HEALTH AND HEALTH CARE IN SINGAPORE: TECHNOLOGY, TRANSPLANTS, MEDICAL TOURISM

HEALTH AND HEALTH CARE IN SINGAPORE:

Singapore has the world’s forth longest life expectancy. Life expectancy at birth: total population: 84.07; male: 81.67 years; female: 86.64 years. "Life expectancy" is an abstract and complicated concept a complex formula that attempts to predict the lifespan of children born today by subjecting a hypothetical child born today to the current risk of dying in each bracket he or she mature through until, in effect, the accumulated risk of death is 100 percent. As a result of better lifestyles, Singaporeans are living a lot longer today. Life expectancy in 1970 was 66.

Singapore has some of world’s lowest infant mortality and maternal mortality rates. Lowest infant mortality (deaths of 1,000 live births): 1) Japan (4); 2) Singapore (5); 3) Norway (5); 4) Germany (5). [Source: United Nations Population Division]

Maternal mortality rate: 3 deaths/100,000 live births (2010), country comparison to the world: 182. Infant mortality rate: total: 2.59 deaths/1,000 live births, country comparison to the world: 221; male: 2.73 deaths/1,000 live births; female: 2.44 deaths/1,000 live births (2013 est.). [Source: CIA World Factbook =]

The state of health in Singapore is good by international standards. According to the Ministry of Health, rising standards of living, high levels of education, good housing, safe water supply and sanitation, quality medical services, and the active promotion of preventive medicine all have helped to significantly boost the health of Singaporeans. [Source: Library of Congress, 2006]

As indicated by their long life expectancy and low death rates, Singaporeans generally enjoyed good health. Standards of nutrition and environmental sanitation were high. The Ministry of the Environment's Vector Control and Research Department was responsible for controlling mosquitoes, flies, rats, and other disease-bearing animals; the Food Control Department and the Hawkers Department inspected food producers and outlets for cleanliness and sanitation. The Ministry of the Environment's Public Affairs Department conducted educational campaigns on such topics as environmental sanitation, control of mosquito-breeding sites, proper disposal of refuse, and food handling. Educational efforts were backed up by sanctions, which included fines of up to S$500 for spitting or failing to flush public toilets. [Source: Library of Congress, 1989]

Singaporeans Have Worst Eyesight in World

Singaporeans have the worst eyesight in the world with 34 percent of young children short-sighted and the number accelerating, according to a study the National Eye Centre. AFP reported: “Genetic and environmental factors were blamed, with follow up studies including investigations into whether Singapore children have too much homework and spend too much time in front of television and computer screens. [Source: Agence France Presse, August 15, 2000 \=\]

“The study showed the number of seven-year-olds suffering from myopia had doubled in three years, with children of Chinese descent the worst affected. Professor Donald Tan of the Eye Research Institute, which assisted with the survey, said studies were under way to try to reverse the syndrome. "We were quite taken aback by these figures. We have always known Chinese have a higher degree of myopia than other ethnic groups, but there is something in our environment in Singapore which triggers it more than Hong Kong and Taiwan," Tan told AFP. \=\

“The new data, taken from a 1999 study of 1005 children aged between seven and nine, found 34 percent had myopia, compared to a rate of 19 percent in Taiwan, 12 percent in Hong Kong and 7.5 percent in the United States. Of seven-year-olds, one in four was myopic compared to one in eight in 1996. By the time the children reached nine, 43 percent will suffer from myopia or short-sightedness, the report found. By ethnic background, 34 percent of the Chinese children in Singapore have myopia, compared to 24 percent of Indians and 19 percent of Malays. \=\

“Tan said the gene pool in Singapore had not changed much in the past five decades while cases of myopia had escalated in recent years. "It's the million dollar question as to what is the cause. Is it because suddenly in Singapore our children are spending many hours reading, writing and doing homework. Maybe using computers. Maybe it's the lighting in homes," Tan said. "We're predicting a rising prevalence of very severe myopia, much worse than we've seen in the older cohorts," he said. A 1997 study of young men enrolling for national service found 83 percent were myopic. “ \=\

Fighting Obesity in Singapore

Obesity - adult prevalence rate: 7.1 percent (2008). country comparison to the world: 142 Children under the age of 5 years underweight: 3.3 percent (2000), country comparison to the world: 108. [Source: CIA World Factbook]

In 2004, Gillian Wong of Associated Press wrote: “The government is trying to mobilize its adult population to fight the flab. Every September the city-state holds a monthlong fitness campaign aimed at getting the entire population to eat better and stay active. The theme for 2004 is “Fighting Obesity” and the campaign was launched with a mass aerobic workout class that had 12,000 people sweating it out together on the beach. Even Singapore’s Prime Minister Lee Hsien Loong, who is tall and trim at 52, took part, with TV cameras capturing him sweating, punching and stomping it out with the locals. [Source: Gillian Wong, Associated Press, October 3, 2004 ==]

“Compared to the United States and Western Europe, Singapore’s vigilance seems remarkable. Two-thirds of Americans are overweight. Singapore health ministry figures show that one in three people need to lose weight, and about 6 percent of its 4 million people are obese — at least 30 pounds too heavy. But those numbers may soon expand dramatically as officials here prepare to revise their measurement standards to match new research indicating Asians suffer bad health effects at a lower weight than Caucasians. ==

“We noticed that although Singaporeans are less obese compared to people of (other) developed countries, our heart disease trend is similar to theirs,” says Mabel Yap, head of research and information at the government’s Health Promotion Board. Yap conducted a study that showed Singaporeans had 5 percent to 6 percent more fat in their bodies than European Caucasians of the same age and same body-mass index. BMI is a calculation of weight and height commonly used as a benchmark for body fat. ==

