Research Strengthening: Why Filipinos should be given more opportunities to do health and medical research

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Dr Don Eliseo Lucero-Prisno III is an Associate Professor of Public Health at the Department of Public Health of Xi'an Jiaotong-Liverpool University (XJTLU). Before joining XJTLU, he was with the Master of Public Health (MPH) Programme of the Department of Public Health and Policy of the University of Liverpool (UoL) in the UK since 2009 where he remains as Honorary Lecturer of Public Health until the present. He is also affiliated with the Faculty of Management and Development Studies of the University of the Philippines (Open University) as Senior Lecturer in International Health, a Research Fellow of Medical Research in International Health of the Centre for International Health of the Ludwig Maximilian University (LMU) in Munich, Germany and a Research Associate Fellow of Cardiff University in Wales.  Don has published in the fields of global health and public health in scientific journals and has authored five book chapters. He is a member of many international organizations, working groups and committees.  He is a sough-after speaker and has been invited to deliver presentations in numerous conferences, meetings, trainings and guest lectures all over the world.  He is a global leader in empowering individuals to become critical thinkers and leaders in global health through his popular global health courses that have been delivered in many parts of Asia, Africa and Europe.  His work has been recognised through a number of international awards including the prestigious Global Health Promotion Practice Award by the International Union for Health Promotion and Education (IUHPE) and the World Health Organization (WHO) and The Outstanding Young Man (TOYM) in Global Health by the President of the Philippines.

  1. Can you briefly describe your research interests?

I am in the fields of global health and public health.  I am particularly interested in health systems and policy and the social determinants of health particularly access of marginalized and poor populations.

  1. What made you decide to do research in this field?

It is based on what I went through in life.  Coming from a very poor background, it made me think how people who do not have resources and opportunities have the same access as those who have.  The dynamics that surround this phenomenon is an interesting field for me--from the global determinants to the immediate ones.  It was incumbent upon me to understand and investigate and find the answers and solutions.

  1. Would you recommend research/research degrees and why?

I would highly recommend having research degrees as they provide a solid and strong foundation to any field of study and inquiry.  One gets to have a better understanding of the approaches and how they innovate these approaches to have a better way of producing evidence.  Of course having a degree is just a start.  Using them continuously makes one a seasoned researcher.

  1. Can you briefly describe your journey to your current position in research?

While I was in my bachelor days, I already had an inkling to get into research as it fascinated me.  It started with my bachelor days when we had research methods modules and actual research plans and projects.  The numbers we played around with was a fascinating stuff to answer unique problems.  As I went through my MD I did research electives.  I even worked for a research center in the middle of my medical school.  And every time I study masters, of which I have two (MPH and MSc) I was always fascinated with reading research articles.  So I try to hone myself with methods by doing a diploma in research methods.  Obviously the PhD is the ultimate degree which made me become an independent researcher.  Until I got to develop many linkages and many awards, which made me feel confident and fulfilled with what I am doing.

  1. What advice would you have for Filipinos embarking or thinking of embarking on a career in research?

To be able to produce evidence that would translate to policy and practice is a noble and fulfilling career as it impacts lives of people.  There are many opportunities that would lead one to while doing research.  This is what many people do not understand.  Thus Filipinos should start embracing this endeavor by providing themselves with the proper mindset and skills.  The rest will follow.

  1. What are the principal differences between research in the UK/China and the Philippines with respect to opportunity?

Funding is a major factor in any research environment.  As there are more research funding opportunities in the UK and China, research thrives better in these environments.  In the developing world like the Philippines this is a major challenge.  Thus we do not see many researchers.  A proper and effective national framework should be in place to enable research strengthening.  These are in different fronts--policy, funding, institutions, education, and incentives to name a few.

  1. Two of PILAR's goals are to a) raise awareness of the research culture in places like the UK and the resulting benefits; and b) provide Filipinos with opportunities to do research. What kind of initiatives would incentivise you to stay in the Philippines and have a research career there?

