Research Personality: Dr. Zanariah Hussein

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Dr. Zanariah Hussein is a Consultant Endocrinologist and Physician at Hospital Putrajaya, where she is the Head of the Endocrinology Subspecialty Service. She obtained an MBBS from the University of Malaya and an MRCP from Edinburgh, UK. She holds various educational administrative positions including the Chairperson for the Endocrine Fellowship Training Program, Honorary Lecturer at the Faculty of Medicine UiTM, UKM and UM as well as a member and Ministry of Health representative for the Specialty Conjoint Board for Masters of Internal Medicine.

Dr. Zanariah is an active member in the Malaysian Endocrine and Metabolic Society, Asia Pacific Neuroendocrine Tumour Society, National Diabetes Institute, The Endocrine Society, USA, and the American Association of Clinical Endocrinologists. She is and has been an Investigator and Co-Investigator in over 40 mulicentre clinical trials and has published over 50 national and international peer reviewed journals.

Despite the many hats she wears and the international recognition for her research contributions, Dr. Zanariah remains a humble and down-to-earth clinician. She recently shared with CRM about her experience running clinical trials.

Can you describe when and how you first got involved in clinical trials? 

My first experience with clinical trials was when I was training as a fellow in endocrinology, in 1998, whereby my then supervisor was involved in a diabetes trial at Hospital Kuala Lumpur (HKL). I subsequently became a sub-investigator in one of the trials when I was pursuing my postgraduate training at ospital Universiti Kebangsaan Malaysia (HUKM) and began taking the role of a principal investigator (PI) when I was called to serve at Hospital Putrajaya.

How do you divide your time between clinical practice and conducting trials?

In the beginning it was not too difficult because I was a co-investigator and did not have much responsibility. In addition, the number of trials at that time was perhaps, one a year. In recent years, the number of trials at Hospital Putrajaya has seen an increase, but with a dedicated team of study coordinators, I managed to press on and have allocated different days for performing research and clinic duties.

Our team consists of 4 consultant endocrinologists who are PIs and co-investigators. Recently, we have assigned one or two specialist physician trainees into several clinical studies. In the past we had to look for our own study coordinators and we did not have a Clinical Research Centre (CRC). We hired our own study coordinators but also had our diabetes nurses helping us. This was difficult because they had other roles to play. But with an established CRC and study coordinators who are 100 percent dedicated to clinical trials, it has been superb.

What are the challenges that you face when conducting a clinical trial?

The challenge is trying to get other members of the team to be as enthusiastic about the trial as you are. You have to ensure equal participation and it can be difficult because everybody has different roles to play. Before having my own study coordinators, I would have to key data into the electronic case report form all by myself. But now, with a dedicated and supportive study team, clinical trials has become much more manageable.

How does your patient respond when asked to participate in a clinical trial?

There are a group of patients who have been with us for a long time and usually they are seen to be the ones we fall back on when we have trials. We are lucky to have progressed over the decades having some of the same patients being involved and are very eager to be involved again. Of course those who have never participated in clinical trials before will appear apprehensive at first when we approach them. Effective communication with patients is not just about delivering the right information. It is also about anticipating their needs and being mindful of their different perspectives and knowledge.

Can you tell us how has your patients benefited from participating in a clinical trial?

Those who have participated in a trial become more in tune with their disease and up-to-date with the administered therapies. Apart from running diabetes trials, other endocrine-related trials that are conducted in Putrajaya Hospital include Cushing’s disease, acromegaly, and growth hormone deficiency. We encourage trials of rare diseases to be conducted here as there is none such at the moment. Our team has managed to fulfil the requirements for the Cushing’s disease trial and the patients that are on this trial were given the opportunity to receive the most up-to-date therapy. Patients would suffer if they were to wait until a new/improved drug is marketed.

What is your motivation behind conducting clinical trials?

My motivation comes from the opportunity to perform the most ideal of practice, and keeping up to date with the current ways of managing disease. This has been the reason to pursue that, and also to get the other team members to embark on this rewarding journey. Through good clinical practice (GCP), one learns to handle clinical trials the right way and this include proper handling of records and ensuring that adverse events are recorded and handled appropriately. These good practices and habits can be translated into one’s clinical practice

In your opinion, what are the necessary qualities of a Principal investigator?

Principal investigators must be interested and committed in conducting clinical trials as it usually demands a lot of their time. They must believe that their efforts can ultimately contribute to the development of new therapies.

What do you see are the strengths of Hospital Putrajaya when it comes to conducting clinical trials?

Putrajaya Hospital has the experience in conducting clinical trials even though it has only been in operation since 2001. One of our strength include having the experience of managing diabetes trials for more than a decade. We have 4 endocrinologists and an established CRC. These factors are paramount in building the reputation of the site to encourage industry sponsored research. Looking forward, we want to develop Putrajaya Hospital as a site for other endocrine trials and to work towards building our reputation in Southeast Asia.

Why do you think it is important for a clinician to get involved in clinical trials?

Clinical trials can improve a clinician’s overall career and profession. It keeps you up-to-date with the latest medical technology and therapies and by getting involved, clinicians will be at the forefront of medicine in the area that they specialize in, especially with newer drugs and interventions. They will have the benefit of being at the cutting edge of medicine, have the privilege of knowing what is coming up in the future and being able to participate in discussions with internationally recognized experts in the field. This will translate into a better understanding of the disease and no doubt improve a clinician’s clinical practice.

Do you have any personal dreams or goals that you strive to achieve?

I was never that ambitious and only wanted to be a small time general practitioner in the early days. Somehow, our goals tend to evolve with time and once we find an area of interest, you may just want to do more. But I think what’s most important is to try and make a difference in this world.

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