To define obesity, most countries follow standards set by the World Health Organization, which defines overweight as a BMI of more than 25, and obesity as a BMI of 30 or over. These levels are largely based on data derived from research on Caucasians. “If you truly want to define obesity, it should be about excessive body fat and related health risks,” said Yap. Yap has recommended that the country’s health policy-makers lower the BMI at which a person would be considered overweight from 25 to 23. That could lead to as much as half of all the island’s residents being too fat, instead of just 1 in 3. “It’s enough to alarm,” she said. ==

Health Care in Singapore

Singapore offers some of best medical care in the world. World's top health care systems: 1) France; 2) Italy; 3) San Marino; 4) Andorra; 5) Malta; 6) Singapore; 7) Spain; 8) Oman; 9) Austria; and 10) Japan. [Source: World Health Organization]

Health expenditures: 4 percent of GDP (2010), country comparison to the world: 168 Physicians density: 1.83 physicians/1,000 population (2009); Hospital bed density: 3.14 beds/1,000 population (2008). [Source: CIA World Factbook]

Two health care delivery “cluster” systems are available to Singaporeans. The western cluster, the National Healthcare Group, provides comprehensive public health care through a network of four hospitals, one national center, nine polyclinics, three specialty institutes, nine business divisions, and more than 11,000 staff members. The eastern cluster, Singapore Health Services, offers three hospitals, five national specialist centers, a network of primary health care clinics, and more than 12,000 staff members. Medical insurance is available via Medisave for hospitalization and some outpatient services, Medifund for those unable to pay for their medical expenses, Medishield for catastrophic illness, and Eldershield for senior citizens with severe disabilities. In 2005 Singapore had 29 hospitals with 11,830 hospital beds, as well as 6,748 physicians (1.6 physicians per 1,000 population or one physician for every 640 persons) and 20,167 nurses and midwives (4.6 nurses per 1,000 population or one nurse for every 220 persons). Traditional Chinese medicine also is widely practiced. In fiscal year (FY) 2005, 6.3 percent of total government expenditures was spent on health care. [Source: Library of Congress, 2006]

In the 1980s, the population was served by nine government hospitals with 7,717 beds and by twelve private hospitals with 2,076 beds. In 1987 the Ministry of Health certified 2,941 physicians, 9,129 nurses, 653 dentists, and 487 pharmacists. Five of the nine government hospitals were general hospitals, providing a complete range of medical services and twenty-four hour emergency rooms, and the other four each had a specialty: obstetrics and gynecology, dermatology and venereology, psychiatry, or infectious diseases. In 1987 the Ministry of Health's Community Health Service operated twenty-four clinics in major housing complexes, offering primary medical treatment for injuries and common diseases. The Maternal and Child Health Service provided preventive health care for mothers and preschool children at twenty-three clinics, while school children were served by the School Health Service. New York Times- Library of Congress, 1989 *]

Government hospitals and clinics charged fees for their services, although the fees were generally low and the medical services were heavily subsidized. The fees were intended to discourage frivolous use of the medical system and to demonstrate that residents were responsible for their own health costs, as Singapore was not a welfare state. After 1984 Singaporeans could pay for their medical expenses through the Medisave Scheme, under which 6 percent of the monthly income of every contributor to the Central Provident Fund could be set aside for the medical expenses of the contributor and the contributor's spouse, parents, grandparents, and children in all government or private hospitals.

The government has offered free dentistry to teenagers in middle schools.

In the 1960s, National Geographic journalist Kenneth MacLeish concluded that there was very little Singaporeans wouldn't eat in the name of either health or hunger. In Chinese medicine shops stag horns were sold to make men more manly. Rhinoceros horns were used to reduce fever. Tiger bones and organs and fossils marketed as dragon bones were sold to give strength.

Maintaining Good Health Care in Singapore

Simon Parker wrote in the Asia Times, “Singapore has one of the most advanced health care sectors in the Asian region. It is backed by the government's investment in the sector, which in the year 2004 was an estimated 5.9 percent of total government expenditure. Recurrent health expenditure topped about S$1.61 billion (US$950 million) in the same year, while development health spending touched S$97 million. There are about 11,840 hospital beds in 29 hospitals and specialty centers in Singapore. This is a ratio of about 3.7 beds per 1000 residents. While there are private medical facilities available, the government remains the dominant health care provider, allowing it to control the supply of hospital beds, the introduction of high-tech medical equipment and the rate at which costs rise, which in turn helps set the bench mark for how much the private sector charges. [Source: Simon Parker, Asia Times, October 21, 2005 *+*]

“The cost of running the country's health sector is borne both by the government and the public, under the guiding philosophy of individual responsibility and community support. Patients pay for part of their treatment, an amount that varies depending on the level of service they demand. The remaining funds come from government subsidies, which aim to keep health care affordable for all members of the general public. An extensive health care financing framework for individuals also exists. Singaporeans can help defray potentially high medical costs by investing regularly in one of the nation's health care savings plans, which include Medisave, MediShield and ElderShield. Medifund, targeted to those individuals unable to pay for their medical treatment, buttresses the system. *+*

