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PHL left behind by neighbors in health diagnostics R and D.

Decrepit, dark and with cranky equipment. This is the image one would have when the name of the Philippine General Hospital (PGH) comes to mind.

However, did you know that health diagnostics at the PGH are on a par with the private sector's state-of-the-art equipment?

Dr. Carmencita Padilla, the chancellor of University of the Philippines Manila, said, 'We got a huge budget [from the government] a few years ago to upgrade our diagnostics.'

Academician Dr. Jaime Montoya, also the head of DOST-PCHRD

She explained that all 28 operating rooms in PGH that serve 600,000 patients a year are 'state-of-the-art' and affordable 'because the equipment were provided by the government.'

But not everyone has the luxury of affordability and accessibility, and not every hospital in the country has high-quality equipment. For Padilla, all government hospitals must be state-of-the-art, 'not just PGH.'

The status of health diagnostics in other public hospitals need more improvement, the reason Filipinos opt to seek the nearest private diagnostics facility for tests that may not be affordable. The affordable ones are for basic tests, such as urinalysis or blood count, but in more complicated situations, diagnostics can be expensive or inaccessible.

Chancellor of University of the Philippines Manila Dr. Carmencita Padilla

In order to address these concerns, research and development, policy and regulation must be formulated for the benefit of the people. But creating these meet a lot of blocks along the way.

'One of the things we have to do is bring down the cost of medical devices because it is definitely expensive,' Padilla told the BusinessMirror. This is one of the projects Padilla is working with the Philippine Council for Health Research and Development (PCHRD) of the Department of Science and Technology (DOST).

Innovations on health diagnostics R and D in PHL

In the Philippines, research, development and innovation on health diagnostics are done by only a few institutions. These concerns were discussed during the Joint Policy Workshop on Diagnostics in Southeast Asia held in Tagaytay City last month. It was organized by The Academy of Medical Sciences (AMS) and National Academy of Science and Technology (NAST). Academician Dr. Jaime Montoya, who is also the head of DOST-PCHRD, told the BusinessMirror that there are many problems the health diagnostics research and development (R and D) face in the country.

'First, on innovation, we are doing diagnostics R and D in the country but only in few identified institutions, such as the University of the Philippines, University of Santo Tomas, Ateneo de Manila University and De La Salle University.'

Montoya added that these universities focus only on priority diseases like dengue, influenza and tuberculosis, because these diseases 'cause significant mortality in the country.'

The reason behind this is that these institutions could not access government funding unless topics for R and D are aligned with the National Unified Health Research Agenda set by the Philippine National Health Research System.

The workshop's goal was for health diagnostics to be used to look at the patients holistically and not just at a certain condition.

It also aims to build AMS's report on multimorbidity, or the 'the coexistence of two or more chronic conditions in the same individual that has a specific impact on safety issues in primary care,' as defined by the World Health Organization.

In terms of investments in R and D for diagnostics, Montoya said the country is left behind.

'Actually, [the Philippines is] just better off than Cambodia, Laos and Myanmar [in Southeast Asia], while Vietnam is almost the same level as us depending on what reference you look.'

Even though PCHRD has allotted NAST a budget of P70 million for 2018, P72 million for 2019 and P200 million for 2020 through its Grants-in-Aid program for R and D on health diagnostics, among the Asean nations and in terms of innovation, the Philippines still tails behind its neighbors, such as Malaysia, Thailand and Indonesia.

The lack of researchers, scientists and data

What are reasons R and D for health diagnostics in the country has not improved?

'[The reason] is not just about support and money but also human resource,' Montoya said. 'We have a lot of doctors, but most doctors do not go into research, they go into clinical practice.'

Montoya added he wants to encourage doctors to do research because they are the ones who know both worlds. For him, they are the perfect people to be involved.

'They know the practice of medicine, and they know what's going to be used, and they also know about science and medicine.'

Currently, most of the researchers who work in the health sciences are not medical doctors. According to Montoya, they are either people in laboratory or public health.

Padilla, on the other hand, said that she needs more interested clinicians and researchers.