There are many reasons to stay in the Philippines to work in the field of research as it is rife with many determinants of health.  I work more in the developing world which is the central in the study of public health and global health.  Strong international collaborations will not isolate researchers from the developing world such as the Philippines thus a good approach to keep them in their countries.  Research funding and better incentives such as salaries would be another approach.  This would include recognition.  Research appreciation should start at the grassroots level and from a young age.  

Raising awareness of scientific research by Filipinos

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Dexter Canoy is an epidemiologist at the Cancer Epidemiology Unit primarily working on cardiovascular disease outcomes and their determinants in the Million Women Study, a cohort of over a million middle-aged UK women who are being followed prospectively. He has research interests in the aetiology of chronic diseases and determinants of major causes of morbidity and mortality in the population, and conducted epidemiological research in large-scale (big data) settings. Dexter continues to pursue research into obesity, healthy ageing and life course epidemiology, and is currently investigating determinants of women’s health, including the role of reproductive factors, in the development of cardiovascular disease.

Dexter has trained in clinical medicine at the University of the Philippines – Philippine General Hospital before reading epidemiology for his doctorate at the University of Cambridge. He has previously conducted research in the EPIC-Norfolk cohort study (University of Cambridge), focusing on associations between adiposity phenotypes and cardiovascular disease risks, and Northern Finland Birth Cohort Study (University of Oulu in Finland and Imperial College London), focusing on early life factors of adult cardiovascular, metabolic and respiratory health. Prior to joining the unit in 2010, he was based at the University of Manchester where he pursued research in obesity and cardiovascular disease, closely collaborating with public health, social science and bio-health informatics experts.

He can run a bit, swim a bit, and fence a bit, at least when he’s not injured. But he is rarely injury-free, or so he claims.  

  1. Can you briefly describe your research interests?

I am broadly interested in the epidemiology of chronic (non-communicable) diseases, their burden in the population, and what contributes to the development of these diseases. For many years, I have been involved in epidemiological research using data from some of the world’s largest cohort studies to help identify how factors, such as obesity and reproductive health, influence cardiovascular disease risk.  

  1. What made you decide to do research in this field?

I was keen to understand the wider determinants of cardiovascular disease in the population, and their interrelation with biological factors that are closely associated with cardiovascular disease aetiology. This approach could potentially prevent more cardiovascular disease events from occurring than would be possible by focusing on individual clinical patients alone.

  1. Would you recommend research/research degrees and why?

Doctors and healthcare professionals should have inquiring minds. Obtaining further degree or training in research could help in enabling them to make credible enquiries and pursue questions using valid methods when they conduct independent research themselves or participate in collaborative research. Further research education or training could be useful in critical assessment of new findings, which is crucial in the practice of evidence-based medicine.

  1. Can you briefly describe your journey to your current position in research?

After medical school, I had the opportunity to pursue Master and doctoral degrees in epidemiology at University of Cambridge. My first postdoctoral research work involved a birth cohort in Finland (near the Arctic Circle) which was followed from birth to adulthood. I then moved to the University of Manchester to collaborate with other disciplines with expertise in using large and complex health databases. In 2010, I moved to the University of Oxford to be part of the research team behind the Million Women Study, the largest prospective cohort in the world. 

  1. What advice would you have for Filipinos embarking or thinking of embarking on a career in research?

Research is exciting and rewarding. It is certainly an interesting career path to take. Filipinos should explore ways to obtain further education and training, which could very well be taken in the Philippines. However, it would be ideal to pursue studies and obtain experience in research-intensive institutions, such as those found in the UK.

  1. What are the principal differences between research in the UK and the Philippines with respect to opportunity?

Until recently, research funding in the Philippines have been very limited. The UK invests in research as it is seen as vital in developing the economy and societal welfare. Research infrastructures and institutions have been built and established for a long time in the UK. Unlike in the Philippines, it is possible to pursue research as a full-time career in the UK. There are challenges, of course, not least, by the uncertainties of the UK leaving the European Union (EU), as many research scientists and clinicians are working closely with colleagues in the EU.  

  1. Two of PILAR's goals are to a) raise awareness of the research culture in places like the UK and the resulting benefits; and b) provide Filipinos with opportunities to do research. What kind of initiatives would incentivise you to stay in the Philippines and have a research career there?

