Profile: Associate Professor Sanjay Chotirmall: Clinician-scientist, bridge-builder and mentor

Q: What motivated you to enter the field of scientific research? Was there someone who inspired you?

I probably got interested in science when I started doing work in rare lung diseases as a house officer in 2005, specifically working on cystic fibrosis. This is a genetic disease of an epithelial chloride ion channel that in simple terms dehydrates – so you get very young patients with thick sputum, recurrent infections, constipation, diabetes etc. These patients usually don’t survive past the age of 40 although this is changing. As a houseman, I had direct clinical contact and I got to speak with them and understand what they had to go through. This got me interested in basic science because it brought science to the bedside for me. To see these patients suffer and die at such a young age, it inspired me to do research.

As a result, I always say to my staff and students something a mentor taught me, which is “Research exists for patients and not vice versa”. We have to think about patients and the impact our research can have on patients when we design and conduct it. The patients and the problems that patients face are what inspires us, and the way science can be used to help them is the basis for our research and what motivates me.

One of the key reasons for returning home to Singapore was I noticed that there was very little in the literature that addressed respiratory disease in an Asian setting. I joined LKCMedicine with the mindset that I wanted to generate some important data and science for Asian patients suffering from lung disease. Most studies in respiratory medicine or lung disease have predominantly been done in non-Asian populations and we really needed data to better understand the disease here. We have made some contributions since I have returned to Singapore but there is much left to do. 

Q: What made you decide to take on the role of Assistant Dean, Faculty Affairs, at LKCMedicine?

It was a role that arrived at the right time. I started at LKCMedicine on 1 September 2015 and have been with the School now for six years. A few months ago, when I was approached for this role, I was happy to take it on. I want to take on roles where I can make a positive contribution, and working with the junior tenure track faculty, of whom I share great friendship with many of them, is something that I value and is important to me. What’s more, this role will allow me to formally contribute back to the School.

Q: Could you share some of your plans in this new role?

First of all, I like to see myself as a human bridge between the tenure track faculty and our senior management, and bring thoughts, ideas and opinions to the table.

Having been through the NTU promotion and tenure process, I feel that I can contribute to assisting many of my colleagues who have yet to undergo this process. I believe that being in the Office of Faculty Affairs gives me insight from both sides. This is the second area that I see myself contributing to. 

The third area is to play a part to further develop our faculty development and mentorship programmes. We already have a LKCMedicine mentoring programme but I think we can always improve. We can never have enough mentorship or mentors and we can never stop developing as a faculty. I hope to bring more to the faculty development and mentoring side of things over the next few years.

Q: Having received international recognition for your accomplishments in respiratory research, what would you consider as your biggest breakthrough to date?

While recognition is wonderful for me and my team, as I said before, you should never lose sight of why you did the research to begin with. We did it for the patients and if the research has impact on patients then we have been successful whether or not we are being recognised for it. While we have had several research successes, the most important success we have had is in training the next generation of clinician scientists.

Dr Tiew Pei Yee is a prime example – she joined my group after completing her senior residency and recently completed her PhD at LKCMedicine within three years. She is now back at Singapore General Hospital as a consultant, inspiring others to take the research path and contributing to the growing translational science community in respiratory medicine in Singapore. She was the first individual to be brave enough to step up and want to do her PhD in a field that was really undeveloped across Singapore from an academic perspective. She juggled a one day a week clinical commitment with her PhD and finished it within a few years, publishing several high impact papers.

Therefore, I see the biggest breakthrough is producing one of our own in my time here rather than any of the individual projects or papers. Each of the individual projects has its own importance but I think a greater importance is creating a platform and inspiration for future generations to continue the work we have started for far longer than I can. While every scientific breakthrough is important, creating the resources and training the next generation to contribute back to the academic community is a better means to position us for many future breakthroughs.

Front row, from left: A/Prof Chotirmall, Prof Wisia Wedzicha, Professor of Respiratory Medicine at Imperial College London and LKCMedicine Visiting Professor, and Dr Tiew Pei Yee. Back row, from left: Dr Micheal Mac Aogain and Dr Poh Tuang Yeow, post-doctoral fellows mentored by A/Prof Chotirmall at LKCMedicine.

Q: You and your research team recently received the NHG Research Impact Award for advancing in bronchiectasis knowledge and management. What does this award mean to you?

