Scientist To Watch: Dr. Swee Tan
Dr. Swee Tan (ONZM MBBS PhD FRACS) Founder and Executive Director of the Gillies McIndoe Research Institute, Wellington, New Zealand. Consultant Plastic & Cranio-Maxillofacial Surgeon at Wellington Regional Plastic, Maxillofacial & Burns Unit, Hutt Hospital, Wellington, New Zealand.
Dr. Swee Tan is the Founder and Executive Director of the Gillies McIndoe Research Institute and a Consultant Plastic & Cranio-Maxillofacial Surgeon at the Wellington Regional Plastic, Maxillofacial & Burns Unit, Hutt Hospital, Wellington, New Zealand. He obtained an MBBS from the University of Melbourne in 1985 and an FRACS from the Royal Australasian College of Surgeons in 1992. Sparked by his interest and passion in researching the cause of, and a better way to treat strawberry birthmarks, he enrolled for a part-time PhD degree at the University of Otago and graduated in 2001.
He was appointed the Director of the Wellington Regional Plastic, Maxillofacial & Burns Unit, Hutt Hospital between 2000 and 2006 and Director of Surgery at the Hutt Valley District Health Board, Wellington, a post he held from 2007 to 2013.
He is an elected member of 13 national and international professional and scientific societies and the past President of the Australian and New Zealand Head & Neck Cancer Society. Dr. Tan is internationally renowned for his research into vascular birthmarks and head and neck cancer. His team and their collaborators have received countless international award for their work.
The accolades he has received include the Officer of the New Zealand Order of Merit (ONZM), Wellingtonian of the Year – Science & Technology, ‘Living Treasure’ of the Museum of Wellington – City and Sea, the New Zealand Medical Association Chair’s Award, the Royal Australasian College of Surgeons’ Research Award, the Fervent Global Love of Lives Medal and the Inspire Welling Ambassador Award. Dr. Tan has authored over 110 publications in peer-reviewed journals and book chapters and has delivered numerous lectures at international conferences.
In the last National Conference for Clinical Research held at Kuching, Sarawak, CRM was privileged to meet and interview the good doctor who has made several medical breakthroughs, notably in the understanding and treatment of strawberry birthmarks.
Dr. Tan, how did you first get involved in basic research?
My journey in basic science research began when I was on a craniofacial research fellowship at the Boston Children’s Hospital and Harvard Medical School in 1995 following the realization that if I want to come up with a better treatment, I need to understand the cellular and molecular mechanisms that regulate the particular condition – and the one condition that interested me most was strawberry birthmark (a.k.a. hemangioma). Although a benign tumor, it is fascinating that hemangiomas have a built-in mechanism for proliferation and a system to self-destruct. Deep inside, I felt that if we got this figured out, then we would understand cancer better and maybe find a cure. And that’s how it all got started.
What propelled you into this journey – the discovery of the origin and treatment of haemangiomas?
This was born out from my dissatisfaction on the existing treatment for hemangiomas. Many different treatments that had been developed over the last 100 years such as surgery, radiotherapy, steroids, interferons, chemotherapy and lasers – none was satisfactory. Having worked with children, I was all too familiar with their loss of confidence due to the disfigurement caused by hemangiomas, some of which also threaten function or life itself. As a new consultant in 1996, the strategy was to do nothing unless the condition warranted intervention.
Hemangiomas grow for up to a year and then gradually shrink. Some will disappear completely but about half of them will leave behind a blemish. The old paradigm was to do nothing, and if something had to be done, it would be aimed at stopping the growth and wait for nature to take its course. It might take between 5 and 10 years for the tumor to gradually regress. For those patients who were left with a blemish, surgery and/or laser was done, usually before the child started schooling. One of my first patients was a 6-year old girl whom I performed surgery on, in 1996, to remove a large fatty lump that distorted her upper lip and cheek, caused by a large hemangioma that had regressed. She and her family were delighted with the results but I was profoundly unhappy because her mother showed me a series of photographs showing the lesion growing from nothing to a large tumor before gradually shrinking, leaving her with a fatty lump. I was convinced that the only way to come up with a better treatment was to understand the biology of this tumor. To do this, I retrained as a scientist and enrolled as a part-time PhD student.
Are you still involve in clinical practice?
I probably work about 80 hours a week, one third spent on clinical work and the rest on research. I still very much enjoy clinical surgery and most of my work is head and neck cancer, followed by vascular anomalies.
How big is your research team at the Gillies McIndoe Research Institute (GMRI)?
The GMRI currently hosts 11 research staff and two research students. The two research students, one a 5th year medical student and the other a 4th year medical student who had elected to stay on at the GMRI after their summer placement to do a year of full-time research working towards a BMedSc (Hons) degree, before going back to complete their medical degree.
Where do you get your motivation to conduct research on haemangiomas?
The fact that the treatment we had back then was unsatisfactory and the desire to relieve the pain and trauma that these children had to go through spurred me on to come up with a simple and more effective treatment with less side effects. I believe that your success will be judged when you stop doing what you’re doing now. Treatment for many types of head and neck cancer often involves surgery followed by radiotherapy and sometimes chemotherapy as well. Surgery is mutilating and some patients require hospitalization for a couple of weeks, followed by radiotherapy. Despite the radical treatment the chance of survival is about 50% and the statistics have not changed for 40 years. My hope is that one day, we will come up with a radically different treatment for cancer that bypasses everything that we have used in the last 100 years.
Dr. Tan, you have led your research team on the ground-breaking discovery that strawberry birthmarks are caused by stem cells regulated by a hormone system. Can you tell me more about this medical breakthrough?
