Research Personality: Professor Dr. Sim Kui Hian
The man at the heart of research
Professor Dr. Sim Kui Hian graduated with an MBBS from Monash University and completed his cardiology fellowship at Monash Medical Centre, Melbourne, Australia. Currently, he holds numerous national and international professional positions including President of the Asian Pacific Society of Cardiology, President of Malaysia Chapter of the American College of Cardiology, Board Member of the World Heart Federation, Visiting Senior Consultant Cardiologist at the Sarawak General Hospital (SGH) Heart Centre, Advisor of Clinical Research Centre (CRC) SGH, and was the immediate Past President of the National Heart Association of Malaysia. He is also a member of the Hospital Visitor Board of SGH and a board member of Clinical Research Malaysia (CRM).
His research interests include cardiac computed tomography (CT), cardiac magnetic resonance imaging (MRI), antiplatelet, metabolic syndrome and acute coronary syndrome (ACS) biomarkers. With over a decade of experience in cardiology and clinical research, CRM was most honoured to have the opportunity to interview the highly renowned heart specialist and researcher who founded the Clinical Research Centre at the SGH. Following are excerpts from the interview:
You ventured into clinical research in Malaysia at a time when Malaysia was not ready to be a centre for clinical trials. Could you tell us how you got involved in clinical research and where did Malaysia stand in terms of industry-sponsored research (ISR) during your early working years?
I was involved in clinical research during my cardiology training stint at the Monash Medical Centre in Melbourne. When I came back to Malaysia in 1998 after 17 years in Australia, I had a hard time convincing the major clinical research industry players of our ability to conduct clinical trials locally because we did not have any previous track record. Being unable to secure a collaboration with multinational drug companies, my colleagues and I started on a few small clinical trials despite several hiccups along the way.
During a discussion with several sponsors in 1999 and 2000, I requested the help of my Australian counterparts to convince the sponsors that we were capable of carrying out clinical trials in Penang, where I was based at that time. Building on the experience we had in conducting clinical research locally and the opportunity given by several drug companies, we managed to build up our credentials. Along the way, other companies and contract research organizations started to approach us with new clinical trials.
How many trials have you conducted so far?
At least 100 multi-centre clinical trials in Malaysia and abroad. In more than 50 of these trials, I was the Principal Investigator (PI), and in more than 20 trials I became the country or regional PI.
Do you mainly conduct ISR?
Most of the trials that I have conducted are industry-sponsored. During those times, we did not have a trained team of clinical research physicians, nurses and study coordinators. We also lacked the knowledge, experience and expertise in developing clinical trial protocols, design and statistics, as well as GCP compliance for our staff and all the other supporting facilities such as a –80 °C refrigerator. Unless the research is in public health or conducted in a university, support from the Ministry of Health for clinical research at that time was insufficient. We realised that if we wanted to conduct our own trials, it was best to collaborate with the ISR players as they can provide training to our research team and handle all the legal and administrative work.
If you want your efforts and contributions to the medical industry to be recognized by the international community, involvement in research is the only way to go
Are all your trials related to cardiology?
Yes, and this includes trials on lipids, high blood pressure, diabetes, antiplatelets and cardiovascular devices such as coronary stents.
Is there any trial which you particularly remember?
There are just too many to recall. Most of the clinical trials that I had participated in were published in reputable international journals. However, I am particularly proud to have co-authored two clinical trials which have been published in the New England Journal of Medicine (which had the highest impact factor among general medical journals in 2012). Being able to document my name in renowned medical journals is testament of my team’s hard work and recognition in the medical field, despite being from the jungles of Borneo.
Did you face any difficulties recruiting patients?
Not really. However, I believe that this issue is not so much about the number of patients an investigator recruits, but more on how capable he/she is in leading and managing the trials. And that can only come through on-the-ground experience and definitely not sitting in an ivory tower.
Most doctors do not have the time to be involved in clinical research as they feel that clinical work takes up too much of their time from their daily clinical practice. What is your take on this?
I believe that it is just a matter of whether you want to do it. If it is something that you do not want to do, having 72 hours in a day won’t be enough to get the job done. On the contrary, if it is something that you want to do, the job can be completed even if you only have 12 hours in a day.
Prof Dr. Sim with CRM & CRC Sarawak staff.
Are you still involved in clinical trials?
If I am around in SGH Heart Centre, I still do. If not, I have a team to run them for me. Clinical trials is not a one-man show. We need to have a team of people that are contactable 24/7. Patients must be assured that if anything happens and I am not around to deal with them, my team mates are there to provide assistance.
How big is you team and was it difficult to get people to join your research team?
About 10 cardiologists. Here in SGH Heart Centre, we adopted clinical research as part of our department’s activities, thus making it a culture whereby everyone participates in it.
Did you always wanted to become a doctor when you were young?
Not really. My father was the youngest of 7 brothers and none of my family members and relatives were doctors. Hence I wanted to be different and be the first doctor in the family.
Okay, but why cardiology?
I lived in Australia for 17 years. I was six months short of completing my specialisation in intensive care when two of my good friends who were cardiologists asked me to specialise in cardiology so that we could meet up once a year at international meetings. That was how I ended up in this field. So, you see, no one is born with their destiny stamped on their forehead. No one knows what the future holds.
You are married with two children. How supportive is your family and do you find time for any hobbies?
My wife has been working alongside me during our training stint in Monash and understands the nature of my work. When my son was younger, he used to tell his friends that his dad is a doctor but works in an airport; simply for the fact that I was travelling so often. There is hardly any time for myself having to juggle between clinical service, hospital and NGO activities, research and politics.
What do you think are the common challenges in promoting clinical research among medical professionals in our country?
The window of opportunity for conducting clinical research in Malaysia is very small because we are seen as a glass half full. Clinical trials have been gaining momentum and becoming competitive in the last few years, with China and India becoming a favourable destination for clinical trials bolstered by their ability to conduct fast and cheap trials. If we do not upgrade our skills and capabilities, once these countries become the major players in clinical research, our services might not be needed anymore.
In your opinion, why do you think many medical professionals are not interested in clinical research?
It all boils down to having passion and enthusiasm in clinical research. Equally important is the realisation that clinical research is a reflection of one’s clinical practice and a platform to be recognised internationally.
Having conducted so many industry-sponsored clinical trials, do you think Malaysia has the potential to become a centre for ISR?
There is no reason why we cannot achieve it. But if we do not move with the emerging research industry giants (China and India), we will definitely be left behind.
You are currently the President of Malaysia Chapter of the American College of Cardiology, President of the Asian Pacific Society of Cardiology (APSIC), Board Member of the World Heart Federation and on the Executive Committee of the Asian Society of Cardiovascular Imaging. What advice would you like to give to our young and budding medical professionals?
Well, generally if you want your efforts and contributions to the medical industry to be recognised by the international community, involvement in research is the only way to go. Very rarely can clinical service alone place you in the international spotlight. At the end of the day, passion, perseverance, hard work and teamwork are the recipe for a successful career in clinical research.
Featured in CRM Bulletin Issue 2
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