This award is extra special for a few reasons. It’s a celebration of team science and teamwork. This is a combination of top-level clinical care for bronchiectasis patients that is delivered at Tan Tock Seng Hospital, high level translational science conducted at LKCMedicine and very high-quality service delivery that results. People tend to think of these three aspects of patient care as separate but our team, in winning this award, wants to demonstrate that all three are inherently interlinked and vital components that influence one another. The award is a testimony to each of those pillars being achieved to a level where we can have impact on patients.

We learn from our patients through our research but at the same we are making a global impact for the discipline. Our patients are teaching the rest of the world about bronchiectasis and aspects of bronchiectasis that were previously unknown. We have a lot of patients in Asia with this chronic debilitating lung disease that many people don’t understand or even know about. The award shows that working together can achieve a lot for patients and the patient is the most critical part of the team. Without patients, there is no clinical service. Without the patients, there is no research. It comes back to what I started the conversation with: if you don’t lose focus on why you are doing what you are doing, which is the patient, you won’t go far off in what you are ultimately aiming to achieve.

Q: Last year, you were interviewed by The LKCMedicine for your perspective on science in COVID-19 times. One year on, could you share your thoughts on the impact of the ongoing pandemic on the research community?

While this has been a very difficult time for everyone, there are opportunities among the darkness and some positive things that have come out of this situation. One has obviously been teamwork and collaboration. For scientists around the world to collaborate toward a single cause and go from sequence to vaccine in record time, conducting clinical trials at very high level and at breath-taking speeds, has been probably one of science’s greatest achievements. This shows that when we all move in the same direction, things can be achieved in science and they can be achieved in a real timely way. 

The second big thing that has come out of COVID-19 is telemedicine and digital health. There was always a reluctance towards that approach in clinical practice but it looks like an approach that we are going to adopt routinely, hopefully, when the whole pandemic starts to abate. That can only be a good thing for patients because they get quicker, easier, and more access to medical advice. Only the ones that need it the most need to go to the hospital. The digital space in medicine is on its way up in terms of wearables and monitoring at home. COVID has accelerated all of that more because the situation necessitated it.

The third aspect that COVID has brought attention to is some of the other grand challenges that the world is facing. I was told as I was training that there are three main threats to mankind. One of them is a pandemic, which is what we’re facing. The other two that need to be thought about are antimicrobial resistance and climate change. The pandemic has brought some of these other issues to the forefront. There needs to be a sustained interest, education and research in tackling these issues on a global scale. Again, the only way we are going to be able to tackle big problems is through inter-disciplinary teamwork.

On the other side, there are a couple of not so good things that COVID has brought out, the first being that communication and information dissemination were major challenges. Confidence in science and scientists has unfortunately been put into question at times because of the way information is being generated and critically communicated. COVID has created an “infodemic” that is very hard to fully comprehend. The relationship between science and the public has clearly been affected somewhat in the way that information was being spread and published through the mainstream media and social media even before it reached the scientific literature.

Another aspect of COVID is that it has taken a major toll on the mental health and wellness of many people. It’s an area that has always been an issue but has been accelerated as a result of COVID lockdowns, isolation and the economic consequence.

The other negative aspect, which was always present but been further highlighted, is inequality and inequity between people and populations. We have seen poorer health outcomes in people with poorer access to healthcare. Vaccine inequity is a global problem. There are some countries that are fortunate enough to consider third booster shots whereas other countries have not been able to administer a single dose to a significant proportion of their population. This vaccine inequity and healthcare inequality has been highlighted through this pandemic and it’s something that the world will need to think about going forward. It was always there but has been clearly highlighted by COVID-19.

Q: Outside of work, what are some of the things you like to do in your free time?

There are several things I love doing. We like taking Simba, my 7-month-old goldendoodle puppy, out to play soccer. I love going swimming with my daughter Siya. We love doing our movie nights at home on Friday or Saturday, with popcorn. My daughter is a Disney princess fanatic and I have been through each Disney princess movie about six times. We recently watched The Little Mermaid, Beauty and the Beast, Aladdin, Finding Nemo, and Toy Story. Family time is really important to me and my wife Amandeep and we do our very best to make some important protected time, especially over the weekends, to allow for that.