Monday, July 29, 2013 C7
HEALTH Brain overdrive leads to burnout
Photo: Corbis
................................................. Kate Whitehead life@scmp.com
T
he global pharmaceutical industry spends about US$50 billion a year on research and development. Thanks to its growing expertise in clinical trials, Hong Kong is gearing up to take a larger slice of it. A combination of global regulatory changes and growing local competency has catapulted the city forward. In 2004, 221 clinical trials were conducted in Hong Kong; by 2008, that had risen to 360, and the number has stayed about constant each year since. Members of the Hong Kong Association of the Pharmaceutical Industry, which represents major drug companies, conducted 11 trials in 1999, 79 in 2006, and 123 in 2008. The biggest area for research in Hong Kong is oncology, taking up 28 per cent of trials at Hong Kong University and 24 per cent at Chinese University. Endocrinology is next, followed by gastroenterology and hepatology, and cardiology. Most clinical trials are undertaken by pharmaceutical companies looking to prove a drug’s efficacy and safety before bringing it to market. To ensure independence, they are conducted by academic centres, which charge fees but usually don’t make profits, and are closely supervised by an ethics committee. “In the old days, most trials were done in the West,” says Henry Yau, assistant registrar of HKU’s Clinical Trials Centre based at Queen Mary Hospital. “There were two reasons: because the industry was there, and drug companies like to do research in their home countries; and because a US company, for example, might not be able to do a trial overseas – if it wanted to sell a drug in Britain, for example, it would have to repeat the trials there.” That all started to change in the mid-1990s, when the International Conference on Harmonisation, a body that combines the medical regulatory authorities of the US, European Union and Japan, produced Good Clinical Practice, a quality standard for the regulation of trials. It “made drug regulation a global business”, Yau says, and at a stroke made international trials feasible. Asia has been one of the main regions to benefit, in particular cities with developed health care systems and an international outlook, such as Hong Kong and Singapore. Around 1998, Yau says Hong Kong suddenly started to get a lot of inquiries from
“The most important thing in a phase one trial is understanding of risk,” says Zee. “If there’s no understanding of the value of the trial, it can be very dangerous. You have to have full understanding of the consent form. You have to explain the benefits and the risks – and for phase one, there’s almost no benefit.” He says phase one is important to Hong Kong, particularly with the emergence of growing regional rivals such as Taiwan and South Korea, as it looks to position itself as a route into the potentially massive market over the border. “In terms of the future in Hong Kong is set to become a popular venue for pharmaceutical Hong Kong, early drug companies to conduct drug trials, writes Richard Lord development is important. In China, recruitment is really fast, so you can easily do a big phase three trial there. So our role in Hong Kong is in phase one and two, and then you go to the mainland or wherever for phase three.” Hong Kong Association of the Pharmaceutical Industry executive director Sabrina Chan says the city needs to do more in this regard. “The biggest priority to increase the number of trials in Hong Kong is being the gateway to China.” Getting drugs approved on the mainland can be complicated, she adds, with a Tak-cheung contracts, and intellectual pharmaceutical companies clinical trial has changed property respected. everywhere. Along with its certificate from global practice It also has a high-quality equivalent at Chinese the State Food in treating public health care system that University, HKU’s Clinical The number of clinical trials and Drug NPC by boasts perhaps the city’s Trials Centre was born. undertaken in Hong Kong in Administration establishing biggest advantage: a Over the past 15 years, it has 2008 taking about that centralised system of patient undertaken more than 700 a year. chemotherapy records, in English, that covers trials for pharmaceutical In Hong Kong, trial in conjunction 90 per cent of the population, companies. About 60 or 70 new certificates take about with and is the global gold standard. ones start each year, about 220 three months, but the Hong radiotherapy is more effective Kim Lee, chief scientific are ongoing and 50 more are Kong portion of a mainland than using radiotherapy alone. officer in Hong Kong for being prepared. trial will only be recognised if a Hong Kong’s expertise in Novartis Pharmaceuticals, says Hong Kong enjoys a certificate from the FDA is trials, however, is limited. More Hong Kong is the first place her number of advantages in forthcoming. than half are phase three, with company goes to for trialling pharmaceuticals: good “Efficiency is a competitive