Modern medicine has quelled many ailments – but at a cost. With more complex treatments come more complex outcomes. An array of side effects from increasingly potent drugs and complications from the growing stable of surgical procedures are among the new challenges doctors today must grapple with.
This is why the story does not just end with finding novel treatments, said Dr David Allen, 54, a pioneer in the field of infectious diseases here.
Cancer patients today, for instance, have better chances of survival thanks to stronger chemotherapy drugs. Now, more than 60 per cent of breast cancer patients can live for another 20 years. In the 1990s, only about 40 per cent would have done so.
‘But the survival comes with consequences,’ said Dr Allen, an American who came to Singapore in 1989 at the request of the Health Ministry to help lay the foundation for the field of infectious diseases – something that was almost non-existent at that time.
One of the side effects of such cancer therapy is infections, such as of the mouth, skin, and lungs. This is because cancer drugs can suppress the ability of the bone marrow to make white blood cells, which are crucial in fending off infections.
‘As a result, compared to 20 years ago, patients are sicker; their problems more complex,’ said Dr Allen.
He drew parallels to how more people are surviving traffic accidents, which were often fatal in the past as emergency care was not as efficient then.
‘Now people can survive the accident. But we deal with other consequences – bleeding, infection, and blood clots,’ he said. ‘It’s the beauty of modern medicine, but also the cost of modern medicine.’
Dr Allen, who in 1992 was the first to helm an all-new infectious diseases department at the Communicable Disease Centre (CDC) in Tan Tock Seng Hospital, trained the first generation of infectious diseases doctors in Singapore.
Associate Professor Leo Yee Sin, who runs the CDC now, was among Dr Allen’s first batch of medical trainees.
He returned to his practice in Texas in 1994 but visits Singapore regularly to teach.
He is in town to lecture at the National University Hospital, Tan Tock Seng Hospital and Alexandra Hospital, as well as to collect an award for his contributions.
The inaugural Monteiro Award is named after the late Professor Ernest Monteiro, whose research on the polio vaccine helped to eliminate the disease here.
Dr Allen received the award last Sunday from Prof Monteiro’s son, Dr Edmund Monteiro, 78, also an infectious diseases doctor.
It is conferred by the College of Physicians Singapore, on a grant from the Society of Infectious Diseases (Singapore).
Modern medicine, however effective, has yet to stem most infectious diseases. Dr Allen recalled that dengue fever, tuberculosis and HIV/Aids were some infections he dealt with in the 1990s. All are still in the news.
Last year, dengue hit record epidemic levels, with more than 4,600 infections registered at the end of the peak transmission period in October.
And in November last year, it was reported that there were more new cases of tuberculosis among Singaporeans and foreigners, with the year’s final tally expected to exceed 2010′s total of 1,478 cases among residents.
Meanwhile, efforts to raise awareness and acceptance of HIV are still being stepped up, with advocacy group Action for Aids rolling out a mobile van last month to encourage more people to get tested.
The first-line treatment for many infections has remained the same over the years, said Dr Allen.
What has changed is simply the range and types of tools used to tackle the diseases. For example, doctors now have more drugs to use as second- and third-line treatments, he said.
‘If we have problems, failures, side effects… we have drugs available now that we didn’t have back then.’
Here, another kind of cost is incurred: investment in education. Doctors have to be properly trained on how – and when – to administer treatments.
‘Just because you have a tool doesn’t mean you should use the tool,’ he said. ‘You still have to be selective – to ask yourself when is it helpful, and when it doesn’t really help any more.
Still, the field of infectious diseases – which developed in the US only in the 1960s – has come far.
In the early 1990s, the concept was still quite new in Singapore, and doctors had to explain to people what it entailed, said Dr Allen.
He recalled how he had to treat a patient who had been bitten by a crocodile. Maggots had covered the wound by the time the man was admitted to hospital. The medical team opted not to remove the maggots immediately as they eat bacteria and dead tissue.
‘Actually, it’s not a bad thing – the maggots will probably do a better job than us,’ said Dr Allen. ‘But his family was rather disturbed.’
At that time, a team of only seven doctors covered the whole island as far as infectious diseases were concerned.
Singapore now has 45 registered infectious diseases specialists working in hospitals and clinics.
The Health Ministry also collates and publishes data on infectious diseases on its website weekly.
Medical care of infectious diseases here is now ‘superb’, noted Dr Allen. Research efforts have also been heartening, he added.
Universities, hospitals and scientists at the Biopolis are among the many institutions studying infections.
He looks forward to more research studies in the field, especially now that there are more diagnostic and therapeutic methods available.
‘It’s both easier and harder to practise now,’ he said. ‘Easier in that sometimes when we run into dead ends, we have more options to turn to.’
The difficulty for doctors, on the other hand, lies in picking the best way to treat a patient.
Ongoing investigations are required to compare which methods are better, he said.
‘There will never be sufficient research – whether it’s on astrophysics, or how to bake a chicken properly, or in dealing with infectious diseases,’ he joked.
‘We can always do better.’
The Straits Times Poon Chian Hui