“The country also boasts a strong biomedical-sciences sector. In 2004 manufacturing output from this sector surged by 33 percent on-year to S$15.8 billion, a figure that looks set to grow as an increasing number of multinational pharmaceutical and medical equipment firms set up operations in Singapore. Numerous leading pharmaceutical firms have also set up their regional clinical trial centers in the city-state, including AstraZeneca, Aventis, GlaxoSmithKline, Merck & Co, Novartis and Novo Nordisk. The move to develop the nation's biomedical sector appears to be on track, highlighted by the decision of the European drug major, Novartis, to set up a US$180 million pharmaceutical-production center in Singapore. Work on the new plant and distribution center commenced in March, and once completed it is expected to employ more than 150 people. *+*

“Yet like many industrialized nations, Singapore's health sector is endeavoring to find ways to cope with the increasing proportion of the population aged more than 60 years. While in 1999 only 11 percent of the population was more than 60, by 2030 this group is expected to account for 27 percent of the nation's population. The spiraling cost of medical technology, combined with rising expectations from a more demanding public are also key challenges confronting the nation's health system. "All over the world, medical inflation exceeds the general CPI (consumer price index)," Health Minister Khaw Boon said in May. "If there is no transformation in the way health care is delivered, health care must eventually bankrupt all economies. We need to find creative ways to deliver more with less, maintain if not raise standards, while cutting out wastages and squeezing out inefficiency." *+*

“Apart from providing a world-class health system for Singaporeans, the government continues to focus on attracting foreigners to the city-state, whether as patients or investors. As part of the drive to attract more foreign patients, the government is continuing to position Singapore as a regional hub for medical treatment and research. The government, partly through the Singapore Economic Development Board, is also looking to enhance the country's clinical-research base and biomedical-sciences industry. The continuing development of the Biopolis illustrates this. *+*

“Moreover, in light of the SARS (severe acute respiratory syndrome) epidemic and bird flu outbreak, the government is also setting up a Regional Emerging Disease Intervention Center as part of the Biopolis. This institution will endeavor to better monitor, treat and prevent critical infectious-disease threats in the region as well as government efforts to differentiate Singapore's health system from those in neighboring countries, helping to attract additional investment. “ *+*

Singapore Has Worst Patient-Doctor Ratio: Report

A report released in February 2007 said that Singapore has the worst patient-to-doctor ratio among developed countries and is aiming to rectify the problem through a global effort to attract doctors. AFP reported: “Top health ministry officials went to Australia and London last year to convince Singaporean doctors studying or working there to return, and to encourage top foreign doctors to practise in Singapore, the Straits Times said. It quoted the health ministry's permanent secretary Yong Ying I, who was dispatched to London last year, as saying Singapore has the worst patient-to-doctor ratio among developed countries. [Source: Agence France Presse, February 21, 2007 \*/]

"We have very efficient doctors and they work very hard. But somewhere along the way we also don't have enough," the newspaper quoted Yong as saying."If you want to bring down waiting times, we need to recruit more doctors, much more than a few percent." The city-state is faced with an ageing population but is also seeking to bolster its role as a top provider of quality healthcare services for patients from abroad. \*/

“Singapore, Southeast Asia's most advanced economy, had a population of about 4.4 million with 6748 doctors registered in 2005, according to official statistics. The goal is to have one doctor per patient in public hospitals, up from a ratio of one per every two, the report said. The country needs to produce 400-600 locally trained doctors annually, up from the current level of more than 200, the paper quoted Health Minister Khaw Boon Wan as saying. Khaw cautioned that "much as we will try to recruit as many as we can, we will be lucky to half-succeed," which was why he sent his top two ministry officials to scout for doctors abroad, the report said.” \*/

Foreigners Lose Medical Perks under Singaporeans-First Policy

Starting in October 2007, foreigners working in Singapore had have to pay more for medical services as part of new social policies giving priority to Singaporean citizens. AFP reported: Under a Singaporeans-first policy unveiled by Prime Minister Lee Hsien Loong, healthcare subsidies in public hospitals will be slashed for non-citizens and rechanneled to meet the needs of the ageing local population. Labour-starved Singapore depends heavily on foreign workers and professionals, ranging from construction workers and domestics to professionals and heads of multinational corporations and international banks. [Source: Agence France Presse, December 11, 2006 ~]

“Competition from foreigners for jobs is a politically sensitive issue in Singapore but officials maintain that "foreign talent" is essential to ensure the economy's long-term competitiveness. The Straits Times newspaper said 875,000 foreigners and 480,000 permanent residents will be affected by the reduction of medical subsidies, which will save the government S$36 million (US$23 million) a year. The money will be ploughed back into subsidies for the elderly and other needy citizens. It will also be more expensive for companies to hire foreign workers because of higher medical insurance costs. ~

"This move will indicate to Singaporeans that Singapore citizens matter -- that's what it's all about," the Today newspaper quoted national trades union boss Lim Boon Heng as saying after the announcement on lower medical subsidies. Public education costs for foreigners' children are also set to rise. ~

Singapore Wants Doctors to Stop Dispensing Drugs Themselves

In 2005, AFP reported: “The Singapore government is planning to stop doctors from selling the drugs they prescribe to their patients in a bid to keep up with the changing needs of an ageing population, media reports said. Doctors who offer only consultation services would be able to "concentrate more on the care and counselling of patients, rather than the prescription of the drugs," director of medical services at the health ministry (MOH), K. Satku, told the Straits Times. [Source: Agence France Presse, January 1, 2005 +++]

“General practitioners in Singapore currently dispense drugs to patients themselves, but this has triggered complaints that doctors could prescribe expensive medication for their own profit rather than the patients' benefit. Any change though will take years to implement as a significant portion of doctors' incomes come from the sale of medication, and a sudden ban might cause some medical professionals to jack up their consultation fees and drive up healthcare costs in general, Satku said. +++