another quarter phase four and hepatology trials, and is also medical education and a lot of advantage of Hong Kong, and just 16 per cent phase two. very high on the list for myopia, highly qualified scientists, and under this system, that Phase two is when the bulk of infectious diseases, multiple a reputation for producing advantage is not as big as it the work is done in sclerosis and psoriasis. reliable, high-quality data. could be,” says Chan. establishing that it actually “It’s important that we look There is also geographical With drug patents only works; phase three confirms into diseases that affect people compactness; wealth and a lasting 20 years, a few months the findings of the first two in Hong Kong,” says Benny Zee good education system – both can make a big difference to a phases; phase four makes sure Chung-ying, director of correlated with a lower droppharmaceutical company; that all is going as planned Chinese University’s Centre for out rate among trial Chan says the industry once the drug is on sale. Clinical Trials based at Prince participants – low taxes and a would like a mainland FDADuring the ultra-cautious of Wales Hospital. “There are good legal system, with reliable approved certificate issued in phase one, the basic safety of Asian diseases that we need to Hong Kong. the drug is tested. With its focus on.” The other big issue, Chan higher level of uncertainty and With a condition such as says, is facilitation from the risk, this phase requires nasopharyngeal carcinoma, Hospital Authority. “After the facilities that haven’t been which is 25 times more certificate is approved, you available here – until now. common among certain need a lot of backup from the In the 2011 budget, the southern Chinese than almost Hospital Authority: legal, government allocated everyone else, Zee says: “If we research, nursing and so on.” HK$1 billion to a new Health don’t do anything, no one will. But generally, the feeling is and Medical Research Fund to Big drug firms aren’t going to optimistic. The city’s position finance phase one centres at do it for a drug that will only as a clinical trials centre could the two clinical trial centres sell in southern China.” be just starting to take shape. and both will be open for A Chinese University study BENNY ZEE, CHINESE UNIVERSITY life@scmp.com business soon. led by Professor Anthony Chan
TESTING
TIMES
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It’s important that we look into diseases that affect people in Hong Kong
Are you always rushing from one place to the next? Do you often eat without really tasting the food? If you do, then listen up: part of your brain may be in overdrive, acting as though you’re being chased by a predator. Not only is it not doing you any good, it’s also making you function inefficiently. The amygdala is the brain region that is involved with the fight and flight system and the experiencing of emotions. This is the part of the brain that senses danger and gets us to respond even before we have a chance to think about it. It’s an immediate responlse. But when our lives are not in danger, the amygdala should be turned off, otherwise we would be living in constant overdrive, a frantic mode of being that risks burning us out.
We end up brooding about the past, or worrying about the future PROFESSOR MARK WILLIAMS
“For people who rush around, their amygdala is permanently on. It’s an illusion of creative productivity,” says Mark Williams, director of the Oxford Mindfulness Centre at Oxford University. For the past 20 years, Williams has been studying the benefits of mindfulness meditation, a simple form of meditation based on Buddhist practices. Working with two other psychologists, John Teasedale at Cambridge University and Zindel Segal at the University of Toronto, he has focused on helping people with depression. The three were drawn to the potential benefits of a mindfulness stress reduction programme developed by Jon Kabat-Zinn in the late 1970s, which was based on Buddhist teachings. Adapting the programme, they developed Mindfulnessbased cognitive therapy. Accompanied by guided meditations, the eight-week course is taught at centres or can be done by self-study with a book and CD, Mindfulness: A Practical Guide to Finding Peace in a Frantic World. Mindfulness is about observation without criticism. A typical meditation consists of focusing your attention on your breath as it flows in and out of your body. The idea is not to try to banish your thoughts, but to notice them as they come and let them go. By doing so, you realise that thoughts and feelings – the good as well as the bad – are transient. Mindfulness allows the meditator to catch their negative thought patterns before they tip them over into a downward spiral. This helps people take control of their lives. “Humans have an extraordinary ability to do
