BOSTON - The theme of this year's annual meeting of the American Association for the Advancement of Science is "Science and Technology from a Global Perspective." On the biomedical side, global health challenges received much attention. (See BioWorld Today, Feb. 15, 2008.)

But some of the more hopeful aspects of globalized medicine were sounded in a panel on "Translation of Fundamental Cancer Biology: Toward Clinical Innovation - Singapore Model" on Friday.

The panelists spoke on the advantages of Singapore's geographic location and size, its highly educated population and the tight integration of multiple basic and clinical institutes in the country's Biopolis research complex.

But they also suggested that the country's bureaucracy has basic philosophical differences to its U.S. equivalents. For one thing, the drug approval process has the potential to react more flexibly to changing scientific ideas about the underlying nature of illnesses. For example, it is widely accepted that cancer is caused by the combination of several mutations. But the FDA mandates testing one drug at a time.

Panelist Edison Liu, director of the genome institute of Singapore and head of its equivalent of the FDA, said that "there is a philosophical difference [to the U.S.] in some of these Asian jurisdictions" that leads to a greater integration of health and science.

He said that the greater integration, along with Singapore's small size, makes it easier to consider changes to the drug approval process. "In Singapore, it's possible to get the key opinion leaders together and discuss what might be a rational strategy," he said.

And Nancy Jenkins, now deputy director of the institute of molecular and cell biology, which is part of the biopolis complex, told BioWorld Today after the panel discussion that a key factor in her decision to relocate to Singapore was frustration with another U.S. bureaucracy: the National Institutes of Health. That institution revamped its conflict-of-interest rules in 2005, angering many researchers. (See BioWorld Today, Feb. 7, 2005.) Jenkins admitted that there were "some bad eggs" with egregious conflicts of interest among the NIH staff, and some oversight was necessary. But the NIH reaction, she said, was overkill, crippling researchers' ability to work with industry at all.

Jenkins said that applied research, at least in its later stages, is "absolutely dependent" on collaborations with industry, and the new NIH rules made such collaborations all but impossible and precipitated her decision to relocate to Singapore.

Jenkins was very direct. Her description of the NIH's current ethics rules is: "Let's make sure that nobody can do anything." But perhaps the most interesting, and surely the most controversial, facet of the speaker's claims is that one of Singapore's strengths is a combination of its ethnic mix and the way that diversity is perceived and utilized.

During the panel discussion, John Wong, dean of the Yong Loo Lin school of medicine, gave several examples of ethnic differences in response to drugs. The average dose of the anti-clotting agent warfarin for an ethnic Indian, he said, is triple of that needed by an ethnic Chinese person, and the response rate to Iressa and Tarceva also is much higher in Asians than Caucasians.

In general, both wanted and unwanted responses to several cancer agents appear to be stronger in Asians than Caucasians - Wong said that using the doses of doxorubicin and cyclophosphamide, a standard breast cancer treatment, that are average for Caucasian patients "would give half of Asian patients life-threatening complications." The discussion of such ethnic differences got lively during the question-and-answer session, when an audience member noted that ethnic differences in drug response are a touchy issue to even investigate in the U.S. Wong said that in Singapore, not separating out ethnic differences would be seen as "a disservice to our patients."

Liu added that it helps that there is no longer a stark ethnic divide between investigators and subjects. "At one point, all geneticists were white and all subjects were of color," he said. Now, "it's a very different mindset about exactly the same issues . . . from being exploited, it's become a source of pride."

Average ethnic differences in drug response are due to the fact that ethnicity correlates with certain SNPs that affect the response. But the reason that ethnic differences in genetics are such a hot-button issue in the U.S. is that they correlated with something else: socioeconomic differences.

That makes them politically loaded, but poverty also changes physiology - in fact, a concurrent AAAS session on "Poverty and the Brain" explored that very issue on Friday. Liu told BioWorld Today that Singapore, too, is not a society where the content of one's character is all that counts. Ethnic Malays, who make up roughly 7 percent of the population, are more likely to be poor than either Chinese or Indian ethnic origin.

But, both Liu and Jenkins said, the government has taken a very active role in preventing segregation. "The isolating effects of poverty are just not there as much," Liu said.

Steps that have been taken range from making English the national language when the country was first formed (which prevented any ethnic group from having an intrinsic advantage) to actively controlling the ethnic mix in housing and schools to make sure they are integrated. Singapore's small size and public transport system also means that "there's no ghettoization," Liu said. "A poor person can take a bus to almost anywhere."

That includes to one of the five public hospitals. Liu said that the Singapore, whose health care system is a mix of public and private, has the fifth-highest life expectancy in the world - for which it spends a paltry 3.5 percent of its GDP.