"This is something that touches people's rice bowl, so you cannot charge in and change it. We must prepare our doctors," the paper quoted him as saying. Doctors interviewed by the paper were skeptical of the plan, saying that patients would prefer the convenience of getting a consultation and medication at the same place. +++

Singapore’s Organ Transplant Policy

Singapore’s organ donor policy assumes that all citizens are willing donors, unless they have registered with the government that they wish to opt out. Reuters reported: Between 1995 and 2007, “more than 270 Singaporeans have gone abroad, mostly to China, for organ transplants, the Health Ministry said. To ease the organ shortage, Singapore amended its Human Organ Transplant Act in 2004 to expand the pool of organ donors and the type of organs that could be donated. [Source: Reuters February 28, 2007 <+>]

“Hospitals can remove the kidneys, liver, heart and corneas of all non-Muslim Singapore citizens or permanent residents when they die, unless they have objected. Muslims can choose to donate their organs, as in Iran and Malaysia, although many believe that the dead should be buried with all their organs intact. Doctors say a system which assumes all citizens are organ donors is necessary because even though many people are in favour of donating their organs, few actually come forward. <+>

“While many European countries, including Belgium, Denmark, Norway, Switzerland, and Spain, have laws similar to Singapore's Transplant Act, it can still be a sensitive issue. When Brazil passed a similar law in 1998, it triggered a public outcry. The Federal Attorney later conceded that families could prevent the removal of organs for transplant. <+>

“Critics say laws which assume all citizens are organ donors are inadequate because the definition of death is debatable. Others are concerned that life-support may be turned off prematurely or that people may be unaware of the opt-out option. "It should be up to the citizens to decide. These are their bodies, their organs, and therefore their decisions," said Dr Choi Kin. "If an accident should occur, it would be too late for them to opt out, even if they do not agree to donate." In Singapore, some doctors had urged amending the Transplant Act, giving families the right to block such donations. <+>

Scuffle for Organs Sparks Donor Debate in Singapore

In 2007 Reuters reported: “As members of Sim Tee Hua's family sat at his bedside to pray for his recovery, they were horrified to learn that the hospital staff were about to turn off his life-support machine and use his organs for transplants. The scenes that followed have shocked and upset not just Sim's family but many other Singaporeans, sparking a debate over the country's organ donor policy. Doctors at Singapore General Hospital had declared Sim brain-dead and said they could not delay switching off life support any longer because of the risk of damage to Sim's organs. [Source: Reuters February 28, 2007 <+>]

“Sim's family had no objection to his organs being used for transplants but wanted doctors to wait one more day before turning off the life support machine. But as Sim's 68-year-old mother and about 20 other relatives knelt weeping before the doctors, begging them to wait, nine police officers entered the ward and restrained the distraught family while Sim's body was quickly whisked away. "The hospital staff were running as they wheeled him out of the back door of the room. They were behaving like robbers," said Sim Chew Hiah, one of Sim's elder sisters. <+>

“The Sim family's experience has prompted a wave of letters to the local media, with some people saying they would opt out in protest, and added fire to a debate about organ trading. Lee Wei Ling - a prominent doctor who is the daughter of Lee Kuan Yew - last month urged the government to legalise organ trading, or the buying or selling of human organs for cash. "Organ trading is frowned upon and usually not allowed in countries where political correctness reigns," said Lee in a letter to the Straits Times. "If monetary incentive makes a potential living donor more willing to save another life, what is wrong in allowing that ?" Her views have some support from the public. "If I can sell my organs, give my children a better life, and save someone else's life too, why not? Not everyone drives a Mercedes," said Khalid, 32, who gave only his first name. <+>

“After the outcry over the Sim family's forced donation, the hospital and health ministry said in a statement that they would "continue to find practical solutions to minimize the emotional distress of families and staff in such situations." Sim's kidneys went to patients who had waited six to eight years for donor organs, the ministry said. His parents were offered five years of subsidised hospital fees - and his family received a thank-you letter from the ministry for their "generous organ donation." <+>

Singapore Tycoon Gets Kidney from Hanged Gangster

Organ trading is illegal in Singapore. Anyone caught buying or selling human organs in Singapore may be jailed up to a year or fined up to US$6,500.

In 2009, Reuters reported: “An ailing Singapore tycoon jailed briefly last year for trying to buy a kidney has received one in a transplant from a hanged murderer, the Straits Times newspaper reported on Saturday. The newspaper said Tang Wee Sung, of the landmark C.K. Tang department store on the city state's swish Orchard Road, was given a kidney donated by gangster Tan Jor Chin, who was hanged at Changi Prison on Friday morning. [Source: Reuters, January 10, 2009]

Tan, 42, known as "One-Eyed Dragon" because he was blind in his right eye, was found guilty in 2007 of shooting a business associate. The newspaper quoted Tan's mistress as saying the gangster had wanted to donate his organs after his death. Tang, 56, was jailed for a day and fined S$17,000 (about 7,800 pounds) for trying to buy a kidney from an Indonesian man last year. The Straits Times said Tang suffers from several ailments including asthma, diabetes and heart problems and had triple bypass surgery last year. [Ibid]

Medical Advances in Singapore

Medical researchers in Singapore have changed bone marrow cells into heart muscle in a breakthrough that could help millions of people with serious heart trouble. Many people with heart trouble suffer because their heart muscles don’t function and eventually die. Singapore researchers have also produced the world’s smallest heart pump. It is about the size of a pill and helps the heart recover when it gets tired.

