China News Weekly reporter/Niu He Du Wei
Published in the 1071st issue of "China News Weekly" magazine on December 5, 2022
At the "2022 Shenzhen Global Innovative Talent Forum" held on November 1, Yan Ning, a well-known structural biologist, announced that she would resign as a professor at Princeton University and return to China to establish the Shenzhen Academy of Hospital Sciences (hereinafter referred to as "Shenzhen Academy of Medical Sciences").
With this official announcement, the Academy of Medical Sciences mentioned by Yan Ning was pushed into the public eye.
Shenzhen Academy of Medical Sciences is a new type of research and development institution integrating scientific research, transformation, student training, funding and other functions. The English abbreviation is "SMART".
Wu Jun, deputy director of the Propaganda Department of the Shenzhen Municipal Party Committee, told China News Weekly, "There are many decisions behind the construction of the Shenzhen Academy of Medical Sciences. Yan Ning will serve as the president of the Academy of Medical Sciences in the future. At present, the relevant procedures are still being processed and have not yet been officially appointed. "
Where is the new Shenzhen Medical Academy?
The planning for the construction of Shenzhen Academy of Medical Sciences started three or four years ago.
In 2019, the Central Committee of the Communist Party of China and the State Council supported Shenzhen's construction of a "pioneering demonstration zone of socialism with Chinese characteristics" and the implementation of comprehensive reform pilot documents, and supported Shenzhen's construction of a new mechanism for the Academy of Medical Sciences.
In March last year, the "Shenzhen Academy of Medical Sciences Construction Plan" issued by the Shenzhen Municipal Government proposed that by the middle of this century, Shenzhen Academy of Medical Sciences will become a world-renowned medical research institution.
The highlight of Shenzhen Academy of Medical Sciences lies in the "new mechanism".
"Compared with the traditional Academy of Medical Sciences, Shenzhen Academy of Medical Sciences is not only a pure research institution, but its more core function is to undertake the public management and service functions of medical science and technology research endowed by the government." In April last year, the Shenzhen Municipal Health Commission Science and Education Director Zhou Liping said publicly.
The construction idea of the Academy of Medical Sciences is to make it a hub-type scientific research institution, linking government policies, public health needs, scientists' research interests and industry needs.
Yan Ning mentioned in his speech on November 1 that "basic research is inseparable from medicine and medicine".
From the hospital bed to the laboratory, to the pharmaceutical company, and back to the hospital bed, it is the important mission of Shenzhen Academy of Medical Sciences to open up this end-to-end connection.
"The past cognition of the medical and health field needs to be changed. 'Going it alone' is the traditional medical research method, and the medical school model of 'medicine + other disciplines' needs to be opened." Former president of Soochow University, engaged in molecular immunology and virology Xiong Sidong, the researcher, told China News Weekly that domestic medical science has developed rapidly in the past 10 years, and the body has also grown rapidly, but this is far from enough.
In his view, modern medicine is not only a medical problem, but also requires the integration of knowledge from multiple disciplines such as engineering, mathematics, and materials.
"The key to the successful development of mRNA vaccines is not a breakthrough in medicine, but a breakthrough in the field of materials science, because researchers have found lipid nanoparticles (LNP) that can wrap and protect mRNA from degradation." He gave an example.
The main responsibility of the hospital is "medicine", the main responsibility of the medical school is "teaching", and the main responsibility of the medical science academy is "research".
Xiong Sidong said, "In the past, medical scientific research could be carried out by collecting a few mice, a laboratory bench, and a few microscopes. Now medical research requires a large research cohort, big data support, and even the participation of artificial intelligence."
Xiong Sidong analyzed that due to the large population base and the large number of patients, China's translational medicine has its own advantages.
However, a large amount of data only provides possibilities for translational medicine, and does not mean that it has the corresponding translational medical research capabilities.
Early translational medicine was "bed to the lab", that is, research from the bed to the laboratory.
Today, translational medicine research capabilities should be two-way, and should also have specific strategies for transforming major achievements in basic research into disease prevention and treatment.
According to media reports, domestic medical research results generally encounter the problem of "difficulty in transformation". A large number of research results cannot be turned into actual products or solutions. Regulatory policies for new technologies are lagging behind, pricing for new technology applications is difficult, whether new drugs and new technologies can be included in medical insurance, etc.
Shenzhen Academy of Medical Sciences will establish a "1+N+X" clinical research and transformation collaborative innovation body aimed at research transformation bottlenecks, and will also build an international high-level translational medicine center.
This includes the construction of a high-level international clinical research hospital with 300 beds.
Scientific researchers of Shenzhen Academy of Medical Sciences are allowed to "invest in technology shares". In addition, Shenzhen Academy of Medical Sciences will also transform enterprises through investment and "shareholding" and gradually transition from a single scientific and technological research and development to a scientific research-industrial complex.
