2.                 Clinical research in our public healthcare institutions has come a long way.  In the past, only a few doctors conducted clinical research in hospitals, with little active support from the hospital administration.  The Government’s overriding priority then was to keep healthcare costs low.  We worried that clinical research would lead to more expensive treatments and raise healthcare costs.  We looked at the billions of dollars that developed countries like the US spent on medical research, and decided that Singapore could not afford such a pursuit.  Let others do and pay for the research, and we would adopt the new treatments and procedures after they have been established.  It was a cheaper and more efficient way to raise our medical standards.

3.                 Many of those considerations remain valid today.  Keeping basic healthcare affordable for all Singaporeans is still vitally important.  But since we embarked on the broader effort to promote R&D in Singapore, we now have to see the issue of clinical research in a new perspective.  We have concluded that as part of our R&D drive, there is scope for us to do more clinical research, especially if we focus our resources on a few carefully selected areas like cancer and cardiovascular disease.  Such clinical research can benefit Singapore in several ways. 

4.                 First, a decade of investment in the life sciences and Biopolis has laid a strong foundation for biomedical research in Singapore.  Many outstanding researchers are now actively doing high quality research in Singapore.  To derive full value from their efforts, we need to follow through the basic R&D, and translate scientific discoveries into real clinical applications.  Insights gained at the laboratory bench have to be translated into better treatment protocols, therapies, diagnostic kits, or even drugs and devices, to benefit patients.  Indeed, our international scientific advisors have strongly recommended that Singapore invest in translational and clinical research to close this gap between bench and bed.  

5.                 Second, a strong clinical research environment will support our emphasis on an evidence-based approach to healthcare. Our healthcare system is already highly productive in terms of service delivery, and there is little scope for major cost savings by doing things slightly better.  Major cost savings must come from applying knowledge to improve and transform the practice of medicine. 

6.                 One source of breakthroughs is new drugs and procedures.  But these are often expensive, so we need protocols to make sure that they are properly administered, and will be used only when they are cost-effective, and appropriate to patients’ needs.  Then only can we raise the standards of medical care, and keep down medical costs, or at least slow their increase.  To develop and validate these protocols, and confirm that they work with Singapore patients, we need to do clinical research.

7.                 Third, clinical research will help us grow our medical capabilities, stay ahead of our competitors, and maintain our status as a regional medical hub.  Increasingly, our competitive edge in healthcare has to be based on better knowledge and stronger skills, grounded on scientific research, rather than being the cheapest.  This is how world-class medical centres like Duke and Johns Hopkins maintain their pre-eminence.  Their research institutions are closely linked to hospitals and medical schools.  Such integrated set ups make it easier for clinicians and researchers to collaborate across disciplines, and across hospital-school lines. 

8.                 For these reasons, we decided to step up our investments in clinical research, and reorganise our public healthcare system to better support this endeavour. 

9.                 Earlier this year, we took a major step to put the NUS School of Medicine, Faculty of Dentistry, and the National University Hospital, under a single Board with common management.  This merged entity, the National University Health System (or NUHS), will integrate clinical care, research and education, so that our doctors, scientists, teaching faculty and staff can work more effectively together.  The NUHS will provide the platform to translate discoveries from the laboratory benches of A*STAR and Biopolis into new applications and treatments for patients. 

10.             This Centre for Translational Medicine (CeTM) is another important piece in our overall efforts.  It will be the flagship building for translational research and education in the Kent Ridge campus.  In the field of cancer, for example, clinicians and basic scientists will be able to work with researchers from the Cancer Research Centre of Excellence led by Professor Dan Tenen.  The CeTM will also provide facilities for research collaboration across different fields such as bio-engineering and robotics. It will leverage on the broader strengths of the university, and strongly encourage interdisciplinary research.

11.             Indeed, much scientific discovery is collaborative and not confined within artificial boundaries or traditional academic disciplines.  The use of computer simulation models, for example, encompasses all fields of science, be it biology, mathematics, or physics.  Expertise in implementing algorithms in one discipline should be shared across the others.  It is through greater collaboration and interaction across disciplines that we can exploit opportunities for cross-fertilisation of ideas, and achieve future scientific breakthroughs. 