In December 2000, Singapore doctors announced they had achieved the world’s first successful human birth (a set of twins) conceived from both frozen eggs and frozen sperm. Before this there had been many cases of non-frozen eggs being joined with frozen sperm as well as with non-frozen sperm being joined with frozen eggs. The procedure was performed on a couple in which the mother could only ovulate with drugs and the father produced semen with no sperm (doctors spent four hours locating eight sperm cells in the father’s testicular cells).

A five-year-old Malaysian boy was cured of a rare blood disease by doctors at Singapore General Hospital using blood take from the umbilical chord of a baby. The child suffered from a genetic disease that caused chronic anemia and usually kills before children reach their late teens. The procedure was the first in the world using umbilical chord blood from an unrelated donor.

The Singaporean company Pestbuster developed an insect trap that lures flies, mosquitos and other insects to their doom by making them think they are heading for a human. The trap looks like a black plastic cage and works by replicating the skin temperatures and carbon dioxide release of humans and by giving off nonvisible light that mosquitos find inviting.

Singapore is also a leader in stem cell research.

Medical Technology in Singapore

Singapore is a world leader in cochlear implants, high-tech devices described as “bionic ears” that help children born deaf to hear. The implants are two-piece devices with a small receptor that is surgically mounted in the skull and is connected to a wire in the cochlea, the part of the inner ear that converts sound vibrations into nerve impulses sent to the brain. The second part of the devise, a separate speech processing unit, is mounted behind the ear. It contains a microphone that picks up sound and coverts it digital signals that are conveyed to the implants.

Singapore researchers are also carefully studying the human genetic code and comparing it with the genetic code of other of other organisms in hopes making medical discoveries regarded ailments that have a clear genetic link such as head and neck cancers. Other scientists in Singapore studying the genetic code are working to develop drugs “tailored for different ethnic groups” and using Singapore’s own multi-cultrual popualtion for studies.

Surgery on conjoined twins (Siamese twins) relies on virtual-reality software—developed in Singapore—that allowed scientists to see inside the skulls and organs of the twins months before any surgery is done so that doctors can develop could a game plan on what to do. The technology, called a VizDExter, features a 3-D simulator in which doctors wearing 3-D glasses manipulate digital images so it seems like brain and internal organs are in three-dimensional space.

Singapore as a Biomedical Center

In 2006 the Straits Times reports that biomedical sciences make up about 5 percent of Singapore's gross domestic product, up from virtually nothing five years ago. "The industry has created 10,200 jobs, and there are already over 50 pharmaceutical, medical-technology, and biotechnology multinational companies with substantial operations here," the newspaper said.

Singapore identified biomedical sciences as growth sector for its economy. It has tried to reinvent itself as the biomedical center of Asia and spending billions to do so. It is has offered substantial tax breaks to attract international biomedical companies and skilled foreign researchers and has poured money into schools to train students in fields like molecular biology, genetic engineering and industrial biotechnology. Hundreds of million of dollars has been earmarked for scientific research in the private sector.

Singapore has opened a “Biopolis.” a center that will house a full complement of research and development (R&D) activities, including medical research, drug-discovery efforts and medical-technology research. "The overwhelming demand for spaces at Biopolis leading to the accelerated Phase II development, signals the exponential growth of the biomedical sciences R&D community in Singapore," Yeoh Keat Chuan, deputy director of the Biomedical Sciences Group of the Singapore Economic Development Board, said in June. It is expected that the center will eventually encompass about 2000 researchers.

Singapore wants to establish itself as a biomedical center in part because it is facing increased competition in the electronic, industry and believes it has a better chance for success and making advances in the increasingly lucrative biomedical field.

Alan Colan, the Scottish scientist who cloned Dolly the sheep, moved to Singapore to do research on diabetes at Biopolis. Johns Hopkins University opened up a research center in Singapore in 1999, its first outside the United States. A neurosurgeon with the university told AP. “There’s a lot of good things going on in Singapore. It’s perfectly situated to be a magnet for that area.” GlaxoSmithKline, Eli Lilly and Novartis and drug companies have production facilities and research centers in Singapore.

In 2003, AFP reported: “A multi-million dollar project funded by the Singapore government to find a cure for epilepsy and Parkinson's disease has been suspended after alleged breach of medical ethics, the Sunday Times reported. Researchers taking part in the S$10 million (US$5.75 million) project at the National Neuroscience Institute are alleged to have taken blood samples directly from patients without informing their doctors, the report said. This breached the confidentiality of patients who were not told why their blood were being taken. They thought their doctors had requested the samples. [Source: Agence France Presse, January 19, 2003]

“The alleged actions are in direct breach of the guidelines drawn up by the Bioethics Advisory Committee which says tissue samples can only be taken from patients provided they have given their consent and have been told of the medical facts and risks involved. "The most glaring point is that the doctors treating the patients were not informed that their patients' blood is being taken for research," said Michael Yap, head of the institute's executive committee. Yap is now heading the investigations into the alleged breach of ethics. The project, headed by world renowned epilepsy expert Simon Shorvon, tracks mutations in the DNA of epilepsy and Parkinson's patients.” [Ibid]

Singapore Effort to Attract Top Biomedical Talent

A number of star scientists have been brought to Singapore as part of an effort to make Singapore a hub of biomedical research and drugs production. Scientists in the United States now face restrictions on government funding for stem cell research, shriveling grants, and curbs on commercial spin-offs from their work such as consulting and other fees, scientists told Reuters. "The amount of money going toward research is going down. It doesn't have a high priority (in the United States). In Singapore it does," the scientist said, adding that they would like to exploit some of their Singapore-funded research commercially. [Source: Sara Webb and Mia Shanley, Reuters, January 10, 2006 ^\^]