We need to strengthen institutions that support and promote research, and build infrastructures (physical and human) that would enable us to pursue high-quality research. Substantial investments from the government and from the industry are certainly needed. Developing networks of Filipino researchers nationally and globally may be very useful. Opportunities for established researchers and young students/professionals to meet, interact and collaborate should be promoted as it might be transformative particularly for the younger generation.

What are the current state and prospects for precision medicine in the Philippines?

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Precision medicine is one of the most promising initiatives for the cost-effective improvement of treating diseases, especially cancer. In layman’s terms, “precision medicine” can be described as customized healthcare for each patient based on their biological, behavioral and environmental differences. Many developed countries are investing heavily in research into precision medicine; however, countries outside the U.S., Europe, and Japan, collectively make up to 60 percent of the world’s population but contribute less than 1 percent of sequenced genomic data globally (Genetic Literacy Project).

Developing countries such as the Philippines historically focus their health resources on managing and eliminating communicable diseases, but do not create programs like the Human Genome Project, which was conducted with the goal of sequencing all of the DNA that make up the human genome, and mapping and understanding all the genes in the genome. As a consequence of this effort, researchers have discovered just over 1,800 disease genes with more than 2,000 genetic tests for human conditions and 350 biotechnology-based products currently in clinical trials (Genome Mag).

PILAR briefly met with Dr. Gerardo Cornelio, who was previously President of the Philippine Society of Medical Oncology and is currently Chair of the Cancer Institute, St Luke’s Global City. PILAR asked Dr. Cornelio on his thoughts about precision medicine in the Philippines, with a focus on genomics-based precision medicine.

Why in your opinion does the Philippines need genomics-fuelled precision medicine especially given the prohibitive costs of genomics techniques?

The Philippines needs genomics and precision medicine to keep up with current state-of-the-art treatments. We have always found a way to counter costs by the “bayanihan” method amongst Filipinos. Many of our patients survive because of support coming from relatives working overseas since they pay out of pocket. Insurance does not cover expensive medicines such as chemo or targeted therapies unless it has a critical care rider. Relatives from all over the world help out but most of these treatments by pharma industries depend on each country’s GDP so we get to keep up with costs.

What is the current state of genomics-based precision medicine in the Philippines in terms of both knowledge and clinical practice?

The current state is still slow, only a few centers in the Philippines have the capability to do these tests.

How is your organisation working to overcome these challenges?

St Luke’s just acquired a next-generation-sequencing machine and is in the process of validating its use. We want to keep up with the best in the world so we partnered with the Mayo Clinic in the U.S. The biggest challenges are ignorance, and refusal to believe from some sectors. A lot still believe in alternative treatments without science hence we often see more advanced cases of cancer. Another challenge is the rising cost, we need more government funding and support for healthcare.

How can universities and non-profits like PILAR work with your organisation to go further, faster and with more confidence in delivering on the promise of genomics-based precision medicine? Also, what are your views on balancing the need for privacy against the benefit that these data can have on research and clinical practice?

Partnering with universities would be best so that trials are carried out academically. I believe healthcare is one sector that may be exploited with regards to encroaching on individual’s privacy but in the end it would benefit more people if done properly and ethically.

What advice would you give to young Filipino clinicians, scientists or entrepreneurs thinking of doing something related to genomics-based precision medicine?

I would really encourage participation in investigator- or industry-sponsored clinical trials with genomic-based precision medicine because it is the only way we can prove the benefits of precision medicine to our patients in the long term.

The Need for More Research Funding in the Philippines

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Research into the basic biomedical sciences has underpinned many of the practices and products we see today in modern medicine. Early research into the genes that determine when and how a cell dies are today being exploited through the use of targeted therapies for a range of different diseases including cancer and neurodegenerative disorders. Nuclear magnetic resonance technology was originally developed to determine the structure of chemicals. Today, however, this technology forms the basis for magnetic resonance imaging (MRI), which is a crucial diagnostic procedure in the clinician’s toolkit. The basic scientists who discovered these phenomena and technologies quite possibly did not foresee the medical inventions that would eventually result from their work; however, their findings were an important step towards allowing others to start thinking about potential applications.