She added she needs clinicians to do research because they can provide questions. 'They may not be the one who will develop it but they are keen to develop the data that will be used for policy.' Besides the human resources, another problem is on data. Padilla said the Philippines has more health statistics than data. Data is a direct result of a research and can be used to create new information. Statistics, on the other hand, is the result of data gathering.

'PGH is putting a lot of attention now on producing more research from our patients so we can produce data for our government,' Padilla explained. 'Our problem is we don't have much data, and we have more statistics. I'm really glad that the DOH [Department of Health] is looking at their data [now], because our data can feed into DOH for them to come up with policies.'

She noted that without data, 'we could not make policies.'

The real problem: 'Valleys of death'

For Montoya, the real problem is the translational gaps, or what he called 'valleys of death,' and he cited two of them.

The first concern for Montoya is that most researches done by institutions 'either just get published or never gets published or ends in the laboratory and doesn't go beyond that.'

Montoya emphasized that the reason is lack of adoptor.

He explained that for a research or technology done inside the laboratory to work for the public, clinical trials are needed, and these are very expensive.

'Clinical trials are done by multinational companies so, the government, for example, rarely invest in clinical trials because they're very expensive.'

Montoya explained that clinical trials involve thousands of patients and are followed up across time, therefore making it resource-intensive, and this is where the valley of death comes in.

'This is the point of proof of concept and commercialization to the market, and scientists don't know how to bridge this,' he noted.

The academician said industries know more about these steps. He is hoping that more partnerships be made between scientists or institutions with companies, and these companies must be involved early.

'Not when the technology is almost there, and then you present it to the market or industry. They will say, 'we don't see it to be useful,' and then you lose everything you have done in the past.'

All initial development must be done in partnership with possible adoptors even if the government is funding these researches.

The other valley of death is the incentives for companies who invest in diagnostics because 'there are more risks than benefits.'

He said there must be 'something' for these companies, because they invest in money and they face the uncertainty of return of investment, because these companies want the test to be available on a wide scale, at the very least.

'This is something that is very hard to do with the current setup that we have [in the country],' Montoya lamented. 'That is why, through the Asean network, we can get expertise across the region, exchange, collaborate so that we can improve the systems we have.'

Montoya believes that the country has the know-how, the scientists and research institutes. 'What we lack are [the means on] how to bridge the valleys of death, how to bring it [R and D] to the market, because this will include the knowledge of the market and information, which scientists are not experts on.'

Asean DxD Initiative

In the 75th Meeting of Asean Committee on Science and Technology in Cebu City last month, the Philippines and Singapore jointly chaired the Asean Diagnostics (Dx) Development Initiative where it addressed the clinical needs of the member-states and to accelerate solutions to the market.

'Through this initiative, we are partnering with DxD Singapore because they have the connections with industry partners, the big and small companies in the Asean region, and they will actually match our technologies, our scientists to the right channels and maybe also guide us to the valleys of death,' Montoya said.

According to Dr. Sidney Yee, CEO of the Dx Development Hub (DxD Hub) and executive vice president of the Incubation and Startup Management Division, 'This is actually a public-private platform that is able to bring the industry and the public sector, regulators, experts and policy-makers together as early as possible to ask questions, consider the issues needed to be considered very early on at the point of developing a solution.'

Yee meant that they will open up a call for proposals on January 2019 on an Asean-wide search and use these proposals to accelerate innovations of health diagnostics into the market for adoption.

'It will take away the sequential workflow, and we can accelerate the time [to reach the] market.'

According to Yee, at present it takes eight to 10 years to develop and market health device and technology to the Asean nations. But with the proposed DxD Hub, it will now take only two to three years to complete the process.

Yee also told the BusinessMirror that this initiative is 'something that makes sense to our Asean community.'

For Yee, it's not just for the test or certain health diagnostic or medical device to work, it must meet the three As: accuracy, affordability and accessibility.

'We'll use first the projects chosen from the call as pilot cases to take to this public-private partnership, and we will still talk with different companies,' Yee said.

She hopes that with more corporate investors, nongovernment organizations and some charitable foundations, they can see if they can do very specific funding for building these solutions for health diagnostics.
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Publication:Business Mirror (Makati City, Philippines)
Geographic Code:9PHIL
Date:Nov 25, 2018
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