Singapore — A plate of worms; a blood-pressure
cuff sitting on a table near a housing project; an endoscope used to peer into
the stomach.
All are emblematic of the wide variety of Asian
research I got a glimpse of in four days of interviews here.
Why do so many scholars think that the 21st century
will be the Asian century? The answer isn’t just that many Asian universities
are racing to be research powerhouses. Depending on the country, there’s as
much stumbling as there is running.
A different answer is that the focus of biomedical
research, by virtue of population alone, will have to shift to Asia. About
4.1-billion of the planet’s roughly seven-billion people live in Asia.
Demographic shifts in the Asian population will shape research: China’s
one-child policy and family-planning programs promoted in many other Asian
countries, for instance, have led to a larger proportion of the Asian
population being elderly, with fewer young people to take care of them.
The blood-pressure cuff and the plate of worms are
symbols of aging research. I saw a blood-pressure cuff on a table in an
open-air pavilion near a government-housing project in Singapore, where
researchers were trying to help the elderly manage their own health care. As
for the worms, some National University of Singapore scientists are using a
popular research model, C. elegans, to find out why some worms age well and
others don’t. The worms, unlike humans, are genetically identical, so
differences cannot be blamed on genes. Graduate students gaze through
microscopes at plates of worms to find the ones that are aging well.
Gastric cancer may not seem, at first glance, to be
an exciting research topic. But consider this: Early detection could mean the
difference between just having the stomach lining removed through a small
incision rather than major surgery to take the whole stomach out. Older Chinese
men are disproportionately affected by gastric cancer. “It’s very much an Asian
disease,” says Wei Peng Yong, a senior consultant at the National University
Cancer Institute in Singapore.
The researcher who can come up with a good test that
finds those in the early stages of the disease could spare millions of people
the risks of major surgery, and the subsequent effects of having to live
without a stomach.
Once in Hong Kong, a university administrator drove
me past three tall apartment buildings clustered next to each other. He told me
more than 900,000 people lived there. That’s when it clicked for me: One highly
contagious, lethal virus on an elevator button and a lot of people could die.
In addition, scientists understand that as Asian urban areas expand out into
rural, agricultural ones, more infectious agents could make the jump from
animals to humans. Emerging infectious diseases have been an early focus of
Asian research.
In Singapore, I met a few researchers working on
infectious diseases. One was Vernonika Von Messling, a German-trained
veterinarian who has spent time at the Mayo Clinic and a research institute at
the University of Quebec, and who is interested in respiratory viruses,
including those that cause the flu. For her, one of Singapore’s attractions is
the ease of working with pigtail macaques, a monkey from Southeast Asia that,
were she working in North America, would need to be imported and quarantined.
Focusing on bacteria and viruses alone is never
enough, though. Ultimately, how health care is organized drives the delivery of
medical treatment, and studying that delivery often falls to social scientists.
Sometimes Asian countries have shied away from
supporting social scientists, for fear that their research would be critical of
governments. That is changing.
Eric A. Finkelstein, a health economist, says that
when he moved to the Duke-NUS Graduate Medical School in Singapore from the Research
Triangle Institute, in North Carolina, he was the second health economist in
the country. He is interested in the “economic causes and consequences of
health behaviors.”
He originally thought his job change would be a step
down, but he wanted to try living in Asia. After two and a half years here, he
doesn’t feel that he made a bad move: In 2012 alone, he has 15 papers published
or forthcoming. Despite just a short time abroad, Mr. Finkelstein feels that he
has been instantly labeled “global” and that his career has gained cachet.
Singaporean health care is organized differently
than in the United States, and those differences can shed light on consumer
choice, Mr. Finkelstein has found. Singaporeans with health-savings accounts
that contain both their own money and employers’ contributions seem to have
less interest in spending that money on expensive late-stage cancer treatments,
for instance, and as a result, utilization of those treatments is lower in
Singapore.
Across Asia, researchers like Dr. Von Messling and
Mr. Finkelstein are building informal, “bottom up” coalitions of researchers on
many topics so they can share everything from tissue samples to ideas. Western
researchers not involved in the region risk being on the outside of those networks,
looking in.
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