Most private investors and businesses do not want to get into basic research because there isn’t a clear idea of what and when a product may result; however, all these inventions that matured from basic research would not have happened if the research was not done in the first place.

Governments in the EU, UK, Australia and the USA are making major investments to enhance research (especially in the field of precision medicine research) (SCIEX). In the Philippines, the council that is mandated to support health science research is The Philippine Council for Health Research and Development (PCHRD).

Medical & Health Research in the Philippines

Dr. Jaime Montoya, the Executive Director of PCHRD, outlined the challenges for health research in the Philippines and explains why cooperation and partnership are the best ways for a country to raise ‘new funds’. With the decreasing resources especially in the field of research, the country needs a spotlight in this category to make it more effective and focused on the population’s needs.

“A shortage of resources will always be an issue (here and I believe in most countries!)… the current difficult funding situation gives us the opportunity to be resourceful in how we use our existing funds and work with others. A practical approach I see is to increase cooperation between the national programmes and health initiatives so that they address common problems – ideally aligned with our research priorities. This kind of cooperation creates ‘new funding’ by focusing the attention of existing activities on common goals. Today, different groups have resources for their own goals and objectives. But we can achieve higher investment and higher impact by working together toward on a common agenda. In addition to unlocking new funds, this approach fosters participative democracy and a spirit of community responsibility to contribute to the overall good.” (COHRED)

Dr. Montoya’s goal on achieving higher impact through collaboration between departments, disciplines and institutions (including academic, government and private industry) is the key to enhancing the medical and health research in the Philippines. This type of interdisciplinary/ multi-contextual collaboration can enhance efficiency and improve the health and medical system through shared research.

With better funding for different fields of biomedical science, the Philippines will be able to achieve better research findings, which could ultimately help save lives and drive economic prosperity. According to Dr. Tamkun, “It’s important to keep the research going not just because of the discoveries, but it’s also a very big component of the training environment here.” (Collegian). With the current status of funding, there may not be enough support to help different biomedical disciplines who are crucial for enhancing the health and medical industry in the country.

Precision Oncology and the future of Cancer

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Precision medicine has extensively been applied in oncology compared to other fields in medicine. For many scientists and oncologists, ‘personalised medicine’ can often be interchanged with ‘genomic medicine’, which is customised medical care based on a person’s unique genetic makeup.

Greater than 99% of a person’s DNA is identical from one person to the other, but the 1% helps to explain these differences. The small variations in genes may increase susceptibility to a specific diseases or provide protection from certain illnesses. Right now, scientists and researchers are trying to discover how these subtle gene differences cause large differences in health. Once there is a better understanding of these differences, it can lead to better prevention, diagnosis and treatment to different health conditions.

The Future of Precision Oncology

There is still a lot of criticism about precision oncology and the future of cancer. Debates include: How many patients this approach can benefit; the challenges in credentialing and validating drug targets; the design of the clinical trial; deploying techniques beyond DNA sequencing and many more.

According to researchers from the Memorial Sloan Kettering Cancer Center, they note that these challenges are not criticisms of the therapeutic approach, but is part of the learning process which asks for greater commitment to precision studies based on underlying science and early clinical successes.

We are at the end of the beginning of this process. We have learned a lot and we have a lot to learn,” explained Barry Taylor, PhD, Associate Director of the Marie Josée and Henry R. Kravis Center for Molecular Oncology (CMO) at MSK and a third coauthor of the study. “Precision oncology is an attractive yet challenging strategy. A healthy dose of skepticism is essential to advancing a scientific dialogue.” (MSKCC)

Progress in precision oncology requires innovations beyond conventional approaches. Human cancers are complex and cannot be analysed or treated based on one-for-all, empirical strategies. To identify important therapeutical targets, there needs to be a more systematic approach in bringing big data to medical technology. With all the new and powerful tools being available to the medical industry, the main challenge will be in aligning multidisciplinary teams to improve every step in the precision oncology ecosystem. If done correctly, the research community will have better tools to make transformative insights into basic biology of cancer and its treatment.

Thus, the success of precision oncology will rely heavily on advancements in technology (specifically genomic sequencing technology), improved and standardised data gathering and sharing, and better access to cutting-edge medication. In order to achieve them, multidisciplinary collaboration is often the key, especially in countries where resources are limited.

