In this edition, Vip Viprakasit, MD, DPhil, talks about working in a limited-resource setting, falling in love with the red cell, and his surprising talent for singing.
Hear more from our interview with Dr. Viprakasit in Sound Bites.
What did you want to be when you grew up?
I'm fortunate that I am doing what I thought I would be doing. During high school, I became interested in medicine. It seemed like a challenging field and, more important, I loved the challenge of making a diagnosis. To me, it was like playing the role of the detective in the mystery novels I loved to read. As a specialist in red cell disorders, I like to think of myself as a detective who finds the culprit but also cares for patients.
Now, in Thailand, there is an apprentice training program where high school students interested in medicine can go to the hospital and gain exposure to the medical world. Back in my time, that wasn't available!
To get to where I am today, I have relied on plenty of luck – and a bit of hard work.
Did you always know that you wanted to specialize in red cell disorders?
I first trained as a general pediatrician at Chiang Mai University in northern Thailand, then continued my training in pediatric hematology/oncology at Siriraj Hospital at Mahidol University in Bangkok. Later, I pursued my postgraduate training in molecular hematology at the Weatherall Institute of Molecular Medicine at Oxford University in the U.K.
Typically, when you choose to subspecialize in pediatric hematology, you pursue one of two routes: classical hematology or malignant hematology. I quickly realized that my passion was the red cell, anemias, and thalassemias. There is no other way to say it: The red cell is my cup of tea. There are so many mysteries to solve!
During your training, what advice did you receive from your mentors and advisors?
There were two important mentors in my career. First, Voravarn Tanphaichitr, MD, who was my predecessor in my current position at Siriraj Hospital. She also was the leading expert in red cells in Thailand and in Southeast Asia. With her work in thalassemia and iron chelation therapy, she set a great example of working within your limitations. Even though she started her research work 40 to 50 years ago, she showed me that you can still conduct excellent clinical investigation and do important research if you have the determination.
The second important mentor is Douglas R. Higgs, FRS, who was my supervisor during my postgraduate training at Oxford University. Like my earlier mentor, Prof. Higgs is a world-renowned expert in the red cell and thalassemia and provided a wonderful example of a successful researcher. However, he worked in very different circumstances, running one of the biggest programs in red cell research at one of the most renowned universities in the world.
Prof. Higgs taught me three important lessons that I've carried with me throughout my career: First, he demonstrated logical thinking; second, he taught me about critical analysis; and third, he helped me master my communication skills. Communication is an important skill for any practitioner, and, as a non-native English speaker, I was especially grateful for his guidance.
Having trained in diverse settings, what do you see as the biggest differences between working in a limited-resource country and a developed country?
The two settings are very different – both in resources and types of patients. In Thailand, we have one of the biggest cohorts of people with thalassemia and tropical hematologic disorders in the world, so our database for that condition is huge. The limitation, though, is our infrastructure. With limited access to the diagnostic technology, Thai clinicians and scientists need to adapt.
Also, while we cannot compete with the infrastructure available to Oxford or Harvard or Johns Hopkins, the U.K. and U.S. do not have large patient pools. Studies there are conducted first in animal models or cell models – which is important – but in Asia, we have the opportunity to relate what we find in these models directly to the real world.
Fortunately, through my training abroad, I have had many opportunities to make connections with leading researchers around the world. Even though there are limitations on how we can conduct studies in Thailand, our network of collaborators has expanded greatly by building bridges between international colleagues. I'm able to send colleagues my questions and ask for help on certain cases. I have learned that making connections is vital to conducting research in a limited-resource country like Thailand. This type of collaboration is almost always fruitful and will lead you to a new way of discovery.
Do you have any other advice for younger hematologists or trainees who are working in limitedresource settings?
I was asked to speak about how to lead a successful research career in southeast Asia at a recent Highlights of ASH® in Asia- Pacific in Bali, Indonesia. While I was recounting my experiences as a clinician-researcher practicing in this area of the world, I challenged the notion that working in these areas means you are working at a disadvantage.
People assume that if you are a clinician-researcher working in Boston or London, everything will be perfect and easy, but working in Bangkok or Kuala Lumpur will mean a difficult career full of insurmountable challenges. In my opinion, doing research in these types of areas is a blessing.
Institutions in areas with seemingly unlimited resources tend to ask similar questions or conduct similar experiments; for instance, you might see back-to-back papers on the same research question published in a peer-reviewed journal. Investigators there also are working within a "publish-or-perish" environment, competing with other top-notch centers for publication and funding.
In Asia, we cannot compete with these institutions, and being removed from that competition means that we can ask different questions. In our corner of the world, we can be more creative in the questions we ask and in the routes we take to find answers. I think this affords us the opportunity to form closer relationships with our patients. Because I'm conducting research and running my clinic at the hospital, whatever I do in my research efforts can be directly translated into my clinical practice. Any discoveries I make don't just live in a peer-reviewed journal; they can live in the exam room and can help improve patients' lives.
Also, in my international fellowship, I share the same advice with our trainees, no matter what country they joined us from: Look carefully at your patients; they are your best teachers. If you pay attention and try to understand them, they will teach you something new.
What are your proudest career accomplishments?
In 2014, I discovered KLF1, the gene that causes a new form of hereditary hemolytic anemia and published those findings in Blood. Through our research, we learned that if a patent inherited the mutations from both parents, he or she is likely to develop a severe anemia. This condition has probably been present in Southeast Asia for decades, or maybe even centuries, but had never been identified.
I am so proud of this discovery because we were able to help patients who presented with an as-yet unexplained anemia. Before identifying KLF1, we couldn't understand what was going on, or why a boy or girl developed severe anemia and required regular transfusions. My detective work was successful, and we found the cause!
Now that we know the cause, we can translate the knowledge about this genetic abnormality into clinical practice. One of the happiest moments in my career was this summer: I was able to help a family in which both parents carried KLF1 and wanted to have a child by performing preimplantation genetic diagnosis of the disease, which allowed for selection of unaffected, human leukocyte antigen–matched embryos.
Also, in the past few years, I started my own company, ATGenes. As a molecular biologist, I have the training to make more complex diagnoses with genetic testing, but many of my colleagues in Thailand or other nearby countries do not have the training or access to the appropriate molecular technology. With ATGenes, I wanted to provide these services for clinicians; ultimately, I can increase the number of patients and families who will benefit from my research.
The company has existed for three years and we have grown to employ about 50 people. It's still a start-up that we're trying to get off the ground, so that is how I spend most of my time outside of the hospital and the lab.
How do you spend the little free time that you have left?
I spend most of my free time going to the cinema with my son. He turned 14 this year, so I'm not sure how much longer he will enjoy going to the movies with me. I'll have to accept that when the time comes, but for now, I like going with him to see animated movies and sci-fi movies – basically anything but romantic comedies.
I also enjoy spending as much time as I can with my wife. She is a veterinarian ophthalmologist and is director of the largest veterinary teaching hospital in Thailand.
Given her occupation, do you have many pets at home?
We don't have any! I think she has enough of that at work. I joke that it's the same for me – I'm a pediatrician, and we only have one child!
Does your son want to follow in his parents' footsteps and become a doctor?
He has already decided it's not for him, which is understandable. As you can imagine, my wife and I are both very busy with our practices, and she's a hospital director so her job is even crazier than mine.
What is one thing that people would be surprised to learn about you?
I'm a surprisingly good singer. I have no training and I cannot play any instruments, but I can sing everything from opera to country to jazz.