Boxing clever in research

Ireland is pushing to move scientific discoveries towards patient benefit – and we can learn a lot from Singapore, writes CLAIRE O'CONNELL

AT FIRST glance Ireland and Singapore may not seem to have much in common. Yet, when it comes to biomedical science, the two countries have ploughed similar furrows in recent years, investing in basic research.

But recently Singapore has forged ahead with plans to move discoveries from the scientific bench towards the patient’s bedside. So what can Ireland learn from the Asian hub about clinical research?

The key lies in attracting good people, building up infrastructure and homing in on the rare diseases we harbour, according to Prof Edward Holmes, executive chairman of Singapore’s national medical research council, who sees similar drivers of medical research in the two countries.

“Both have a strong presence of medical device and pharmaceutical companies and that serves as a strong foundation and part of the economic landscape,” he says.

Nor should we overlook the strength of being a relatively compact country: “There’s an advantage to being small, you can get most of the needed players around the table to make important decisions.”

Singapore and Ireland each started to invest public money in targeted basic biomedical research around the turn of the century, and in Singapore the focus was initially on the “Biopolis”, an international research and development centre located close to major universities and hospital facilities.

But in 2006 Singapore made an effort to boost “translational” research in order to realise the full economic and clinical potential of biomedical sciences, says Holmes, who was in Dublin recently to address a national strategic forum on clinical research hosted by the Irish Platform for Patients’ Organisations, Science and Industry (IPPOSI).

Singapore’s strategy centred on attracting good researchers, building facilities that could bring bench scientists and clinicians together and being savvy about the particular diseases where they chose to translate the research, says Holmes.

Now the country is building up its cadre of clinician scientists (researchers trained in both medicine and science), and critical infrastructure such as tissue banks, informatics systems and dedicated medical imaging facilities are being put in place too, he adds.

Another string to Singapore’s bow has been stem cell research.

“Singapore got into that game very early and the stem cell consortium is one of its pillars of strength. I think stem cells are still in early days for everyone but it will be a critical area,” says Holmes.

Yet even with all those connected people and facilities, a small country like Singapore still has to box clever when choosing where to specialise, says Holmes, and the trick has been to find a niche. “Because of where Singapore is, Asia is obviously important, so they are using the strength of having a microcosm of the Asian population to look at. They have about 70 per cent ethnic Chinese population and about 10 per cent Indian and Malay population,” he says. “So the focus is really on diseases that are relevant in those populations, and even though Singapore is quite small with about five million people, it asks questions from clinical research that are relevant to a much larger group of people.”

In practice, that means tackling diseases like gastric cancer and dengue fever, getting insights into disease from a few hundred patients rather than thousands of patients, says Holmes.

Ireland could similarly focus clinical research on conditions such as coeliac disease, sarcoidosis and schizophrenia that have an unusually high prevalence here, according to Dr Seamas Donnelly, chairman of an IPPOSI think tank set up last year to examine clinical research in Ireland.

The focus on translating discoveries into medicines and better practice is centre stage in the Department of Health’s Action Plan For Health Research 2009-13, which was unveiled in November.

A key step in the process is to build up our numbers of clinical scientists to help bridge the gap between bench and patient, notes Donnelly.

There have already been some moves in that direction: the Health Research Board has to date funded seven clinician scientists to reduce their clinical duties so they can lead a research team, and it also co-funds a scheme with the Health Service Executive to allow registrar-level doctors integrate PhD research into their training to be a consultant.

But more is needed to support medical doctors who want to invest time in research, says Donnelly, noting that for many a heavy clinical workload can relegate research to evenings and weekends. “People drive innovation and I think we have very creative, talented people. You could buy out a day of [clinician] time so they can devote their energies and talents for clinical research in daylight hours.”

Donnelly is medical director of the clinical research centre at St Vincent’s University Hospital in Dublin. The Mater, Beaumont and St James’s hospitals also have dedicated clinical research centres and plans are afoot for similar facilities in Cork and Galway. Meanwhile, the All Ireland Cooperative Oncology Research Group (ICORG) brings experts together in cancer clinical trials.

“In that context there’s a possibility for national integrated clinical networks, an opportunity to bring 10,000 patients together with a particular disease in a national way, with clinical details anonymised and sample collection, to provide a very firm foundation, a resource to contribute towards Ireland taking the lead in a particular disease,” he says.

“It’s a matter of national co-ordination and national funding. We are not looking for significantly more investment than is going in, we just need to spend it in a focused way.”

Holmes agrees it’s a question of marshalling resources: “Almost all the ingredients are here in Ireland. Singapore was maybe fortunate to get into clinical research a little earlier, when everyone’s economy was a little better than it is right now. But the tide will turn, it always does.”

What is clinical research?

A recent survey revealed that over half of respondents in Ireland understand what is involved in clinical research.

“Initially about 49 per cent have a very narrow view of clinical research, mainly to do with clinical trials,” says Dr Seamas Donnelly, a board director at Irish Platform for Patients’ Organisations, Science and Industry (IPPOSI), which commissioned the research to be carried out by Drury.

“But when you do the focus groups with [respondents] and show them that clinical research goes beyond that narrow focus to sharing your anonymised personal health data, to giving a blood sample, to giving a leftover piece from a biopsy that might be used in diagnosis, they become extremely positive in that environment.

“Then you get an 80 per cent very positive feedback from the Irish public with regard to sustained investment in medical research. There is an information gap there, but it shows it’s a narrow gap. With a small amount of information the Irish public get it.”