Sara Webb and Mia Shanley of Reuters wrote: Scientists say have they have “been won over by Singapore's scientific freedom, deep pockets and interest in commercial applications, at a time when the U.S. government's National Cancer Institute in Maryland began a clamp-down on consulting work by its scientists. New economic pillars beyond the traditional hi-tech manufacturing and financial services are being built in the biotech, education and healthcare sectors. This is being done partly by attracting world-famous names to the island republic through larger investment budgets than are available elsewhere. ^\^

“Philip Yeo, head of Singapore's Economic Development Board, makes no secret of the fact he wants to attract "whales" -- or scientists with an international reputation. Singapore has attracted Sydney Brenner, co-winner of the 2002 Nobel prize in Physiology or Medicine for work on the genetic regulation of organ development. Others include breast cancer researcher Edison Liu, who was born in Hong Kong and emigrated to the United States, and Japan's Yoshiaki Ito. Both had worked at the National Cancer Institute. ^\^

“In an era where funding is critical -- even a microscope can cost half a million dollars -- wealthy Singapore has the money. That, say scientists, has been Singapore's attraction, along with speedy grant approvals and lack of burdensome paperwork. Scientific research today is increasingly about access to grants and rewards such as fame, prizes and commercial spin-offs -- incentives which can sometimes lead to unethical practices, as South Korea's stem cell research scandal has shown. "We don't want to spend the rest of our lives writing grants," one scientist said. ^\^

“One of the foreign stars is Alan Colman, the Scottish scientist who cloned Dolly the sheep and is now undertaking stem cell research in an attempt to cure diabetes. He turned down offers in Britain and the US in favour of Singapore. "What I'm benefiting from is an experiment to see if they can change the mindset of the intelligentsia, the people coming through the universities, to make them more innovative," he said. "Whether it's in my area or others, they're just trying to change people because they recognise it is for their future success." ^\^

Singapore Hooks Top US Cancer Experts

Sara Webb and Mia Shanley of Reuters wrote: “When top U.S. scientists Neal Copeland and Nancy Jenkins arrive in Singapore to set up a new cancer research project, they will bring some extraordinary luggage: thousands and thousands of mice. The husband-and-wife team will bring 50 to 100 different strains of mice for their research into the most common types of human cancer when they move to the city-state in coming weeks. Their decision to relocate to Singapore -- which they chose over leading U.S. cancer research centers at New York's Memorial Sloan-Kettering and California's Stanford University -- is a coup for Singapore, where the government is spending billions of dollars to develop its biomedical industry. "They are a big catch. They are prominent researchers, very successful in the U.S.," said Alan Colman, the British scientist whose team cloned Dolly, the world's most famous sheep. [Source: Sara Webb and Mia Shanley, Reuters, January 10, 2006 ^\^]

“Copeland, 58, and Jenkins, 55, use the mouse genome to study which genes trigger cancers in humans. "We use mouse genetics as a tool for human diseases," Copeland said, adding that their research tries to identify the genes and develop the drugs to fight the most common cancers. Copeland and Jenkins met 25 years ago as researchers at Harvard Medical School, and have worked together for more than 20 years, co-authoring over 700 research papers. Their most recent work employs a technique known as "sleeping beauty" because of the way that it uses inactive genetic material to activate or awaken cancer genes. That work could lead to a better understanding of the series of steps that take place when a person develops cancer, said David Lane, who heads the Institute of Molecular and Cell Biology in Singapore where Copeland and Jenkins will work. ^\^

“Lane, who discovered the important "p53" cancer gene which suppresses tumors and whose work in Singapore focuses on zebra fish, said that with the arrival of Copeland and Jenkins, Singapore is starting to attract more interest in the scientific community as it has built up a critical mass of superstars. "People will go to where the big names are," Lane said. "The challenge is to create a place where people want to come." Copeland said that Singapore's quick access to funding was key. The couple's colony of 20,000 mice costs some $1 million a year to maintain. But Copeland and Jenkins, who hope to be based in Singapore for the long run, say the fall-out will have no impact on Singapore's ambitions to become Asia's leading biomedical center. ^\^

Politics-Free Science in Singapore Attract U.S. Biomedical Brainpower

Foreigners, reports The Straits Times of Singapore, account for about two in three of the 2,000 researchers in public institutions under the Agency for Science, Technology and Research-. Paul K. Harral wrote in the Fort Worth Star-Telegram, “Two of the most recent additions are Drs. Judith Swain and Edward Holmes, a husband-and-wife team of scientists and administrators at the University of California in San Diego. "The view of Singapore is that it has become the hottest place in the world to do research," Swain told The Straits Times in a July 11 article. "If I had to place a bet, I'd say that the biomedical sciences are moving faster here than anywhere else." [Source: Paul K. Harral, Fort Worth Star-Telegram, August 12, 2006]

The newspaper reports that foreign talent is helping Singapore fulfill its dream to expand biomedical research and commerce while it trains its own pool of researchers. "What they have found irresistible are funding, freedom, and facilities," the paper said. The flow of scientists has been encouraged, in part, by a perceived anti-science bias on the part of American school students and the Bush administration. "Many U.S.-trained scientists are leaving the U.S. at this time because of the prevailing attitudes of politicians and society toward scientists and science education," Liu said. "When one can go to a country where--as a scientist--one's contribution is recognized and supported, there is an intense draw. As living and working conditions improve in other countries, the draw to remain in the U.S. will lessen." "I was intrigued by the vision and aspirations of Singapore as a nation to make biomedicine a significant part of its economy and its academic fabric," Liu said.