When we discovered the stem cell origin of hemangioma we observed the expression of angiotensin converting enzyme, a component of the renin-angiotensin system, by these very primitive cells. We also observed that female, white and premature infants who have a high incidence of hemangioma also have high levels of renin, another component of the renin-angiotensin system. As we were piecing the pieces of the jigsaw puzzle together, we stumbled on case reports from two independent French groups, one using propranolol (a non-selective beta-blocker) and the other, acebutalol (a predominantly β1-adrenoreceptor blocker) respectively to treat the complication (cardiac failure) resulting from high-dose steroid treatment for hemangioma. Serendipitously the haemangiomas regressed dramatically. We put a list of all the known beta-blockers together and looked at their actions, and concluded that the common mechanism of beta-blockers was the effect on the renin-angiotensin system. Suddenly the whole picture emerged.
Research requires persistence, formulating a good hypothesis based on a concept and a bit of serendipity. It is when all the pieces of the puzzle are put together and something happens at the right time and at the right place that discoveries are made. This is why I feel that having a multidisciplinary input is important because you get to network with people with different backgrounds, unique expertise and perspectives.
Our discoveries underscore the new treatment of hemangioma based on modulation of the renin-angiotensin system that leads to dramatic shrinkage of these tumors within days, negating the need for the traditional treatment using high dose steroids, and lengthy and complicated surgeries over several years. Propranolol is now the treatment of choice for hemangiomas.
In your opinion, what are Malaysia’s strength in terms of conducting clinical research?
Malaysia has the large patient pool that allows clinical trials to be readily conducted here as opposed to elsewhere like New Zealand which only has a population of 4.5 million. And there are a lot of capable clinicians and researchers as well as pharmaceutical companies that are interested in conducting trials in Malaysia. I think what needs to be improved is to make it easier for people who are interested to be involved to participate in clinical trials.
What are your thoughts on encouraging research among clinicians?
You want to encourage clinicians who are genuinely interested in answering a research question, motivated by their curiosity and wanting to push the boundaries. These are the people you want to encourage and assist. I don’t believe in forcing people to get involved when their hearts are not in it.
Efforts should also be made in providing opportunities to the future generation to be involved in research. In New Zealand, opportunities are given to medical students between their first and fifth year of study to get involved in research. In the long run, we foresee that those who may have found interest in research may one day return as academic clinicians. We will end up with a pool of very talented and motivated researchers who are leaders in the country.
Where do you see yourself 10 years from now?
We have been taught that cancer is a problem of normal cells turning “bad” and this “bad” cell made multiple identical copies of itself that form the cancer. There is gathering evidence supporting our concept of cancer stem cells being the basis of cancer. These cancer stem cells are like the “queen bees” that give rise to the cancer cells (the “worker bees”) which consist the bulk of the cancer. These worker bees do not multiply and have a limited life-span. The “queen bees” can make copies of themselves and they can travel to make other hives (metastases). They resist chemotherapy and radiotherapy by going into slow-cycle state which explains why cancers that had seemingly disappeared but only to return later. If this concept is correct, then the mechanism controlling these very primitive stem cells would be entirely different from those that control the cancer cells. While it’s still a concept waiting to be proven, our treatment for hemangioma that targets the stem cells which is regulated by the renin-angiotensin system has shown promising outcomes.
So, ten years from now, I would like to think that we would come up with a new prototype for cancer treatment that does away with conventional cancer treatments that we have been using for the past century.
What would be your advice to young Malaysian researchers who wants to embark on the research journey?
For young researcher who are aspiring to be involved in the rewarding journey of research, they should obtain the necessary training and probably enroll in a higher degree. Having the training that goes with a higher degree definitely gives you a different perspective of looking at a particular problem, accessing it critically and developing a plan to address the research questions.
Dr. Swee Tan’s Early Years
Dr. Tan rose from a poor family of 14 children on the outskirts of a tiny Malaysian village, Senggarang. His father had only primary school education, his mother none. They sent him to a Chinese school and after school he helped out in the plantations, weeding and collecting coconuts and coffee. It was clear from an early age that he didn’t want to work that way forever. By the age of 9 or 10, he knew he wanted to be a doctor. Though people scoffed at the unlikely ambition of a young lad with calloused hands, he was more determined than ever.
He aspired to get into medicine in a Western country, but having a poor grasp of English, he attended Taylor’s College in Kuala Lumpur for nine months to gain the Victorian High School Certificate. Over three terms, he learnt English by reading the newspaper daily, from cover to cover. He then worked in a bookshop in Singapore for a year to save. Australia was offering free tuition to a limited number of students from developing countries in the 1980s, and having gained a place, Dr. Tan began his studies at the medical school of the University of Melbourne. Three times a week, he got up at 5 o’clock in the morning to clean supermarket floors. In his final year, he was apprehended by a surgical registrar for being half an hour late to tutorials. Being given the chance to explain himself, the registrar offered to be a guarantor for his study loan.
Dr. Tan met and fell in love with Sanchia, a student nurse at Royal Melbourne Hospital, and graduated in 1985. In his fifth year, he did his elective in New Zealand and was enthralled by the beauty of the country and its people who were friendly, accepting, unpretentious, and happily “color-blind”. Life slowly unfolded as he persevered in his quest to be a plastic surgeon and researcher.
To date, Dr. Tan has trained with some of the world’s top plastic surgeons in Oxford and Boston. Challenged by the lack of research funds and seen as a heretic by some of the medical establishment for his unorthodox approach to hemangioma, Dr. Tan came out victorious despite the odds against him. He founded the Gillies McIndoe Research Institute which was officially opened by the Prime Minster of New Zealand in 2013. He now heads this institute in its pursuit to research into vascular anomalies, cancer, fibrotic conditions and regenerative medicine, based on the role of stem cells in disease and health, underpinned by his radical concepts.
Featured in CRM Bulletin Issue 5
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