In 2015, Zhang Kan, former director of the Science and Technology Education Division of the Shanghai Health and Family Planning Commission, talked about the resistance and difficulties in the construction of the Shanghai Academy of Medical Sciences in an article.
In his view, the establishment of the Shanghai Academy of Medical Sciences will involve challenges such as institutional abolition and merger, flat design of management levels, adjustment of unreasonable or outdated knowledge structures, and updating of management concepts.
"Shanghai Academy of Medical Sciences aims to break through the fragmented and fragmented structure, strengthen industry management, coordinate the municipal financial investment in health science and technology, and diversify the investment of social capital. Other departments whose interests and powers are touched will often adopt resistance. and non-cooperative attitude to maintain the status quo." Zhang Kan mentioned in the article.
A chief physician of a tertiary hospital in Shenzhen, who did not want to be named, told China News Weekly that these are also common problems in the construction of domestic medical academies.
Shenzhen Academy of Medical Sciences has subverted the "old rules" of previous medical academy, implementing variable establishments, variable levels, market-based salaries, and socialized employment.
The council is the decision-making body of Shenzhen Academy of Medical Sciences; the dean is the legal representative of Shenzhen Academy of Medical Sciences, who is appointed by the council and implements a tenure system.
After Yan Ning announced his joining, it was reported on the Internet that the "real reason" for his return to China was that artificial intelligence would make structural biologists "unemployed".
On November 11, Yan Ning responded by posting a long post on his personal Weibo, “Based on the many structures we have analyzed in the past, AlphaFold’s prediction last year reached our level in 2017; this year is still at our 2017 level. Level (here only for Nav/Cav). In cooperation with the AI team that specializes in structure prediction, they make predictions, and we do experiments to test the interaction between new small molecules and proteins. So far, none of the predictions have been correct.” AlphaFold is the prediction An artificial intelligence platform for protein structure.
Yan Ning said that real researchers are willing to embrace technological progress and make good use of various technologies to explore and answer questions of their own interest.
"In fact, I expect AI to become more and more powerful, so that we can really study the origin of life from a chemical perspective."
Gao Fu, an academician of the Chinese Academy of Sciences, told China News Weekly that the Shenzhen Municipal Government had the foresight to "recruit people first and build buildings later".
If the building is built first and then recruited, without talents, the medical academy will become a decoration like a "castle in the air" without practical value.
Shenzhen Academy of Medical Sciences, challenge geometry?
In the past 10 years, Shenzhen's population has increased by nearly 70%, and the proportion of young and middle-aged people is much higher than the national level.
According to data from the seventh national census, the average age of permanent residents in Shenzhen in 2020 is 32.5 years old.
The demographic dividend has greatly promoted the economic development of Shenzhen.
On October 29, the latest data released by the Shenzhen Bureau of Statistics showed that the GDP of Shenzhen in the first three quarters of this year exceeded 2 trillion yuan, ranking first in Guangdong Province.
Compared with its outstanding economic strength, Shenzhen's medical resources are relatively weak.
According to data from the National Health Commission and the Beijing, Shanghai, Guangzhou and Shenzhen health commissions, as of 2019, there are 58 tertiary hospitals in Beijing.
At present, there are 35 and 39 tertiary hospitals in Shanghai and Guangzhou respectively, and there are 32 tertiary hospitals in Shenzhen, including two in Pingshan District.
According to the "Shenzhen Academy of Medical Sciences Construction Plan" issued by the Shenzhen Municipal People's Government, the Shenzhen Academy of Medical Sciences is located in Pingshan District, and will be promoted in accordance with the "construction while operating" model.
On November 2, a netizen consulted through the message board of the leaders of People.cn, whether the Shenzhen Academy of Medical Sciences will continue to choose a site within the Pingshan area, or expand the site selection to other districts?
The Shenzhen Municipal Health and Health Commission replied on November 17 that the Shenzhen Academy of Medical Sciences is currently under preparation and will be deployed in multiple locations throughout the city in combination with Shenzhen's urban construction and development planning.
The Shenzhen Municipal Bureau of Planning and Natural Resources stated that Pingshan District attaches great importance to the work related to the project. Please refer to the official media for the progress of the project and relevant information.
According to the data from the Shenzhen Municipal Health and Health Commission, as of July 31, 2022, there were more than 63,000 doctors in Shenzhen, including more than 59,000 practicing physicians and more than 3,400 assistant physicians. Compared with the more than 100,000 doctors in Beijing and the number of doctors in Shanghai Nearly 75,000 doctors still have a gap.
