Professor Edward Holmes: Well, first of all g'day—is that the way you say it?  Thank you, Warwick, for this invitation to visit Australia.  I'll make a few brief comments really from what Singapore refers to itself as the little red dot north of you.  And what's been a new player in this whole new biomedical enterprise, Singapore has been watching and learning from our big brothers and sisters in the US and the UK and maybe some of the experiences that Singapore has had and is in the process of having might be of some value to you here in Australia, because I think it's very much a work or an experiment in progress. 

Seven years ago Singapore was really not even engaged in biomedical research and what this might mean.  Philip Yeo and Sydney Brenner, who's known to you probably as a Nobel Laureate, had the idea to create something called the Biopolis, a very, very exciting experiment to launch Singapore's effort in the biomedical research community.  They succeeded in convincing the government to create an agency called the Agency for Science, Technology and Research, or A*Star, and built this magnificent structure of about 2 million square feet called the Biopolis, which now houses six independent research institutes that are linked together and created the foundation for basic biomedical research within Singapore—a genome institute, a molecular biology institute, a bioengineering institute. 

Then they realised they needed to get closer to medicine to make this whole dream come true and they created a Singapore Institute for Clinical Sciences to act as an effector between the basic science arm and the hospitals and the medical schools in Singapore, created entities like the imaging consortium led by Sir George Radda to bring the latest technologies and imaging not only to basic research, but also to move them into the clinic as a critical infrastructure. 

In addition to that, they launched a very aggressive educational program to train biomedical scientists and convince the government to provide money to train 1,000 PhDs over the next 15 years, about 600 in the biomedical sciences community.  These kids can go anywhere in the world—a lot of them are here in Australia—to receive their PhD and then come back to Singapore. 

Based on this success, the government in Singapore decided two years ago that to really move this where they wanted it to be as a pillar of their economy and to improve the health of Singaporeans, they needed to develop a translational arm.  So two years ago the government appropriated S$1.5 billion, incremental dollars, to support translational and clinical research.  In addition to the investment—and I'll describe what it bought or is in the process of buying in just a moment—they also changed the mission of the Ministry of Health.  And I think this was absolutely critical for Singapore.  Up until that time, the hospitals in Singapore had really one mission, which was to deliver high-quality clinical care in a cost-effective manner to the citizens of Singapore.  And the government made the decision that the mission would be expanded to include clinical research, much like Dr Davies described to you, and that the hospital system would be not only the place to receive health care, but would also be integral in the clinical research mission of the country.  And this has had a profound impact on everyone's job description in the Ministry of Health as a consequence. 

What this has led to—and I'll just mention a few programs because we were asked to say something about the challenges.  And I think the challenges of putting something like the system together in a short period of time have been threefold for Singapore. 

One is the human capital side of this.  While I think Singapore is positioned and is being positioned in the basic science side reasonably well, much like many other countries in the world Singapore does not have the pool of physician scientists or clinician scientists that it needs.  So it's developed a very aggressive system for training individuals, who will not only receive an MD degree or MB BS, but also have an opportunity to get either a masters degree in something like public health and epidemiology or a PhD degree as well.  So one facet of this has been to create a pipeline of physicians who are well grounded in the skills to do both basic and clinical research.  The second was to create a support mechanism for these individuals who had been retrained or recruited to come back in the system and not be swallowed up in the business of doing day-to-day health care.  So awards have been established that provide 100 per cent support for an individual to do research and spend 20 per cent of their time clinically, 80 per cent of their time doing research, and to give them grant support as well.  So they're supernumerary to the health system and are able to concentrate on doing their research. 

A second recognition was we really didn't have the structures in place to facilitate these transfers of information—Dr Zerhouni referred to this earlier today, and he's right—a continuum from basic science up to what we actually do in clinical care, the translation or continuum.  The idea was taken that a tranche of money would be set aside—in this case $25 million for five disease areas—to bring together basic scientists, translational scientists and clinical scientists to focus on a very specific target to try to do something to solve an important problem.  The first one of these awards, for example, was in the small area of gastric cancer, because that's important in the Asian population.  So again it was developing an infrastructure system, much like Dr Zerhouni has done with the clinical translational science awards in the United States, to give a special opportunity to bring together people across these different disciplines to effect translation. 

Then, thirdly, is to develop the infrastructure which would support clinical research, create things like clinical research centres or investigational medicine units within the hospital, as they're called in Singapore; both the US and the UK have clinical research centres and you have them here in Australia as well.  Then something I think that is going to be very important for Singapore is an umbrella organisation to conduct clinical trials throughout the country and have entered into a partnership with Duke University to establish something we call the Singapore Institute for Clinical Research that brings together the hospitals, the physicians in the public hospitals, and the faculty of the schools of medicine and the investigators at these research institutes to really to be able to conduct trials on a large-scale basis in Singapore and across the region. 

Then, lastly, something that very much I think is going to help Singapore is the recognition that the hospital and the research enterprise needed to come together and creation of new entities that had been really the way things had been done in the US for many years, the US is increasingly doing this, where a hospital and a medical school are put under a single governance structure co-owned by the ministry of health and the ministry of education with the purpose of not only providing health care, but participating in clinical research and medical education, the creation, if you will, of an innovation centre around academic and health sciences.  Singapore hopes that these initiatives will be successful in helping it to catch up with what's going on in Australia, the United States, and the UK.  And I think it's an interesting experiment that may be worth watching from Australia to see what does and doesn't work in Singapore and may represent some opportunities for partnerships.  So thanks for inviting us to come, Warwick.  It's been an exciting visit.