Why Singapore

By Edward D. Miller, M.D.

It takes 27 hours from the time I leave home until I reach my hotel room in Singapore, half a world away. I last made the trip in October to sign a new five-year collaboration with Singapore’s government that enlarges Hopkins Medicine’s research and educational presence in Southeast Asia.

What does this small island nation offer Hopkins that is so enticing? Why is the School of Medicine’s first-ever division outside Baltimore situated in this faraway, tropical setting? Singapore is a beautiful, modern city-state of 4.6 million highly educated people. A former British colony just south of Malaysia, it is a young, entrepreneurial country with an international flavor. English is an official language and an integral part of the nation’s booming free-market economy.

In the 1990s, Singapore’s government set out to develop a life sciences presence second to none in that part of the world. Because of Hopkins Medicine’s preeminence at the bench and at the bedside, we were approached about building a hospital and running it. We declined but said we’d be interested in education and research programs based on Hopkins’ groundbreaking clinical scientific training model, which was quite different from the existing approach to medicine in Singapore. What evolved, starting in 1999, was a two-pronged effort, a research arm underwritten by the government and a high-end oncology clinical unit—a hospital within a hospital—in partnership with the National University Hospital.

Along the way, we had a few stumbles in adapting to the country’s culture, its social nuances and our role as a “change agent.” Private physicians feared we would take oncology patients from them. Medical research, meanwhile, had never been given the status it enjoys in our country.

When it was time to renew the agreement last summer, University President Bill Brody and I met with government leaders. We felt Johns Hopkins Singapore had not reached its full potential. Bill laid it on the table: “Why should Hopkins be here?” he asked. “If you don’t think it’s working, tell us.” He didn’t get an answer that day, but Bill’s forthright approach proved crucial in negotiating a much-improved partnership.

The new five-year agreement gives Hopkins expanded research space in the ultra-modern Biopolis biotech park where we can pursue studies in genetic immunotherapy, tissue engineering and cell therapy, tumor virology and cancer biology. On the clinical side, Singapore officials want us to do more than just oncology. Our medical director, Alex Chang, already is regarded as the man to see for cancer treatment.

Now, we’re expanding educational efforts with a full-time faculty of 12, a rotation of Hopkins medical students, Singapore medical students spending time on the East Baltimore campus, and more seminars and forums. Singapore lacks internists who are super diagnosticians, and we’d like to add to that side of their training. There’s also a need to train more oncology nurses to international standards of care. We want to encourage them to play the role of patient advocate, something that’s not regarded as part of their role at present.

The breadth of what we seek to accomplish, with significant help from the local government, represents a unique opportunity that brings value to our institution and to Singapore. It does not, though, offer a template for Hopkins endeavors abroad.

In other countries, Hopkins acts as consultant, strategic planner or medical partner. We’re flooded with offers from foreign governments and medical institutions, and I say no to 90 percent of them. The ones we act on must make financial sense, and they must be consistent with Hopkins’ core mission and objectives.

Singapore’s offer was exceptional because of the government’s eagerness to underwrite our effort. I’ve made it clear to them I won’t take money from East Baltimore to support Singapore’s programs. I could not in good conscience tell a faculty member, I’m sorry, I can’t fund your project because I put the money in Singapore. That wouldn’t be central to our mission.

Here’s what I hope the Johns Hopkins Medicine Division of Biomedical Science in Singapore achieves over the next five years.

• A nucleus of world-class researchers zeroing in on early detection of cancers, immunology, early biomarkers and very special tumors.
• Spin-off business activities from this research.
• Extension of Hopkins’ clinical presence to other internal medicine specialties.
• Sustained and growing clinical scientific training for the region’s health care providers.

None of this will come easily. Singapore’s location, far from our home base in Baltimore, makes recruitment a special challenge. But Singapore is focused on becoming the leading Asian center for biomedical research and development. Hopkins is well-positioned to help shape and participate in that nation’s exciting biomedical future.