In order to improve the level of medical care, Shenzhen launched the "Three Famous Projects" in 2014 focusing on "Famous Doctors (Famous Departments), Famous Hospitals, and Famous Clinics". By introducing high-level medical teams with international and domestic influence, optimizing Medical and health personnel structure.
At present, 91 famous doctors (famous departments) have been introduced and cultivated in Futian District, 39 in Luohu District, and less than 23 in other districts.
"Shenzhen's existing medical institutions have played a significant role in improving the local medical level, such as the affiliated hospital of Shenzhen University and several research institutions set up by the Chinese Academy of Medical Sciences in Shenzhen," Xiong Sidong said.
"Shenzhen's medical background is relatively shallow, and medical talents are relatively scarce." The aforementioned chief physician of a tertiary hospital in Shenzhen said that in recent years, Shenzhen has introduced a large number of medical experts from other places and built new hospitals, and the overall level of diagnosis and treatment has been improving.
However, the introduction and new medical resources need to accumulate over time.
Due to the difficulty of building a large-scale integrated medical, teaching and research team in the short term and the high housing prices in Shenzhen, it is becoming more and more difficult to introduce high-level medical talents.
The first local medical school in Shenzhen, the School of Medicine of Shenzhen University, was established in 2008. More than four years later, the Faculty of Medicine of Shenzhen University was formally established.
The chief physician of the aforementioned tertiary hospital said that there are relatively few professional medical schools in Shenzhen, and doctors in general hospitals seldom do scientific research and teaching, and most of them only do diagnosis and treatment.
According to the data disclosed on the official website of the Shenzhen University School of Medicine in March this year, the School of Medicine will enroll 155 students in 2021 and is expected to enroll 200 students in 2022.
"Shenzhen University's School of Medicine does not have a large annual enrollment scale, and it is difficult for each department or medical specialty to form a large team that combines medicine, teaching, and research." The aforementioned doctor said.
A medical researcher from a university in Beijing told China News Weekly that Shenzhen is a young city.
On the one hand, the number of young people who are sick is small, and the proportion of long-term chronic diseases is not high. There are differences in medical needs compared with those in Beijing, Shanghai and Guangzhou. On the other hand, Guangzhou, which is not far away, has rich medical resources, and some people will choose to go to Guangzhou for treatment. , Shenzhen's local medical supply side was subsequently suppressed.
"Medical scientists with comprehensive development capabilities in medical teaching and research are very scarce in China." The aforementioned chief physician said that after the completion of the Shenzhen Academy of Medical Sciences, it will be able to unite with major hospitals in Shenzhen to train more outstanding medical scientists and promote the tripartite linkage between the Academy of Medical Sciences, the medical department of universities, and hospitals. , and truly promote the development of China's biopharmaceuticals and medical devices.
From this dimension, the outlook is still very optimistic.
The aforementioned Beijing medical researchers said that medicine is a practical discipline oriented toward clinical application, and Yan Ning’s main research direction is structural biology. It is a challenge to manage a medical academy well.
Should not follow suit
Following the Chinese Academy of Medical Sciences, in the past ten or twenty years, many provinces in China have successively established medical academies, including the Anhui Academy of Medical Sciences, which was renamed from the Anhui Provincial Institute of Medical Sciences in 2007, and the Guangdong Academy of Medical Sciences, which was established in 2008. The Shandong Academy of Medical Sciences, which was established in February 2009, etc.
"There are 19 medical academies in China, including 3 at the national level and 16 at the local level." Zhang Kan pointed out in an article published in 2015 that the medical academies are mainly divided into three categories. The medical academy represented by the "one institution, two brands" management model; one is an independent institution represented by the Shandong Academy of Medical Sciences; the other is an affiliated institution that is mostly affiliated to a hospital or the Chinese Center for Disease Control and Prevention. Generally, the district-level medical colleges are the main ones.
The Chinese Academy of Medical Sciences was established in 1956, and the Union Medical College was merged into it in 1957. It now has 19 research institutes, 6 affiliated hospitals, 9 colleges, and 106 out-of-hospital R&D institutions.
"The development of the Chinese Academy of Medical Sciences is mainly due to the simultaneous advancement of hospital treatment, medical teaching, and scientific research, which are mutually integrated, and the integration of resources is more reasonable." The aforementioned chief physician of the top three hospitals in Shenzhen told China News Weekly.
"At this stage, apart from the Chinese Academy of Medical Sciences and a few provincial medical academies, many medical academies have not really become bigger and stronger." The doctor analyzed.
In fact, building an academy of medical sciences is expensive.
On September 29, the construction project of the Meizhou Academy of Medical Sciences Building in Guangdong was launched. The total area of the building is about 110,000 square meters, with a total investment of 865 million yuan.
This is the first prefecture-level city academy of medical sciences in the country. The main functions of the building are scientific research experiments, outpatient and emergency departments, medical technical examinations, inspection centers, and physical examination centers.
