Research Personality: Dr. Tee Hoi Poh
Consultant Gastroenterologist Gastroenterology Unit, Department of Medicine Hospital Tengku Ampuan Afzan, Kuantan, Pahang
There should not be a perception that doctorsare neglecting their regular clinical work to participate in clinical trials. In reality, these doctors are going the extra mile in taking up trials and this should be encouraged.
Dr. Tee Hoi-Poh is a Consultant Gastroenterologist at Hospital Tengku Ampuan Afzan (HTAA), Kuantan. He obtained his MBBS from Bangalore University, India in 1998 and received his MRCP from the Royal Collages of Physicians, UK in 2004. He juggles his roles as consultant gastroenterologist and the Ministry of Health’s Physician in-Charge for the State of Pahang. He is a board member of the National Gastroenterology Training Committee and honorary lecturer at the International Islamic University of Malaysia, Universiti Sains Malaysia and Universiti Kebangsaan Malaysia.
Dr. Tee was awarded three Excellent Service Awards by the Ministry of Health, participated in 14 clinical trials as a principal investigator (PI) and has published extensively in reputable international journals such as the Journal of Gastroenterology and Hepatology and Journal of Microbiology, Immunology and Infection.
His foray into clinical trials began in 2007 when he was a gastroenterology trainee. He was entrusted to run a trial for a proton pump inhibitor to treat peptic ulcer disease in Kota Kinabalu, Sabah. Peptic ulcer disease was quite prevalent in Kota Kinabalu at that time and he managed to recruit sufficient patients to participate very quickly. This spurred him to venture into more industry sponsored and investigator-initiated trials. Being at the right time and place, and having the right support was crucial motivation to him.
Dr. Tee divides his time between clinical practice and trials by getting his trial patients to attend clinic on quieter days. He also credits Clinical Research Malaysia (CRM) for providing assistance through CRM’s Study Coordinators, who handle the scheduling of patients’ appointment days. As PI, the main challenges in performing clinical trials are meeting patient recruitment targets and maintaining the patient’s health and safety. But the devil is in the details. He credits CRM and his study coordinators for helping him in dealing with budget negotiation, plan appointments for patient visits, and calling up potential trial candidates. This frees his time to concentrate on his responsibilities as a PI.
Dr. Tee said that doctors should participate in clinical trials because it gives them a new perspective of the study and practice of medicine. It also prepares them for their future when they may have to take on leadership positions. It is not just clinical issues that need to be considered when doctors participate in clinical trials, doctors must also consider the budget and amount of man power required. In addition, they must consider how best to run a trial with the resources that are currently available, to give the best to their patients. Industry-sponsored clinical trials are designed by the best brains in a particular field. At times when a PI attends the investigator meeting, one can feel the thrill of being a part of the ground-breaking research that will be cherished in future. As a PI, Dr. Tee feels that adhering to the well-designed protocols actually teaches him the best way to manage a particular clinical condition. Dr. Tee gave the example of his clinical trial for the treatment of hepatitis C. The treatment of Hepatitis C is very costly; a course of treatment can amount to RM 150,000. With a clinical trial, he is able to provide the latest treatment to his patients at no cost. Clinical trials also help doctors build good rapport with their patients, as they can offer more than just the standard treatment, when necessary. It is like having a backup plan if all standard treatments fail.
When asked about how his patients respond when asked to participate in a clinical trial, he said that the concept of a clinical trial is still new to most patients. They are not aware of what it is and some might think they are being used as a guinea pig. Most of his patients who have completed a trial, appreciate the efforts made for them. He is proud of the fact that even though his centre is in Kuantan, he can provide his patients with the latest treatment options, on par with a world-class centre.
His patients appreciate having the latest treatments available to them. He said that there will be initial hesitance from his patients, but once the information is explained to them and they are aware that clinical trials are required for all drugs to enter the market, patients become more open. Once they are assured that most drugs that reach phase 3 clinical trials are generally safe and the efficacy is backed up by sufficient evidence, patients tend to have no qualms in participating in the trial.
When asked about what drives his passion in clinical research, Dr. Tee said the satisfaction when his patients respond to the new treatments drives him on. Many of his patients have seen numerous doctors and tried many treatment options. By the time they come to HTAA, they are relying on him to offer them the option of using drugs from clinical trials, which may not be available elsewhere. Once patients participate in the trial and get better, they begin to see the benefits of being a participant in a clinical trial.
When asked about the resources and facilities at HTAA, he said that in general, HTAA does not have the luxury of having multidisciplinary teams as many centres in the Klang Valley have. Many a time, a single consultant has to shoulder on problems involving other disciplines. He gave the example of chronic viral hepatitis which is generally a gastroenterology and hepatology condition. However when complications like hepatocellular carcinoma arises, the gastroenterologist has to liaise with hepatobiliary surgeons, oncologists and interventional radiologists outside HTAA. Many of the rural residents are not keen to travel far for treatment; hence having clinical trials with options of treatment in local hospital offers an attractive option for the patients.
For the future, Dr. Tee expressed hope that there would be friendlier environment toward clinical trials. It is important for policy makers to promote clinical trials as beneficial to the people. Clinical trials, be it investigator initiated or industry-sponsored, are performed to develop new medication or help improve existing treatment options. There should not be a perception that doctors are neglecting their regular clinical work to participate in clinical trials. In reality, these doctors are going the extra mile in taking up trials and this should be encouraged.
