Collaboration towards healthy ageing in Indonesia

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Professor Rebecca Hardy (MRC Unit for Lifelong Health and Ageing at University College London; LHA UCL) and Dr Wahyu Wulaningsih (LHA UCL, PILAR) visited Faculty of Medicine, Universitas Gadjah Mada between May 1-5, 2017 to explore collaboration opportunities which involve the UK and Indonesia. This visit was funded by the UCL Global Engagement Fund and Faculty of Medicine, Universitas Gadjah Mada (FoM UGM).

Rebecca Hardy is a Professor in Epidemiology and Medical Statistics with over 20 years of

experience investigating how individual characteristics and our environment since birth, childhood, through adulthood that influence healthy ageing in later life. During the visit, she delivered a lecture at FoM UGM, in which she spoke to Indonesian students, clinicians and researchers about her experience in studying the process of ageing. Healthy ageing, according to Hardy, is not just about how long you live, or being free from disease, but also about functioning well in old age. Being able to care for oneself and participate in social activities, for instance, are part of healthy ageing.

A life course approach to study healthy ageing

Ageing is a complex process and starts from birth. To find out how we can achieve healthy ageing in old age, scientists have started to evaluate what events could influence the decline of bodily function as we age. In addition, it is necessary to tease out when precisely these events adversely influence the ageing process. For some events, an occurrence in adulthood may be less hazardous on one’s health compared to if they occur in childhood. This ‘life course’ approach can help policymakers and practitioners identify subgroups such as specific age groups in the population who are more susceptible to experience adverse effects of ageing in old age, and therefore, can inform precision prevention.

Insight into challenges in research in Indonesia

Hardy and Wulaningsih visited Sardjito Hospital to engage with clinicians and discuss important issues in lifelong health, such as childhood growth and development. They also took part in a workshop on academic writing for publication organised by FoM UGM at Swiss Bel-In Hotel in Solo, where they exchanged expertise and experience on getting their research published with local researchers. The workshop is particularly aimed to boost research productivity of local researchers, by providing them allotted time and space to fully concentrate on writing for publication. In this workshop, PILAR had a chance to administer a questionnaire about the experience in conducting research in Indonesia to the selected group of researchers. When being asked about what challenges they experience in conducting research in Indonesia, four among the fourteen local researchers mentioned the lack of funding and infrastructure or equipment as the main challenge. Three researchers pointed out difficulties with bureaucracy as the main challenge, with one of them said, “Sometimes we had problems in the bureaucracy when we make multidisciplinary research”. Other issues mentioned included the incompleteness of local data, time limitation, and language.

How to overcome these challenges to do research?

We also asked these researchers how they think these challenges should be addressed. Responses vary and included suggestions for changes at the national level such as improving policies and bureaucracy, with one of them mentioned that, “The national health research and development agency should be more open to researchers from academic institutions”. The remaining responses focused on solutions at individual level, for instance better research plan, communication and collaboration. One researcher in particular advised to “be innovative and be creative”.

What’s next?

A lack of infrastructure and funding is still a major challenge in research in Indonesia and perhaps other low- to middle-income countries. This visit and workshop are only the beginning of a budding international collaboration to improve healthy ageing in Indonesia. In near future, both universities aim to collaborate in research projects and to maintain knowledge exchange in the field of healthy ageing. We will keep reporting how this collaboration progresses. If you are interested to take part, get in touch with us.

Precision Medicine in Lower Middle Income Countries

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There has been a big amount of interest by stakeholders in the field of precision medicine compared to other medical studies in the past (Jama Network). Although a lot of funding has been allocated to this field, low-to-middle-income countries (LMICs) have not had the same amount of financial backing to develop proper research and development. Aside from financial barriers, LMICs have had minimal participation in the research because of other factors including lack of coherent national policies, limited number of well-trained scientists, poor research infrastructure, and local economic and cultural challenges (NCBI).  This is adding to the inequities in health and disparities in access to health care for patients in LMIC countries.

For example, if there is an estimated 234 million surgical procedures performed worldwide, only 4 percent of the poorest one-third of the world’s population undergoes such procedures. What is alarming is there is more surgical need per person in LMICs such as Africa and Southeast Asia compared to North and South America (Jama Network). Health inequities occur not only in surgery, but in maternal and neonatal health, chronic noncommunicable diseases, and cancer.

The health disparity between developed countries and LMICs are alarming. In one country, one person can die from a basic sickness such as diarrhea, while in another country, a patient can have enough financial backing to pay for a 1 year treatment of cystic fibrosis which costs approximately $300,000 (Jama Network).

Investing in Precision Medicine in LMICs

Since the introduction of precision medicine, research and development in the field has been progressing steadily. The research holds promise to improve the understanding of medicine and find ways to cure diseases at a global level. The ultimate goal is to improve the precision of the practice of medicine at individual levels and to inform and educate public health bodies.

Research and development in precision medicine presents a tremendous promise for LMICs because at this time, morbidity and mortality cost of common diseases is disproportionally high. Therefore, an early investment into genomic research has a big potential for returning long-term benefits.