"Over the years in the U.S., I had developed an idea of what I think genomic medicine should be," Liu said. "Much of it required a different way of doing things--new operating systems with different assumptions. The Singaporean government offered me sufficient resources and a clean slate to actualize this personal vision."

That's the academic side of why he moved from the United States. But there's more: "On a personal level, I was getting progressively frustrated at how political correctness and politics have progressively perverted the real goals of biomedicine--to improve human lives and to understand the workings of living things. "The incursion of religious beliefs into scientific management, the use of the NIH [National Institutes of Health] as a political target, the lack of commitment to scientific education on a national scale has been a great disappointment to me," he said. The United States, he said, is the world's premier scientific country, but there are societal issues as well as operational and funding issues involved in the lure of Singapore. "The societal attitudes here give much more respect for scientists than in the U.S.," he said. "Students aspire to learn the sciences and math; U.S. kids disdain these disciplines."

Singapore Build Crab-like Robot to Remove Stomach Cancer

Inspired by Singapore's famous chili crab dish, researchers in the city-state created a miniature robot with a pincer and a hook that can remove early-stage stomach cancers without leaving any scars. Tan Ee Lyn of Reuters wrote: “Mounted on an endoscope, it enters the patient's gut through the mouth. It has a pincer to hold cancerous tissues, and a hook that slices them off and coagulates blood to stop bleeding. With the help of a tiny camera attached to the endoscope, the surgeon sees what's inside the gut and controls the robotic arms remotely while sitting in front of a monitor screen. [Source: Tan Ee Lyn, Reuters, February 1, 2012 \~/]

“"Our movements are very huge and if you want to make very fine movements, your hands will tremble ... But robots can execute very fine movements without trembling," said enterologist Lawrence Ho, who helped design the robot. Professor Ho, who works at Singapore's National University Hospital, said the robot helped remove early-stage stomach cancers in five patients in India and Hong Kong, using a fraction of the time normally taken in open and keyhole surgeries that put patients at higher risk of infection and leave behind scars. \~/

“Stomach, or gastric, cancer is the second leading cause of cancer deaths worldwide and is particularly common in east Asia. Diagnosis of gastric cancer usually occurs at a late stage of the disease when treatment is difficult and often unsuccessful. Louis Phee, associate professor at Singapore's Nanyang Technological Institute's school of mechanical and aerospace engineering, helped design the robot with Ho. They developed the robot after a seafood dinner in Singapore in 2004 with top Hong Kong surgeon Sydney Chung, who suggested they fashioned their device after the crab. Chung is best known for fighting SARS in Hong Kong in 2003. \~/

“"He (Chung) suggested we used the crab as a prototype. The crab can pick up sand and its pincers are very strong," said Ho. "Many things are a certain way because they have evolved and adapted to certain functions ... we created something that followed the human anatomy and borrowed ideas from nature and incorporated the two." The researchers formed a company last October and hope to make the robot commercially available in three years.” \~/

Cancer Therapy Developed in Singapore Reduces Painful Side-Effects

In 2005, AFP reported: “Singaporean researchers have discovered a new way to combat cancer that delivers drugs with microscopic precision and minimises painful side-effects, a scientific institute said. Scientists from the Institute of Bioengineering and Nanotechnology have created "smart" polymer nanoparticles that deliver anti-cancer drugs directly to diseased tissues, according to a statement. [Source: Agence France Presse, March 21, 2005 /*/]

“The new cancer treatment, which has been successfully tested on small animals, would significantly reduce side-effects which cancer patients who undergo traditional chemotherapy commonly suffer, such as fatigue and hair loss. "Previous attempts by other scientists involved the use of core-shell nanoparticles that were only sensitive to temperature," said lead scientist Yang Yi-Yan. /*/

“Drug delivery may be controlled by superficially heating or cooling the environment of the nanoparticles. Yang said the novelty of the invention was "the ability of (our) nanoparticles to target drugs to deep tissues or cell compartments without changes in temperature." Biological signals tagged onto the nanoparticles, which are less than 200 nanometres in size, enable them to recognise tumour sites present in the body and subsequently release the anticancer drugs into the cancer cells. A nanometer is a billionth of a meter, or roughly one-hundred-thousandth the diameter of a human hair. The technology will undergo clinical trials within the next five years, said Yang.” /*/

Medical Tourism in Singapore

Singapore has become a place where foreigners seek overseas medical care for a fraction of the cost back home. “Medical tourists” are visitors that come countries such as Thailand and Singapore for various medical procedures and tests and combine the medical care that with some rest and relaxation, for a price that is often considerably less than what they pay back home. People come to Singapore from all over the world for ultrasound tests, Lasik surgery, barium stomach X-rays and sex change operations. M.R.I.s are only $190. Complete physicals are $250. Many medical tourists come for cosmetic surgery.

