scientists and
researchers.
I hope our hospital
clusters must grasp this significant policy change and its full
implications, so as to take full advantage of it. More of the same
will lead to missed opportunities. The cluster boards and their
leadership will have to fundamentally review their corporate
mission, tweak their governance and reform their HR and financial
policies to meet this exciting new challenge. There are significant
upsides for their doctors and their patients, indeed for Singapore,
if they respond well to the challenge.
The Kent Ridge Campus is
off to a good start. They have undertaken the first step by
integrating the NUS-Yong Loo Lin School of Medicine, the Dental
Faculty and the NUH into the National University Health System to
catalyse the development of the Campus.
I am particularly happy
about this move because it is something on my mind for many years.
We have always wanted to do something like this. The more you can
integrate, be it service, teaching and research, and this is
regardless of entities: it could be MOH, hospitals, MOE or
Universities. If we are in the same campus and if only we can
synergise and collaborate and actively share a similar vision, the
sky is the limit. But if you box yourselves into silos, a lot of
opportunities will be missed. That is why I pushed this unfinished
business and I hope this unfinished business can reap us some good
harvest in due course.
The Outram Campus has a
great chance of success too. It has a strong talent pool and
excellent clinical assets in SGH, the various national centers and
the Duke-NUS Graduate Medical School. If we can further galvanise
the talents, integrate clinical services, teaching and research in a
holistic patient-centric manner, Outram can be unbeatable in this
part of the world.
That is my vision and I
believe the cluster’s board and professor Tan Ser Kiat shared that
vision too. Harnessing its potential will require a carefully
crafted strategy. It will require aligning the mission and values
among its different stakeholders. It will require strong leadership
and sound execution. It can be done and I am determined to help
them along this journey.
Conclusion
I am confident that our
two campuses will succeed in their new mission to exploit
translational and clinical research to benefit our patients. I am
confident because we have many talented doctors. Tonight, we pay
tribute to a representative sample of this talent pool. An
ophthalmologist who pioneered many internationally groundbreaking
surgical techniques to restore sight to the blind. A paediatrician
who laboured for 20 years to develop the world-class National
Paediatric Renal Replacement Programme. Teams of experts coming
together to successfully treat debilitating chronic mental disorders
and high-risk pregnancies. And two distinguished professors who are
excellent role models and mentors to the younger generation of
clinicians and researchers.
They have individually
and collectively improved our healthcare. And that is the ultimate
objective of the new policy to promote clinical research. It is not
the mindless pursuit of esoteric discoveries to score a world’s
first. It is to bring real health benefits to our people, to keep
healthcare standards high yet affordable.
We are more likely to
succeed if we focus on common conditions that affect large numbers
of our people such as diabetes and myopia. Besides doing clinical
trials on new drugs, we should also look at the effectiveness of
treatment with different combinations of existing drugs and the
effectiveness of behavioural modification strategies for different
segments of our population. Such studies may seem mundane but can
potentially benefit large numbers of our patients.
The advancement in
genomics will also present many opportunities for improvement in the
treatment of diseases. For example, scientists are now identifying
many different genetic variations associated with diabetes. It will
take many inquisitive scientists many years of hard work to uncover
which treatment protocol would be more effective for which genetic
variation of the condition. Even the current controversy over
aesthetic medicine shows the need to study effectiveness and health
benefits of treatment procedures. This is how the medical science
makes progress, for the benefit of mankind.
My heartiest
congratulations to the award recipients.
Promoting clinical research in
public hospitals
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