The construction funds of Shenzhen Academy of Medical Sciences mainly come from special government funding, social funding and conversion income.
According to the "2022 Shenzhen Academy of Medical Sciences (Preparation) Department Budget" released by the Shenzhen Municipal Health and Health Commission in May this year, the budget income of the Shenzhen Academy of Medical Sciences in the preparatory stage in 2022 will be 29.18 million yuan, more than 90% of which will be government budget allocations; budget expenditure will be 29.18 million yuan , of which 10.4 million yuan was spent on medical services, which were mainly used for research and demonstration, project evaluation, and public platform construction of the Academy of Medical Sciences, an increase of over 80% compared to last year.
Not only is it expensive to build, but it is also expensive to run the medical school.
An article published in the journal "Shandong Education" in 2021 mentioned that the Shandong Provincial Academy of Medical Sciences invests nearly 100 million yuan a year by publishing recruitment information in internationally renowned journals, holding overseas seminars on talent introduction, and holding international youth scholar forums, etc. way to attract talent.
Xiong Sidong said that because of the high construction and operating costs of medical colleges, although it is necessary to establish medical colleges, all localities should keep a calm mind and not follow suit.
"If all places build identical medical schools, this matter will lose its original meaning." He said.
Zhang Kan pointed out in the aforementioned article that in many cases, a sum of money was invested here to build a technology platform, and other departments also invested money to build a similar laboratory.
The same project applied for a fund in this department today, but tomorrow it will be changed, and a similar project will apply for a funding support in other departments.
The lack of effective communication among various departments leads to repeated investment of resources, and the final research results inevitably lack original innovation and competitiveness.
In the article, Zhang Kan gave suggestions for building the Shanghai Academy of Medical Sciences, evaluating and selecting existing medical research institutions in Shanghai, and giving certain input to the institutes with better evaluation results.
Medical research institutions are evaluated every 5 years. Those with better operation and more output will continue or be newly included in the Shanghai Academy of Medical Sciences, while those with poorer operation and less output will be withdrawn from the Shanghai Academy of Medical Sciences.
There are generally two types of organizational models of foreign medical research institutions. One is the national research institutions represented by the National Institutes of Health (NIH) and the French National Institutes of Health. One type is the research committee represented by the British Medical Research Fund Management Committee. Generally, there is no physical research institution directly under it, and all research and development funds are directed to professional research institutions across the country.
In Shenzhen’s official announcements, it has repeatedly stated that the Shenzhen Academy of Medical Sciences will benchmark against NIH and other world-leading medical science academies.
NIH is one of the largest medical research institutions in the world.
NIH is made up of 27 independent institutes and centers in different biomedical disciplines.
A study published in February 2018 in the Proceedings of the National Academy of Sciences found that from 2010 to 2016, NIH funding directly or indirectly helped develop drugs or drug targets for all 210 FDA-approved drugs.
About 81 percent of NIH's $37.3 billion budget in 2018 went to extramural programs, funding 3,000 universities, medical schools and research institutions around the world.
Domestic traditional medical academies usually only have in-house projects, and the funding is only for researchers in the hospital.
Shenzhen Academy of Medical Sciences will follow the example of NIH and set up both in-hospital and out-of-hospital projects. Out-of-hospital projects will be open to the Guangdong-Hong Kong-Macao Greater Bay Area, the whole country, and even the world through various methods such as "bidding system", "reward system" and "horse racing system" to subsidize non-hospital institutions Or scholars to conduct research or collaborative research across fields.
Xiong Sidong said that although NIH has many direct references, practical experience shows that simple copying has no future. Only by combining China's national conditions and building medical schools around its own clinical needs can it go far.
"It is not advisable to start a new stove or completely copy the model of foreign medical academies." Xiong Sidong believes that the construction of medical academies involves various factors such as talent structure, local medical resources, and policy orientation. There are great differences between regions. Build medical schools according to local conditions.
"Some places with a relatively weak medical foundation purchased sky-high medical equipment costing hundreds of millions of yuan each, only to find that they didn't even have the technicians to operate the equipment. These medical equipment became display items in the window, and it was difficult to play their due role. ."He says.
In Xiong Sidong's view, with the gradual spread and improvement of the National Academy of Medical Sciences, the previous research of stragglers will be gradually replaced, and targeted and organized medical scientific research oriented to major clinical needs will become the mainstream form.
"Building a platform and providing medical services are only one of the functions of the Academy of Medical Sciences. I hope that the Academy of Medical Sciences in the future can become a 'big courtyard without walls', which not only accommodates medicine, but also absorbs talents from multiple disciplines such as science and engineering, instead of becoming a Incubator or service center." Xiong Sidong said.
"China News Weekly" Issue 44, 2022
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