1st Asia Pacific Stroke Workshop

10 Sep 2005

By Dr Balaji Sadasivan, Senior Minister of State for Information, Communications and the Arts and Health

Venue: The Biopolis

Dr Lee Wei Ling

Director, National Neuroscience Institute

Prof Edison Liu

Director, Genome Institute of Singapore

Prof JP Deslypere

Director, Clinical Trials and Epidemiology Research Unit

Dr Christopher Chen

Chairman, 1st Asia Pacific Stroke Workshop Organising Committee

Distinguished guests

Ladies and gentlemen

IMPACT OF STROKE ON SINGAPORE

1       I am delighted to be here this morning for the opening of the 1st Asia Pacific Stroke Workshop. I would like to extend a very warm welcome to all the overseas speakers and participants at this Meeting.

2       We aspire to be  a global leader in many fields, however, I am not sure whether we should view as an accolade the finding, recently published in the journal Stroke, that Singapore leads the world in stroke prevalence. Whilst we might take comfort in some of the possible explanations: a relatively low mortality, high standards of medical care and good case ascertainment, we realise that one of the major drivers is the undisputable demographic fact that our population is ageing rapidly due to an increase in life expectancy combined with a declining birth-rate. By 2030, 18% of our population will be above 65, as compared to 8% in 2003.

3       Many of the elderly will suffer from the chronic conditions associated with aging. Already diabetes, stroke, ischemic heart diseases and cancer are the major conditions affecting Singaporeans, accounting for more than 60% of all deaths. Nor are we alone in this change the Asia Pacific region will see the highest increases in disease burden from stroke in the coming decades. My Ministry has taken steps to deal with this clinical challenge for the health care system by:

a.     instituting health screening programmes for those at increased risk of stroke;

b.    developing an integrated disease management programme for stroke;

c.     setting targets for the reduction of mortality from stroke;

d.    instituting higher standards of care for stroke patients; and

e.    developing and publishing national clinical practice guidelines for the management of patients  with stroke and Transient Ischaemic Attacks, which is now in its 2nd revision.

ORGANIZATION OF THE 1ST ASIA-PACIFIC STROKEWORKSHOP

4       Nevertheless, great challenges remain to be overcome for the effective prevention and treatment of stroke. Thus, it is very timely that the 1st Asia-Pacific Stroke Workshop has been organised to address compelling clinical and scientific questions confronting Stroke Clinicians & Neuroscientists and their patients in Asia. Bringing together leading multidisciplinary experts to identify the important research questions for stroke in Asia and help define the scientific research agenda, will surely assist us in dealing with this devastating disease.

5       I am glad to note the support of the Biomedical Research Council, Clinical Trials and Epidemiology Research Unit, SingHealth & National Healthcare Group and the Genome Institute of Singapore for this novel meeting which is also endorsed by the International Stroke Society. Several major pharmaceutical companies such as Sanofi-Aventis, Bristol-Squibb-Myers, Boeringer-Ingelheim, Pfizer, Boston Scientific, Otsuka and Novo Nordisk are also involved - all of whom are engaged in clinical trials on stroke in the Asia Pacific region.

WHY DO CLINICAL TRAILS AND BIOMEDICAL RESEARCH IN ASIA ?

6       It has long been the case that most clinical trials and biomedical research have been performed in the developed world. However, the arguments for performing high quality research in Asia have become increasingly convincing as follows:

a.                 Firstly, there are large patient pools available in Asia. There is also a high incidence of particular patterns of diseases in Asia. For example, it has been suggested that vascular dementia is more prevalent in Asians as is haemorrhagic stroke. Moreover, the underlying vascular lesions for ischemic stroke in Asians is pre-dominently intracranial in location which quite different from Caucasian populations where vascular lesions are often extracranial.

b.                Secondly, rapid economic development has led to a high growth rate in the use of pharmaceuticals making it economically rational to develop treatments for this emerging market.

c.                 Thirdly, there are an increasing number of physicians and scientists in Asia who are capable of providing high standards of care and research.

d.                Finally, it is important to note that there may be ethnic and genetic differences in the pathophysiology of disease and therapeutic response. The traditional solution has been to have regulations insisting on additional pivotal studies on local patients, but with the development and increasing acceptance of the International Conference on Harmonisation (ICH) guidelines, it is possible that any such epidemiological and pharmacogenetic differences can (and should) be studied as part of large multi-centre studies or in smaller studies with a diverse ethnic mix.

SINGAPORE AS A NEUROSCIENCE RESEARCH HUB FOR THE ASIA-PACIFIC REGION

7       Stroke is the fourth most common cause of death in Singapore accounting for approximately 10% of all deaths annually and over 10,000 admissions. The Singapore Cardiovascular Cohort Study showed a stroke incidence rate of 1.8 / 1,000 person years. More recently, the SPEEDS study showed an age and gender standardised prevalence of 7.7% in those aged 65 and above.

8       A sizable number of Singaporean clinicians and scientists are actively engaged in stroke related research. We should make more progress and nurture new investigators to enhance our ability to perform more sophisticated and innovative studies. Further expansion and development would be greatly facilitated by the strong support given by the government for research and development. The Ministerial Committee for Research and Development has concluded in its recent report that bold reforms are needed to transform Singapore into an R&D driven, innovative, knowledge based enterprise economy. It has been recommended that the total public R&D budget be more than doubled from S$5 billion in FY 2001-2005 to S$12 billion in FY 2006-2010. In addition, private sector R&D is to be encouraged so that R&D will account for 3% of Singapore's GDP by the year 2010.

9       Biopolis, where this workshop is taking place, represents a S$500 million experiment to bring together anchor companies, such as Novartis and Glaxo, with biotech set-ups and research institutes such as the IMCB and GIS so as to catalyse the development of novel therapies and devices. Singapore is already a regional center for clinical trial organization and leadership. In particular, the first regionally designed acute stroke trial was organized between the National Neuroscience Institute and the Chinese University of Hong Kong in 2001 with the Clinical Trials & Epidemiology Research Unit. A further regional acute stroke trial involving more countries and utilizing advanced surrogate outcomes is ongoing.  Through collaboration with other centres in the region, research that is relevant to the people of this region can be organised and conducted.

10     I hope that the distinguished invited experts from the Asia Pacific region and the many Singaporean clinicians and scientists at this novel meeting will be able to:

a.                 Identify the important challenges facing stroke research and treatment in Asia; and

b.                Suggest clear plans on how we can conduct collaborative research and clinical trials based on the highest scientific standards.

11     Finally, I congratulate the Chapter of Neurologists, College of Physicians, Singapore for organising the 2nd Chapter of Neurologists Lecture at this meeting and I hope that this 1st Asia Pacific Stroke Workshop will prove to be an exciting and productive weekend for all of you.

Thank you.