LETTERS: The Health White Paper (HWP) has been long awaited to reform the health system to equitable, credible and sustainable healthcare, focusing on critical and long-standing issues.
The time is ripe to explore and assess the relevance of the newer disciplines of medicine "translated" as subspecialties. Foremost are clinical immunology, immunopathology and clinical pharmacology, which have gained a foothold in Malaysia.
Clinical immunology had made a beginning in Malaysia in the late 1970s, but fell by the wayside when the local clinical immunologist left the country. However, clinical immunology made a "comeback" at the Paediatric Institute, Kuala Lumpur Hospital, in 1986.
Since then, five newer clinicians trained in clinical immunology have returned from excellent centres abroad to provide consultations on immune-mediated diseases in public and private hospitals.
Clinical immunology and immunopathology have the ignominy of not being recognised by the National Specialist Registry (NSR) of the Health Ministry.
Clinical genetics, but not clinical immunology, is recognised by the NSR. Both are examples of translational medicine.
While the genes identify what is amiss in clinical genetics, immunology explains how abnormal genes cause disease in patients.
The NSR adopted clinical genetics as a subspecialty but, unfortunately, distanced itself from clinical immunology, although they work in synergy.
The delay in recognition of clinical immunology is a step backward.Clinical immunology underpins most immune-mediated diseases, specifically primary immunodeficiencies, inborn errors of immunity, allergies and autoimmune diseases.
It also includes the study of immunity to infectious diseases that would spur vaccine discovery.
The HWP also emphasises the preparation of human capital to include training, nurturing and licensing of the workforce of varying categories, which have to be organised in terms of quality in professional development and in-service training.
To benefit from newer technology and research advances, talent should be identified and developed in an excellent ecosystem. Merely emphasising fundamental research is shortsighted. Obsessing about clinical research is self-defeating. Besides clinical care, clinical immunologists are relevant in empowering local data through research, especially in infectious disease or pandemic (Covid-19).
Another downside of Malaysian research practice is the lack of desire to share research programmes and projects between organisations, including the Health Ministry and universities; collaboration has been at best tepid.
We should emulate the trans-Atlantic collaboration between pharmaceutical giants Pfizer (the United States) and BioNTech (Germany), which has succeeded in fast-tracking Covid-19 mRNA vaccine discovery with huge profit.
In a nutshell, we need more talent and more research projects in various aspects to yield cutting-edge discoveries. The present core clinical immunologist role is not merely to treat patients but also to nurture and polish local talent, as well as draw overseas talent together to yield innovations and discoveries.
It is reassuring that recently, home clinical immunologists have been called to train specialists for the new subspecialty in paediatric infectious disease and immunology. However, the NSR's continuing rejection of subspecialty clinical immunology would put us at odds with the spirit of WPH.
This is against a backdrop of increasing detection of cases and high mortality for congenital immunodeficiency/primary immune deficiency.
Let us add value to the White Paper by evaluating and recognising the newer medical disciplines, including clinical immunology.
DR LOKMAN MOHD NOH
Consultant paediatrician; member, Translational Immunology Group for Education Research and Society
The views expressed in this article are the author's own and do not necessarily reflect those of the New Straits Times