Rough number of medical tourists based on data from 2010 and 2011: 1) Thailand, 1.2 million; 2) Singapore, 600,000; 3) the United States, 400,000; 4) India, 390,000; 5) Malaysia , 380,000; 6) Hungary, 360,000; 7) Japan, 80,000. [Source: Japan Tourism Agency]

According to Healthy Travel Media the average cost in Singapore of: 1) heart-valve replacement with bypass surgery is $25,000 compared to $75,000 in the U.S., $9,500 in India, and $25,000 in Thailand; 2) hip replacement surgery is $12,000 compared to $33,000 in the U.S., $11,500 in India and $12,700 in Thailand; and 3) knee replacement surgery is $9,600 compared to $30,000 in the U.S., $10,200 in India and $11,500 in Thailand; The costs include hospital and doctor fees but not travel and lodging. [Source: New York Times, March 21, 2009]

In Singapore: 1) coronary artery bypass surgery costs $16,300 compared to $75,000 to $133,000 in the United States; 2) prostrate surgery (TURP procedure) costs $5,300 compared to $10,000 to $16,000 in the United States; 3) gastric bypass surgery costs $16,500 compared to $35,000 to $52,000 in the United States; and 4) a face lift costs $7,500 compared to $10,500 to $16,000 in the United States. [Source: Patients Beyond Border, U.S. News and World Report, May 12, 2008]

Simon Parker wrote in the Asia Times, “According to the Singapore government, “demand for a strong regional health center in Singapore should surge in the coming decades. Asia's population is expected to grow from 3.2 billion in 2002 to 5.6 billion in 2050, and with it will come an increasingly affluent and demanding class of people who will want the type of quality health care being offered in Singapore. The burgeoning middle classes of India and China are two such target markets.In 2003, about 230,000 foreign patients sought treatment in Singapore, and the country's Economic Review Committee has set a target of serving 1 million foreign patients each year by 2012. [Source: Simon Parker, Asia Times, October 21, 2005 *+*]

Singapore’s VIP Medical Tourism

In 2006, Ansley Ng wrote in Today, “When a king from Nigeria came to Singapore in July with his 10-man entourage — including four tribe chieftains — he didn't just have fine dining and shopping on his mind. He was here to fix his ailing heart, as doctors attended to him at Mount Elizabeth hospital. "The king was impressed with the quality of healthcare in Singapore and said it was comparable to hospitals in the United States and United Kingdom," said Mr Gene Lee, a manager in Parkway Group Healthcare, which owns the hospital. [Source: Ansley Ng, Today, December 13, 2006 <^>]

“The red carpet wasn't just rolled out for the king — Parkway also ensured his men enjoyed themselves here by bringing them to Marina South and Chinatown. While the medical tourism industry has traditionally wooed rich patients from neighbouring countries such as Malaysia, Indonesia and Brunei, local hospitals are seeing a spike in the number of middle-to-upper-class patients from Russia and Nigeria. Like the other medical tourists — some 374,000 foreigners came here last year, compared to 320,000 in 2004 — they come here for anything from a simple health screening to cancer treatment. "Anecdotally, I hear from the hospitals that the Russians and Africans are coming," said Dr Jason Yap, director of SingaporeMedicine, a body set up by the Government in 2003 to lure a million foreign patients here by 2012. "We raise our standard and we do what we do best, provide quality, safety and trustworthy care and we let patients decide where they want to go to," said Dr Yap. <^>

“In 2004, the industry raked in $836 million, including receipts from hotels and shopping, Dr Yap said at a briefing for the first International Medical Travel Conference held in Singapore in December 2006. Three months earlier, the Singapore Tourism Board (STB) ? together with five healthcare companies ? went on a roadshow in Moscow, paving the way for rich Russians to seek medical treatment here. Raffles Hospital, for example, is seeing "four to five Russians a day", said Dr Saw Chit Aung, deputy director of marketing at Raffles Hospital. The revenue from Russian patients jumped 120 percent from 2005 to the third quarter of this year, he said. Patients — including politicians and rich businessmen — chalk up an average bill of $7,000. "While in the past many of them come for health screening, we are seeing a changing trend with patients coming for cardiac surgery, orthopaedic surgery, gastrointestinal surgery and cancer treatment," Dr Saw said. <^>

“Foreign patients now constitute 36 percent of Raffles Hospital's total patient load. The top five markets are Indonesia, Malaysia, Britain, the US and Japan. But the Russians are making an impact, with their big spending. In Parkway, which took in 170 Russian patients this year, the average bill of a Russian patient is between $10,000 and $60,000. Both healthcare groups say the Russians who come here hail from the eastern part of the country in cities like Vladivostok, since those from the west —cities like Moscow — prefer to go to hospitals in Europe. <^>

"With greater affluence and spending power, they come here seeking good quality medical services at a lower price than what they would typically pay in a Western country," said Dr Saw. The emerging markets have also prompted the hiring of more translators as well as the opening up of overseas offices. Parkway, which saw about 30 Nigerian patients this year, will set up an office in Lagos, Nigeria next month, to be followed by three more offices in Nigeria by 2008. Said Mr Lee: "From there, we hope to stream into other states in Africa." <^>

Some of Myanmar’s leaders periodically went to Singapore for unspecified medical treatments.

Image Sources:

Text Sources: New York Times, Washington Post, Los Angeles Times, Times of London, Lonely Planet Guides, Library of Congress, Singapore Tourism Board, Compton’s Encyclopedia, The Guardian, National Geographic, Smithsonian magazine, The New Yorker, Time, Newsweek, Reuters, AP, AFP, Wall Street Journal, The Atlantic Monthly, The Economist, Foreign Policy, Wikipedia, BBC, CNN, and various books, websites and other publications.

Page Top

© 2008 Jeffrey Hays

Last updated June 2015

This site contains copyrighted material the use of which has not always been authorized by the copyright owner. Such material is made available in an effort to advance understanding of country or topic discussed in the article. This constitutes 'fair use' of any such copyrighted material as provided for in section 107 of the US Copyright Law. In accordance with Title 17 U.S.C. Section 107, the material on this site is distributed without profit. If you wish to use copyrighted material from this site for purposes of your own that go beyond 'fair use', you must obtain permission from the copyright owner. If you are the copyright owner and would like this content removed from factsanddetails.com, please contact me.