For an LMIC to have a functional precision medicine program, there needs to be investment in biotechnology. There also needs to be a pool of trained medical geneticists, genetic counselors, genetic epidemiologists, bioinformaticians and computational biologists (NCBI).

At a legislative level, LMIC governments should begin to develop national policies that will address human and technology capacity development within the context of their national economic and socio-cultural uniqueness (NCBI). In parallel, an ethical and legal framework needs to be established to protect the confidential information of the patients. The policies curated by the governmental bodies should encourage international collaboration and promote links between public health programs and researchers.

LMIC’s can maximize the impact of available resources by sharing resources and pooling funds to enhance the research results. There needs to be a push from the different government agencies, the private sector, educational institutions and philanthropists. A more robust engagement of LMICs in research and technological innovations will enable these countries to gain the benefits of the discoveries and improve the health of the population.

The importance of promoting healthy ageing: An experience from the Global Ageing Conference

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Zakia Fitriani, a clinician and research assistant in Yogyakarta, Indonesia, recently won a prestigious Travel Bursary Prize to attend Global Ageing: Challenges and Opportunities Conference organized by the Royal Society of Medicine in London, UK. Below is Zakia’s story about her experience from preparing the application to attending the conference which took place 24-25 April 2017.

I heard information about this event from  one of PILAR’s team, Ms Wahyu Wulaningsih. I am currently working in primary healthcare clinic in Yogyakarta, Indonesia and as a research assistant in the Internal Medicine Department of Gadjah Mada University. During my practice, I meet patients with chronic illnesses and from that, I've learned that in parallel to the increase of aging population in Yogyakarta, there are reports of increased prevalence of chronic/degenerative diseases in the region.

I found the title of the event matched the situation in clinic, so I decided to submit an essay to get the travel bursary offering. I was required to write a 500-words essay outlining why I should attend the event and the impact it has on my job. In my essay, I included data from government sources about the chronic/degenerative diseases problem in Yogyakarta.

However, I found difficulties aligning the idea and using proper words for the essay. I decided to contact Ms Wahyu Wulaningsih and she helped me develop  my idea into a good essay. While waiting for the announcement, I was so happy to find out that I was one of the winners of the travel bursary prize.

The Global Ageing Conference

      The Royal Society of Medicine in London         

The purpose of the conference was to promote healthy ageing i.e to develop and maintain functional ability so elderly people can maintain a good quality of life. The event was held in Royal Society of Medicine, Wimpole Street, London. There were around 100 attendees, with carefully selected Speakers who were the best in their field. The Speakers for the event were Researchers and Decision Makers whom I never imagined to meet in person. The audience ranged from undergraduate students, PhD Students to retired specialist doctors from different parts of the world.

The keynote speaker of the event was Mr. B. Sethia, the President of Royal Society of Medicine. Day one topics discussed about the concept of ageing, the social care, barriers to pain and chronic disease therapy access, and retirement age issues. By the end of day one, I joined a workshop discussion about the ethical issues in end of life care and mental health in cities with ageing societies. The day two topics discussed dementia research. It ended with a panel discussion about global approach to ageing, HIV, and war conflict.

With Professor Karen Glaser, Head of Department, Global Health & Social Medicine, King's College London

Even though the ageing population is not homogeny in every place, I learned that for the first time in human history, the number of people older than 65 will soon be greater than those under age five. Indonesia being one of the less developed countries in the world will soon face an increasing ageing population compared to other countries. To overcome this, we need to identify factors and have preventative measures in place. To do so, the government must ensure that there is appropriate funding, a proper healthcare system and health campaigns targeted to the aged.

One of main issues of ageing people’s health is dementia. Dementia has a health, social, and economic impact in different parts of the world and dementia prevalence increases rapidly in less developed countries. Almost 99 percent of dementia treatments fail.

There are several types and risk factors of dementia that effects dementia management/therapy but the recent issue is the possibility to use gene therapy based approaches as the new tools for neurodegenerative disorder.

In order to contribute and promote healthy ageing, we need to combat the stereotypes and discriminations against the ageing population (ageism).  We should educate patients to overcome the stigma of seeing multi-morbidity as a part of “normal” ageing. We must identify risk factors and prevent chronic/degenerative disease to ensure the wellbeing of the ageing population. The government should prioritize policies for better health (physical and mental systems) and create an ageing-friendly living environment. With better education and a healthier ageing population, the countries can benefit from extended working lives.

It is never too early or too late to promote healthy ageing!

From volunteer statistician to presenting in a research conference

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Sam Marc, a volunteer statistician for Pilar was selected to present his research paper in the 5th Seoul International Conference of Endocrinology and Metabolism (SICEM). His project aims to discover whether there is a correlation among collaboration, funding with government, non-partisan and academic institutions to Indonesian institutions and research output, particularly in the field of diabetes and endocrinology. Read about his journey here.