Incorporating Prevention into Precision Medicine

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Precision medicine is getting a lot of traction in the medtech world. Medical forums are gathering thought-leaders from different parts of the world to solely discuss this topic, exchange ideas and share technological advancements; and government bodies in several developed countries are flushing funds for more research in this field.

Precision medicine, when oversimplified, is “most concerned with finding the most efficacious and least harmful pharmaceutical treatments for avoiding high frequency outcomes among patients with existing disease, such as relapse or death after a diagnosis of cancer” (Pub Med). You can read more about precision medicine in our previous post here.

The Balance Between Prevention and Treatment

When taking an approach to patients with chronic diseases, it should not solely be about medicines or treatment. Management of all the different chronic diseases have to be looked at in a more holistic manner, and should be a balance between prevention and cure. Treatment has to be looked at as the last resort to health maintenance, and preventative measures should also be considered before a patient reaches a critical stage of their health.

Most historical data and application focuses on treatment over prevention, but integrating both paradigms of research can lead to a sounder balance of a patient’s health and wellbeing. Aric Prather, PhD, an assistant professor of psychiatry at Precision Medicine UCSF states that “We need to look at the full spectrum of health determinants – people’s individual experiences, family systems, the community and environmental factors. We know that all those things are likely to be related to health and they are also likely to interact with a lot of things we’re collecting data on at the biological level. Now, we need to begin integrating those measures”.

Precision prevention – is it important?

Precision prevention studies a person’s genetic origins together with environmental exposure. Precision prevention assists in tailoring behavioral interventions to an individuals’ characteristics. With data collected based on individual background, doctors or researchers can better understand how and why a disease could develop (National Cancer Institute). For example, if a patient’s background and environmental exposure is closely linked to having a higher risk of breast cancer, then the patient could benefit from taking more assertive health measures to alter the chances of getting the disease.

At this stage, the two are in a constant struggle. It makes sense to closely study how and in what way our genetic origins influence and interact with distinct environmental challenges so preventative measures and cures can be worked on cohesively instead of in silo. There are successful environmental and social epidemiological studies that illuminate the role of environmental factors such as diet, exercise, and stress on disease risk, but they do not fully explain the variance in the prevalence of several diseases in different populations (NCBI).

With precision medicine and precision prevention still at their early stages of transition, there is so much to be discovered and gained by collaborating with other disciplines and other organizations who are focused on improving prevention and reducing the disease burden in populations. If you have any collaborative projects in this field, or want to do a research paper on this topic, feel free to get in touch with us and share your thoughts.

What is precision medicine?

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There have been radical shifts in technology to enhance the way people live. Houses now can be wired and connected to the internet to create “smart homes” and people can monitor their houses remotely. Gadgets such as the Amazon Echo can be acquired to almost act as your personal assistant. In the lines of health, people are now measuring their key vitals – steps, heart rate, distance, amount of sleep and more with sports watches and medical gadgets, with some sharing their data on social networking sites or storing it on the cloud.

What does this mean for the medical and healthcare field?

In the field of healthcare and medicine, disruptive innovations are constantly being developed to improve the health of patients and reduce costs in health care systems. One of the emerging innovations for disease treatment and prevention is through ‘precision medicine’.

Most of today’s medical treatments are still being designed for the masses, but studies show that many factors influence a patient’s response to a disease treatment (National Center for Biotechnology Information); thus more personalized treatment is necessary.

According to the National Institutes of Health (NIH), precision medicine, also known as personalized medicine or individualized medicine, is a type of treatment that takes individual variation into account to assist patients when getting healthcare treatment. This includes collection and measurement of a patient’s genes, environment, lifestyle and even the microscopic organisms living inside the body.

Precision medicine does not literally mean the creation of drugs or medical devices that are unique to each patient, but rather, the ability to customize treatment based on a group of people’s genetic variants. From this classification method, doctors can more consistently predict their patient’s proneness to certain diseases, the biology of diseases that may develop, and their response to particular treatments.

