Catalyst 2019

Guest-Of-Honour Speech By Minister Vivian Balakrishnan at The Opening Ceremony of Catalyst 2019

19 Aug 2019

Thank you for the opportunity to come back here, because this is the campus where I was a medical student. It is also the campus where I did my postgraduate training. I was even for a very short while the CEO of SGH. I was also a council member of the Medical Alumni Association that used to be a tenant here.

Let me share a few personal reflections based on this journey and how it relates to what you are trying to do here. First, we are in the building of the Alumni Association, and it is worth remembering the Alumni Association is actually pretty old. It’s been here since 1923, and the reason why it was established in 1923, is because in 1905, the first Government medical school was started on this campus.

It is worth also reflecting that this medical school came about because a donor called Mr Tan Jiak Kim approached the colonial authorities and said we need a local medical school to train medical practitioners for the growing population. The colonial authorities said yes, only if you first raise funds. The target was to raise about $75,000, which back then in 1905, was a huge sum of money. In the end, Mr Tan Jiak Kim, and the philanthropic businessmen of that period, raised about $87,000, which exceeded the target, and started a medical school.

In those early years, they (medical students) did not graduate with the MBBS degree. The first graduates had a LMS, a Licentiate in Medicine and Surgery. The Alumni Association was created to fight for equal rights – locals who went through a proper and full medical course should be recognised as medical officers on par with those medical officers who were sent by the colonial authorities to us. It is worth remembering that it was primarily and first and foremost, about (attaining) equality for local graduates.

During my time as a medical student on this campus, in the earlier years, the key objective of a medical school was to produce practitioners, people who, the moment they receive their qualifications, could work as doctors, serve patients and could save lives. It was very practical, and to be honest, even when I look back at my own time, that really was what my medical school was about. And those of you who are more senior here, I think, will recognise that as such.

Then when we reached the mid-80s, and the 90s, there was a change. The purpose of medical school is not just to train doctors, but also research, serious, basic and applied research that will make a difference to clinical practice.

Why did we do that? Well, I think the Government of that time recognised that if we were going to continue to attract and retain the best brains in medicine – people who wanted to be at the cutting edge, pursuing research was one way to attract and retain talent, and also, for us to be able to deliver the best and most advanced health care available at that time to our patients. The next phase came about, a decade, a decade and a half ago, which is about innovation. It is not just enough to practice, not enough to just do research for its own sake, but also to start creating technology that would make a difference, transform our practice, and make a difference to the lives of our people. So in a sense, what I am trying to sketch out for you is that, in fact, even this year, as we celebrate 54 years of National Day, and we commemorate the Bicentennial, there is this narrative of which you are a part of. This just happens to be the latest chapter in the evolution of medical services, medical training, medical research, and medical innovation.

Now, if you stop to think about it, I want then to look at it from a patient's perspective. What do patients want? All patients want a medical system, that, first, has high efficacy. That means the drugs, procedures, the machines actually work, it saves lives, things which are not possible to deliver before can now be done.

Another thing which all patients want is safety, and that whatever you do to me, you are not going to put me at greater risk, but that these new treatments will really make my experience as safe as possible.

The third dimension is efficiency. All of us have been busy clinicians. We have all run clinics with 70 to 100 people waiting for us. And the most common complaint from patients is, “Why do I need to wait so long in order to see you for a few minutes?” People want healthcare to be delivered in a timely and efficient way.

The fourth is the cost of healthcare. You can have the best healthcare system in the world, you can have the safest healthcare system in the world, you can also have the most efficient healthcare system. But if it is the most expensive, or worse, unaffordable healthcare system in the world, it becomes a big political problem, it becomes a big personal problem – if you are unlucky enough to need that type of care.

Now hold these four objectives at the top of your mind first – efficacy, safety, efficiency, cost effectiveness. Now, transport your minds to what has happened in the digital space, particularly over the last 30 years. What's happened in the last 30 years is firstly, the cost of storing information, the bits on your hard disk, is trending to zero. Nowadays, you don't even need a hard disk – it’s in the cloud.

Secondly is the cost of transmitting data. For you to send me an email, that cost of sending a message and of replicating messages also trended to zero. The next phenomenon is what they call the network effect, which means the value of a system increases exponentially with a number of nodes in the network, particularly when information storage and transmission is almost free, it makes it an incredibly useful and valuable entity.

Then, there are a few more things which in more recent years, have also seen dramatic de-escalation of prices. The price of sensors is falling, the price of robotics arms, aiming systems, has also come down not because of work done by doctors, but by engineers, and very often engineers in completely unrelated fields.

Then the next big thing, which we are all familiar with, is the explosion of big data. It's not surprising that you can have explosion of big data when cost of storage, cost of transmission, cost of replication is so low, and cost of sensors are falling. So you have a whole tsunami of data. But really the next breakthrough has been the use of neural networks or simulations of neural networks, in order for us now to reach the stage where pattern recognition which hitherto has been a monopoly of the human mind. Today, automated systems are capable of that. That's why today's computers can see, hear, recognise, and speak.

So if you add these two things – about what patients want, and the impact of the digital revolution more generally – then the question now comes, well, how has it impacted healthcare? And actually, if we are honest with ourselves, we are only just beginning, and it is only just scratching the surface, to truly make healthcare have higher levels of efficacy, higher levels of efficiency, higher levels of safety, and the biggest, and the most difficult nut to crack, being more cost effective.

Now, if you then agree with me that we are still in the very early phases, the next thing then is well, how do we connect? How do we join the dots between the digital revolution on one hand, and the incredible, the exploding expectations and demands of healthcare on the other hand.

I wanted to leave you with three points of how I see these things. Number one, whatever we create, invent, or roll out now, has to focus on personalised medicine. After all, we are now at the day and age where even sequencing our individual genomes is a tiny fraction of what it costs to fund the Human Genome Project just a decade and a half ago. So whatever we do, has to be more personalised, customised. This old habit of hit and miss, let's try and see what works or doesn't work, I think that belongs ultimately to a bygone era.

The next attribute I would suggest you consider is that whatever you invent, and frankly, based on what I have seen and read of the start-ups down here, is that you are looking for connections. You are connecting patients, doctors, nurses, technicians, engineers, a multidisciplinary approach so that we can deliver better healthcare far more effectively than a single doctor alone. I see evidence of that, based on the stories of the start-ups which you have all started or described.

And finally, the other attribute, I would ask you to pay attention to is cost effectiveness. To really make a difference, we have to save money and save time for patients. We need to do that before we can say that we have really harvested the potential of the digital revolution on healthcare.

I’m very glad and happy to be here today. I'm glad that this is a clinician-led innovation, catalyst site. If I can be very frank with you, doctors are very difficult people to manage. But the best people to lead, and to lead by example, and to have moral authority are actually fellow clinicians, fellow healthcare professionals, and that's why I think there is a very useful niche for CATALYST, and for Aardvark Labs. I’m happy to witness the MOUs with the healthcare clusters. This is something crucial, this is something worthwhile. This is something urgent.

So when I say I wish you all the very best, it’s not just flattery. I really mean it from the bottom of my heart. I need all of you to succeed and to succeed quickly in order to make a real difference to the lives of our patients.

Thank you all very much.

Dr Vivian Balakrishnan
Minister-in-Charge Of The Smart Nation Initiative