For all opportunities that landed on my lap this year, I could say that my collaboration with PILAR is one that I should be thankful for, for it unraveled the wonders in working in research and writing, one I grew interest doing. I’ve never imagined that I could step out of the outskirts of the economics profession and work with the medical experts. I did not also expect that heeding the call of PILAR for becoming a volunteer statistician will land me to one of my favorite places in the world, South Korea, to present the paper before the medical audience in a conference there. Truly, this partnership I had in this project with PILAR is one in my books.

But what is this project about? As I mentioned earlier, I volunteered to become a statistician to one of PILAR’s advocacies. This project aims to discover whether there is a correlation among collaboration, funding with government, non-partisan and academic institutions to Indonesian institutions and research output, particularly in the field of diabetes and endocrinology. This project fully utilized my potential earned in economics and applied to our study. Headed by Dr. Wahyu Wulaningsih, she asked me to mine data from the Internet, to verify the linkages existing among international and Indonesian individuals and institutions and finally used what I mined to analyze data through statistics, which took me a couple of months.

I thought my contribution to PILAR’s study concluded when I finally submitted the until Wahyu decided to try our “luck” to have our paper screened for the inclusion in the 5th Seoul International Conference of Endocrinology and Metabolism (SICEM), which was held this April. A bit hesitant though, because of my erring schedule, my almost nil experience in research presentations before the public and becoming the principal author for the study even though I only got minor participation, I still tried to send an entry before the conference’s panel for their thorough review. I said to myself, qualified or not, I am submitting the group’s paper just for the sake of having experience to be exposed before the audience who are knowledgeable in research, something that I’m really looking forward to.

After a month, I received an email from the conference organizers notifying me that our project displayed scientific rigor and will be displayed in a two-day poster presentation in South Korea, all expenses paid. A concoction of emotions is what I felt instantly. First is I felt grateful, because the team’s hard work was recognized. I also felt a bit reluctant, because of being a neophyte in public research conference, the interaction that might take place when I will be meeting a medical professional, and the pressure of becoming the principal author for our study. But what weighs the most is that I will gain experience when I get there and the happiness to immerse myself in South Korean culture and lifestyle.

True enough, fear and reluctance were outweighed by the eagerness to be exposed in such activities I had never experienced before. While all in the conference, especially in oral presentations, served only as a "nice to know" information for me, being all of the research topics are too profound an economist can decipher, I also got the chance to mingle with other people and get to know also Filipinos who are also there in the conference crowd. I also got to appreciate how research conference works, and maybe apply on how can I present my research paper in case my profession calls me to do so. In between presentations, I also savored a quick but satisfying taste of Korean living and I get to meet a few Koreans that we are able to talk about life and maintain friendship through social media accounts.

For this great ride I’ve experienced, I’d like to extend my sincere gratitude to PILAR, especially to Dr. Wahyu Wulaningsih, for being so accommodating for every query that I have in the process of making the paper up to my travel concerns in Korea, patience to understand my schedule, and the wisdom imparted in dealing scientifically with data. If there is another chance, and ample time, I would really like to collaborate again with PILAR. It gave me not only recognition, through participating in SICEM, but also being proud that I have contributed somehow to the betterment of the medical professions through the study I have collaborated with them.

Genetic Testing for Cancer in Asia

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For a medical physician to understand the treatment options for a genetic condition, or the probability of an individual developing a particular disease based on their genetic makeup, the person has to go through laboratory procedures and genetic tests to see if there are any symptoms that portray a particular condition or susceptibility (Genetics Home Reference).

Cancer genetic testing is now a well-known oncology subspecialty with the main goal of identifying high-risk individuals through their genetics. There are several types of technologies used to gauge the presence or absence of certain genetic variants in cells, with tests being available for breast, ovarian, colon, thyroid, and some other cancers.

Many patients can take advantage of genetic testing to find out if they are at risk of developing a particular disease. Patients can then take preventative measures. For some cancers though, research has fallen short in identifying mutations especially as it relates to certain racial or ethnic backgrounds (Journal of Clinical Oncology).

In the Philippines for example, the delivery of medical genetic services remains a challenge for both public and private sectors. Despite the health indices in the country showing recent improvements, there is a lack of geneticists and genetic counsellors to serve patients across the different islands (Journal of Community Genetics).

In Asia, there are a few factors affecting the growth of genetic testing. Aside from the high costs associated with genetic tests, many of the results have been called into question due to a lack of credible standard procedures (Market Data Forecast). There has also been a ban on genetic testing in Asia (except for South Korea and Israel) for insurance purposes, with no specific stances taken.

For genetic testing to be more effective and more affordable for patients, there needs to be a greater focus on medical research. The different racial and ethnic groups in the region need to be educated about the possibilities of a cure for certain cancers. By increasing their knowledge on genetic testing, they may be more confident to seek and undergo genetic testing. Investing more care for those who have a higher risk of positive genetic test results may also incentivize individuals to seek testing.

Private companies and non-profit organizations should take the initiative to help bridge the health science research gap in Asia. 

If more research students or doctors want to do research studies in the Philippines, PILAR will assist in funding and connecting them to the right mentors. To connect with PILAR, click to contact us here.

 

 

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.