The concept of precision medicine has been a part of healthcare for many years. An example is when a blood transfusion needs to take place – blood is not given from a randomly selected donor; instead, the donor’s blood type is matched to the recipient to reduce the risk of complications. When precision medicine is looked at from a more holistic view, its use is still inadequate. Researchers and doctors are hoping to expand this to other areas of health and medicine in the coming years.

As stated in an article by Ken Hamill on “Worldwide Efforts to Accelerate Precision Medicine”, the White House, EU, UK, and Australia are making major investments to enhance the research in this field. The question is – how can the stakeholders in the medical and healthcare field collect, regulate, compile and interpret all this information that would be usable with the rapid scientific developments?

Pilar would like to work with individuals and organisations who want to enhance the potential of applying precision medicine in patients located in developing countries such as the Philippines and Indonesia. Currently, there is no government authority primarily focused on enhancing this field of study. If you are interested in helping out or being a part of the research on precision medicine, drop us a line here and we will get in touch with you shortly.

 

Healthcare and Medical Research in the Philippines: Current state and challenges

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The growth of medical technology and medicine is helping patients to live better and longer lives. Take cancer as an example. Innovations in genomic medicine now mean that patients are able to receive more personalised treatment than ever before as physicians diagnose and target an individual’s cancer based on its molecular profile rather than the gross anatomic and clinical profile. However, in less-developed countries, the application of personalised medicine is still far from where we want it to be.

In the Philippines, cancer is one of the top four causes of death from non-communicable disease (WHO). Although cancer is a huge cost burden on the Philippines’ healthcare system, the availability of healthcare data such as cancer registration is still considerably below international standards. In addition, education, advocacy and focused services for cancer research for Filipinos often rely on private non-profit organisations such as the Philippine Cancer Society. This organisation was founded by a group of laymen and medical doctors who believe that Filipinos deserve better access to healthcare.

Healthcare for all Filipinos

An explanatory note by the Honorable Juan Edgardo “Sonny’ M. Angara announced that, “The State shall protect and promote the right to health of the people and instill health consciousness among them.” (DOH).

However, at the moment, healthcare in the Philippines is still treated as a commodity rather than a human right. When the Department of Health and PhilHealth conducted a joint Benefit Delivery Review for the National Health Insurance Program (NHIP), the survey showed that only 53 percent of the entire population was covered by the program (DOH).

Although this right is assured by the 1987 Constitution, the health care system in the Philippines is still hindered by several factors and is still far from reaching its goal of having healthcare accessible to every Filipino.

Research to improve healthcare

Any form of medical expertise we enjoy today was developed through years of effort by the government, by private entities, by physicians, scientists, and other medical professionals who constantly explore the causes and treatments for various diseases. However, there is still so much to be done in medical research to enhance the lives of Filipinos by lessening the impact of health problems.

To this end, our collaborative research network, primarily comprising higher-education students and early-career academics, aims to advance healthcare in the Philippines through healthcare-related research. We are working with scholars who have expertise in clinical medicine through to computational biology to find out why certain diseases develop as we age, what can be done to better prevent and cure these diseases, and how to optimise healthcare delivery. To attain these goals, it is our ambition to advance the knowledge and skills of early-stage academic researchers, clinicians and students in the Philippines and Indonesia through the provision of advice, research resources, and workshops.

Are you a researcher based in the Philippines or Indonesia? Do you have any ideas of collaborative projects with you or your organisation to achieve the same goals? Feel free to get in touch with us and share your thoughts.

Launch of new blog

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Welcome to PILAR's new blog! This blog page is intended to keep you up to date with news on chronic disease and healthcare research of relevance to the Philippines and Indonesia, upcoming activities, funding or scholarship opportunities, and other useful information for Filipino and Indonesian early career researchers.

If you want to know more about what we do, why not check our aims and objectives, or the work that we have done so far? Also, read what the press has said about our collaborative research, including a study in which we uncovered the negative impact of economic crisis on cancer outcomes, as well as a second research output in which we identified groups of breast cancer patients who are less likely to complete their hormone treatment.

We aim to update this page regularly, so stay tuned for future posts. You can also follow us on Twitter @pilar_network.

Have any suggestion for our website or blog? Let us know.