Professor Mark Williams. Photo: Kate Whitehead counter-factual reasoning – the ability when something happens to say what if this or that happened,” says Williams. The difficulty for the brain is to distinguish between our imaginings and reality, because they can both lead to powerful emotions. In the evolutionary scheme of things, this is a relatively new problem. Says Williams: “We’re so good at remembering the past and imagining the future, what’s reality and what’s not, what actually happened and what will actually happen.” For many Hongkongers it seems that frantic thinking – and being – is an inevitable part of city life. But Williams says that those who practice mindfulness meditation will be able to function more effectively and creatively, even when there are a lot of demands on their time. The benefits can be seen in as little as eight weeks. Williams’ work at Oxford focuses on laboratory tasks. He pays close attention to the work of other scientists imaging the brain. UCLA psychologist David Creswell has used functional magnetic resonance imaging to show that people who always rush around during the day have a big response in their amygdala. Once they have done a mindfulness meditation course, their amygdala isn’t as overactive. Animals are able to turn their amygdala on and off. Gazelles are a good example; if a lion chases them, their amygdala begins firing, and this helps them get away from the predator. But as soon as the lion stops chasing them, the herd is back to grazing within five minutes. They need to eat, and so have learned to turn their amygdala off when they don’t need it. “What we find in humans is the amygdala switches on, but because we have our imagination and we can think about all the future things that might go wrong, it doesn’t so easily switch off for many of us. “We end up worrying about the future or brooding about the past. The amygdala is kept switched on for things that have not even happened yet – we can invent worries,” explains Williams. By practicing mindfulness meditation, one can get better control over their amygdala. Brain imaging scans have shown that after a mindfulness course, the amygdala actually shrinks, and this correlates with the reduction in perceived stress.
Photo: Corbis
Call for urgent action on region’s silent killer ................................................ Jeanette Wang jeanette.wang@scmp.com Before you’re halfway through this article, another person will have died of viral hepatitis. New data shows that every 30 seconds, one person in the AsiaPacific region dies of the disease, a death rate that’s three times as high as HIV/Aids. Yesterday, on World Hepatitis Day, the Coalition to Eradicate Viral Hepatitis in Asia Pacific urged governments to step up their efforts to combat the disease, which claims one million lives in the region each year, up from 695,000 in 1990. “These new figures reveal the increasing threat posed by viral
hepatitis to the Asia-Pacific region and are symptomatic of the poor understanding and lack of political commitment that has typically surrounded these diseases in many countries,” says Professor Chen Ding-Shinn, chairman of the coalition.
These new figures reveal the increasing threat posed by viral hepatitis PROFESSOR CHEN DING-SHINN
Viral hepatitis refers to a group of diseases caused by infection from one of five viruses: A, B, C, D and E. Globally, viral hepatitis kills 1.4 million people each year, similar to the number of deaths from HIV/Aids. About 500 million people worldwide have chronic hepatitis B or C. Of the 350 million people with chronic hepatitis B, three in four live in the Asia-Pacific region. The B virus is spread through contact with the blood or other body fluids of an infected person. “Despite the escalating death toll from viral hepatitis, governments have often been at a loss about how to tackle these diseases,
1,000,000 The number of deaths every year from hepatitis in the Asia-Pacific region
Photo: World Hepatitis Alliance
lacking the technical expertise, resources and even evidence to justify the investments needed to confront viral hepatitis,” says Professor Darrell Crawford, acting dean of the University of Queensland’s School of Medicine and coalition joint secretary. “We now have the evidence that justifies the investment in the form of one million people dying needlessly every year.” In July last year, the World Health Organisation’s (WHO) global hepatitis programme launched the framework for global action as a blueprint for governments to develop strategies to tackle viral hepatitis. Professor Stephen Locarnini, director of the WHO
regional reference laboratory for hepatitis B at the Victorian Infectious Diseases Reference Laboratory, urged governments to come up with a national action plan. “We have a vaccine for hepatitis B and new treatments for chronic hepatitis C that could save millions of lives, but none of these matter if governments fail to tackle viral hepatitis in a more comprehensive way,” he says. To minimise the risk of hepatitis, Dr David Teo, regional medical director at International SOS, advises to get vaccinated, practise good hygiene, watch what you eat, practise safe sex, and avoid contact with blood.