MEDICUS: Looking back, what impact has the formation of the AMC had on research?
Pat Casey: If we hadn’t become an AMC, we would not have had anywhere near the impact that we have had. Each of us would have done some good science and would have probably been known in a couple of areas at some level. Joining forces took it to a whole other level in terms of international recognition and impact on healthcare and health systems.
Lim Soon Thye: Apart from the impact we have as an AMC, the branding that Duke-NUS brings has opened doors for a lot more collaborations both locally and internationally with research institutes like A*STAR and the Singapore University of Technology and Design. This academic culture is very fertile for researchers.
Another critical impact is the talent pool that has come through because of this collaboration. These days, the interest among physicians in courses related to research—whether at the master or PhD level—has gone up a lot. Young faculty want to pursue master’s and PhDs. And the Clinical Sciences (now Clinical and Translational Sciences) PhD offered by Duke-NUS is extremely popular. That in itself is an indication of how the mindset has changed among the current generation of faculty.
MEDICUS: How did you bring the two sides together and trust each other?
Lim Soon Thye: Over the last ten years, things accelerated when Duke-NUS moved into the Khoo Teck Puat building and the joint institutes were formed—that’s when the interaction increased. There was a deliberate attempt to generate interactions. In the early days, people were always asking ‘Who should I talk to at Duke-NUS?’ But now, it’s organic. People know exactly who they’re going to approach; they know who’s in the various signature research programmes. So, the understanding of the landscape has increased a lot.
Pat Casey: We had our two offices of research connected in such a way that there was no wrong door. People could show up at either place and get quality information about how to connect with like-minded people or individuals with similar interests and initiate a collaboration.
MEDICUS: How has this impact been felt by researchers like yourselves?
Lim Soon Thye: To succeed, you need an ecosystem where everyone feels very comfortable—whether you’re a basic scientist, bioinformatician, clinician or trialist. In the earlier years, there’s a lot of discomfort when the different groups interact together because there’s a lot of preconceived ideas of what each of us does.
So, in my team, every Friday morning, scientists, researchers, clinicians come together in a clinical environment where they listen to clinical problems—what patients were diagnosed with, which patients relapsed—and slowly, the discomfort evaporated. So, we have created an environment where people are very comfortable in bringing scientific observations to the clinic back to the scientists. For me, this makes for a very interesting environment to work in, one where I can investigate observations quite seamlessly.
Pat Casey: Together, we’ve created an environment where top young scientists and trainees want to come. And that’s what you want to do—attract the best talent. That’s what makes all the difference.
MEDICUS: You are driving a lot of change, so how do you unwind from this large responsibility?
Pat Casey: I try to be outdoors. I start up every morning at 6.30am or so with a three or four-kilometre walk just to kind of unwind my head to start the day. And I like to get out late in the day as well.
Lim Soon Thye: I will try to do a high-intensity workout three or four times a week because it’s efficient in terms of time. I still have a young family, so that is my biggest source of unwinding.
MEDICUS: So, what have been some of the most notable successes of the AMC?
Lim Soon Thye: It is the investment in the basic sciences. When this crisis came, it demonstrated how quickly we could pull together the resources to do testing, innovation and clinical trials. All the supporting structures enabled an accelerated response to COVID-19. Pandemic response aside, we have been very successful in attracting clinical trials in this AMC. This is important because it provides opportunities to patients who have run out of options.
Pat Casey: In the years before the pandemic, it was really cancer and dengue. Work on Asian-prevalent cancers, in particular, captured the attention of the world and had a huge impact. In the cardiovascular and metabolic arena, our investigators’ work on fibrosis also had a huge impact. In recent years, our programmes in neuroscience and health services research have also had notable impact.
MEDICUS: As we start 2022, what are the key focus areas for research at the SingHealth Duke-NUS AMC?
Lim Soon Thye: For research to be most impactful, it has to match the needs that the country or region is facing. In Singapore, ageing is a definite issue. All the issues related to ageing—whether it is in terms of eye, heart or even cancer—have some common themes. And SingHealth is investing in regenerative medicine as one of the key priorities.
Secondly, health has evolved. We used to go to heroics to try to cure end-stage chronic diseases. But rather than be the hero, why not prevent the disease from developing in the first place? So, our emphasis now is on healthy living and population health. With that comes a new funding model based on population health and that has an impact on how we organise ourselves and adds focus on population health research.
