I started my career as a House Officer (HO) at Hospital Universiti Sains Malaysia (HUSM) after I graduated from the University Hospital of Wales, United Kingdom in 1987. Later, I joined a master program in Internal Medicine at HUSM and was subsequently qualified as a physician in the year 1993.
In 1993, I was posted at Hospital Raja Perempuan Zainab II (HRPZ II), Kota Bahru as a physician. Later in 2001-2003, I joined as a trainee in the field of Infectious Disease and was attached at Hospital Kuala Lumpur and Newcastle upon Tyne Hospital in the United Kingdom. During this training period, I did a lot of clinical audits and clinical studies and had successfully submitted for a poster publication in United Kingdom and Europe. In 2011, I did a short attachment at the Hospital of Infectious Control at Glasgow Hospital in Scotland.
Currently, I am actively involved as a coordinator for Technical Working Group for National Antimicrobial Action Plan. I am also the Chairperson for Clinical Practice Guidelines: Management of Dengue Infection in Adults where we train health providers on dengue management. Apart from that, I work as a State Physician in Kelantan as well as a coordinator for my Hospital Infection and Antibiotic Control. I carry out many more tasks at the national level as a committee member and continue to serve as a consultant for Infectious Disease.
Can you tell us when and how did you first got involved in clinical research?
I started to be interested in clinical research during my master’s degree training at HUSM. After I qualified as a physician, I started to be involved in pharma-drug trials from 1997 and continue to actively involve as a supervisor for postgraduate Internal Medical candidates in their research projects.
When I was the Head of Medical Department in HRPZ II from 2011 till 2017, I realised that having a strong research team was our asset to participate in international clinical research and be recognised as a centre of clinical trials. I took this opportunity to start training my junior specialists and paramedics by sending them to GCP courses conducted by CRC. As the Head of Department (HOD), I kept encouraging specialists to participate as investigator and our goal at that time was that each specialist to conduct or participate in two clinical trials.
As for my team, we have completed at least 10 trials and currently another 4 trials have been approved and are due to start in December 2018 and January 2019.
Based on the number of trials and appraisal by sponsors, we are very proud that our department is recognised as one of the leaders in clinical trials at hospital or ministry level.
How has clinical trials change your practice and management of patient care?
Often, I use the experiences I have gained in clinical trials to improve my own way of practicing medicine during my clinical work. I have become even more particular in documenting clinical history and signs, more particular in providing options on treatments to patients and more respecting of their choices.
Clinical research helps me to understand the need to do more research in clinical areas in order to have a better treatment options for both acute management and chronic diseases. The best drug today for disease treatment may not be the best treatment in 10 years time as there would potentially be a drug that is safer and has more efficacy than the current best.
No new clinical science discovery means the end of new drug development. Most clinical questions can be answered only from good and high-quality research either for drugs or intervention. So, most of the time you will look at current research in the journal publications in order to find answers. I do that most of the time.
What are the main challenges you encounter when conducting a clinical trial and how do you overcome them?
To have a good and experienced team to do research is one of the main challenges. I would not be able to do everything on my own. Most of us feel that our official clinical duty is already too much of a burden. I try to overcome this by getting them interested in clinical research; I invest on creating highly skilled co-investigators and research assistants by providing them quality training and opportunities. Currently, I have at least 10 of them on my team that are willing to participate in conducting clinical trials. We work closely together and have specific roles delegated when there are ongoing clinical trials. Clinical Research Center (CRC) and Clinical Research Malaysia (CRM) have provide amazing access to the training which should not be wasted and ignored.
It can be stressful to manage the limited time and the high work load we have. Hence, we need to organize our work and create time and space for it. Pre-screening the subjects helps the trials to run smoothly and enables us to achieve our target much easier. I also feel that the involvement in research provide an opportunity for me to do something I like and enjoy. I believe this can be considered as part of my productivity to Ministry of Health of Malaysia to be part of the research landscape. As I believe,productivity is about “knowing what you want to do, intending to do it, doing what you wanted to do and see the results”.
What is your motivation behind conducting clinical trials?
The answer is PASSION and INTEREST. Often, I use research as a platform to provide an option to treat patients who are no longer on treatment or has access to new treatment.
What one word best describes your career as a clinical researcher / investigator? Why?
Satisfaction. Once a research has been completed, I felt like I have proven to myself that I have reached my goal that was set at the beginning of the research involvement. I want to set an example to junior doctors that as clinicians, we can still become a clinical researcher and play an important role to actively participate in clinical research.
In the field of clinical research, where do you wish to see Malaysia in the next 10 years?
As one of the main players that provides high quality research centres and investigators globally. CRC and CRM are 2 important bodies that will enhance and bring more research to our country.
What changes would you like to see being made by the policy makers to create a more conducive ecosystem for the conduct of clinical trials in Malaysia?
For clinicians who are interested to do research – especially for investigator-initiated research – a specific/protected time should also be allocated to them to carry out the research and do the write up for journal publications. This should be for both investigator and industry-sponsored clinical trials. Investigators with successful publication at international congress or high impact journal should be given some incentives in form educational grant.