The Road Ahead

12.             While we have made good progress in promoting clinical research, much work remains to be done.  Making organisational changes and building infrastructure like the CeTM are just the first, perhaps easier, steps in a long journey ahead. 

13.             One major challenge is to promote collaboration and integration on a national scale.  This is important because left on their own, organisations form silos naturally, as their staff compete against one another to get ahead.  Competition, in and of itself, is not a bad thing.  Competition to deliver better clinical outcomes, if properly structured, ultimately benefits those served by our healthcare institutions.  Competitive bidding for research grants, coupled with a robust objective process of peer review and evaluation, helps to ensure that money is channelled to the most meritorious projects with the greatest potential impact. 

14.             Unfortunately, experience has also shown that competition can lead to unnecessary rivalry and wasteful duplication.  Each institute wants to build its own facilities.  Each wants to buy its own equipment, instead of sharing with others.  Each wants to hoard patient samples and records, for fear that they will be used by someone else to achieve breakthroughs.  These are bureaucratic and human practices and instincts, but they are counter-productive and harmful to our overall research efforts.

15.             We must therefore find the right balance to harness the benefits of competition to bring out the best in each institution, and at the same time, promote collaboration between institutions to achieve the maximum for science and for Singapore.  This means continually striving to break down silos and make best use of our resources in a coordinated and integrated way.  We should promote collaboration to gain synergy, and enable our research institutions to undertake large-scale clinical trials and projects which each could not do on its own.

16.             The Government is doing its part to lay the foundations for such collaboration.  Top-end equipment and large-scale infrastructure like the research space in CeTM and the Clinical Imaging Research Centre in Kent Ridge are planned centrally, and open to all researchers and scientists.  Disease registries and tissue banks are set up at the national level, ensuring that the critical basic material for research is available to the entire clinical and research community.  

17.             We are also putting systems and key enablers in place to create a more integrated environment.  For example, the Electronic Medical Record system will link all healthcare institutions to a national database of real-time patient information.  Beyond care provision, the database will provide a platform for applications that facilitate clinical research and epidemiological surveillance.  In the long-term, the aim is to build research-grade IT infrastructure, so that anonymous patient medical data can be more effectively mined for research purposes.   

18.             But beyond the systems and structures, the real challenge is in values and mindsets.  This is the most difficult part.  Leaders and staff at every level and in every organisation must put collective interest above individual turf.  In particular, the Boards of Directors have an important role to play.  They have to align their institution’s goals with our national policy intent, and help achieve coordination and collaboration.  They have to manage their staff's natural instincts to compete fiercely, and discourage them from building higher walls or putting down rivals.

19.             This reorientation will take time, but changes are taking place. One good example is the Singapore Gastric Cancer Consortium (SGCC), which was awarded a flagship grant to improve the early detection and treatment for gastric cancer.  The consortium combines the clinical strengths of the four largest public teaching hospitals, with multi-disciplinary expertise from NUS, NTU, the National Cancer Centre, and leading research institutes such as the Genome Institute of Singapore.

20.             With more of such collaborations and joint research efforts, we will be able to get clinicians, researchers and scientists from different institutions to gel together, and feel a shared commitment and ownership in this collective endeavour.  At the same time, we must develop this culture and mindset among our young, so that future generations of doctors and researchers will uphold and sustain the tradition of collaboration and partnership.  

Conclusion

21.             The setting up of the National University Health System, the Centre for Translational Medicine, and the broader changes at Kent Ridge Campus are major developments for our entire healthcare sector.  Major changes are also afoot at the Outram Campus, where the Graduate Medical School has been set up in collaboration with Duke University. 

22.            The building blocks are now in place, but there is still a lot of work to be done. The road ahead will not be easy, and there will no doubt be teething problems along the way.  But amidst these challenges lie great opportunities.  Let us build on our progress so far, and take our clinical research efforts to the next level. With our combined efforts, we can all look forward to an efficient and world-class healthcare system in Singapore.

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