But among all these changes, how do we sustain academic medicine? So, our research and education entities must be able to sustain academic medicine and that means that the need to focus on innovation and commercialisation will be increasingly important in the years to come.
Pat Casey: Ageing and regenerative medicine is an area where we are equipped and poised to contribute and that also fits national priorities and health needs. On the Duke-NUS side, in particular, that’s going to be a major area for us both out of the neuroscience programme and the cardiovascular and metabolic programme.
As Soon Thye said, 10 or 20 years ago, the focus was on fixing problems. Now, we try to head off problems before they come and that’s where population health and precision medicine come into play. At the end of the day, people will still get sick and end up in the hospital. That’s where precision medicine comes in. And that gets back to the core of what Duke-NUS does as well as the research institutes within the health system. We are trying to understand the molecular basis of disease so that we can then go into a patient and understand precisely what’s wrong and hopefully have a tailored suite of responses, therapeutics or interventions that can help that particular person.
And bringing new technologies to bear, particularly in data science and artificial intelligence—this is where the health system has a huge advantage because they have the data. If we can understand how to analyse that data effectively, we can make great strides.
MEDICUS: What do you think are the biggest hurdles to achieving this vision?
Lim Soon Thye: The biggest obstacle is culture. You need to create a culture that makes people want to stay for the greater good. You also need to nurture a spirit of innovation, of wanting to educate the next generation and break the boundaries. And it starts in medical school. Making sure that students feel respected and connected to the clinical environment in the early years of training is very important to imbue the right culture. Creating an environment where we allow talent to flourish, where it’s easy for people to become clinician-scientists. And building a bit of resilience because it is a difficult track.
When I was a young faculty in my early 30s, I went to the University of Southern California to join Alexandra Levine, who encouraged me to ask and investigate all kinds of questions and opened her network to me. This experience was a real turning point. Levine is among the best in the world and she encourages questioning and openness. When I came back to Singapore, I wanted to re-create that kind of environment.
So, to help that culture, we focus on building enabling structures. We make sure that the governance and policies that support innovation and commercialisation are there, so that we make it attractive for people to want to do this. These hygiene factors are very important and we must always be connected to the pulse on the ground.
Pat Casey: Academic science selects a particular type of individual. They’ve got to be very bright, passionate and committed. But they also want to do things their own way, so you have to be able to accommodate a constellation of characters who commit to a basic level of shared culture and mutual respect.
Like Soon Thye, I benefited from terrific mentors early in my career. My postdoc advisor went on to win a Nobel Prize a couple of years after I left the lab but was still in the lab every day talking science. He never turned you away if you had a question and always wanted to work with you if you had an idea, which developed curiosity, and that just made all the difference.
So, the challenge of keeping people at some level of focus is getting them together so that they interact. This is why the last year has been tough. Science runs a lot off of those occasional interactions when we meet someone in the lift or the hallway or have a discussion over coffee—these drive a lot of good science. There are many ways to be successful in science and research, but they all involve a commitment to excellence, a commitment to training and a commitment to working together. If you’re not collaborative in this day and age, you’re not going to succeed. You’re not going to do the same level of science or have the same level of impact that you could have otherwise.
MEDICUS: What will success look like for the AMC?
Pat Casey: You want to see a tangible impact on health. You want to see rates of diabetes, end-stage kidney disease, heart failure—all trending down, while longevity increases. Those are the data points you really would like to see. From the standpoint of a medical school and developing faculty, we want to see that we’re capturing the lion’s share of the funding, that we’re publishing the major papers that are cited and that others use to advance their science.
Lim Soon Thye: Hopefully, we become the benchmark that people use to compare themselves against. The patient experience will be another marker of success—measuring the ability to allow as much health to occur in the community or at home.
We also want to be the employer of choice, the institute that people want to join, the institute that people come to seek help from. A last marker of success would be the joy and pride felt by our workforce.
Pat Casey: I like the idea, Soon Thye, that we are the AMC that others benchmark against rather than us trying to benchmark ourselves against others.
At a macro level, I’ll add that you want to be a country that’s spending ten per cent or less of your GDP while delivering the top healthcare in the world.
MEDICUS: Thank you both for sharing your insights with us.