Prof Kua started his research journey in the field of alcohol abuse management during a time when medical journals were dominated by research papers from the West. Asians were sorely underrepresented in research cohorts. With the paucity of research conducted on local South East Asian populations, he observed that evidence-based guidelines and recommended treatment options at the time were often poorly fitted for locals as they were derived from western research that did not account for our sociocultural and genetic differences.

Recognition of the profound gap between the need for local research and its existing scarcity pushed Prof Kua, and other pioneers, to develop the local research scene. This also marked the start of his career as a pioneer in Psychiatry and Psychiatric research, authoring 350 research papers and 30 books on psychiatry, addiction, and ageing.

The changing landscapes of medical research in Singapore

Early biomedical research in Singapore had to contend with a lack of understanding, support and appreciation of its relevance and importance to local healthcare needs. Initial attempts to develop certain fields of research, for example in preventive medicine, were met with resistance. This was especially true in the field of dementia. Whilst prevention is currently highlighted as a primary focus in dementia research and clinical practice, solid foundational work as well as patient, continual education were required to facilitate mindset shifts in recognising its importance.

One of the prime examples of such foundational effort was Prof Kua’s work on the Jurong Ageing Study in 2011—a 10-year study on dementia prevention in Singapore. During a time where preventive research was typically underfunded, Prof Kua reached out to and leveraged on the support of donors to conduct this important piece of work. With generous donations and a modest rented space at Jurong Point Mall serving as the research base, he embarked on this landmark study. It was to revolutionise preventive approaches to dementia through the introduction of four innovative, community-based interventions: mindfulness, horticulture, art therapy, and choral singing¹. Additionally, the study highlighted the efficacy of psychosocial interventions, such as art, music, Tai Chi, and mindfulness in reducing subsyndromal depression and anxiety in the elderly². By underscoring the importance of preventive care, the study raised awareness about preventive medicine and laid the groundwork for long-term programmes, such as the Age Well Everyday (AWE) Club, aimed at directly improving elderly health through early preventive measures.

Beyond shifts in foci, successful foundational research work has also underpinned a cultural shift in the general public’s perception of research. At a time when medical research was less common in Singapore, patients were unfamiliar with the processes of research participation and were often highly resistant to participating in studies for fear of being treated as test subjects. Today, public appreciation for the role of research in advancing healthcare has grown significantly, owing to the work of pioneers in establishing a reputable and effective research landscape. While there is still scope for improvement, the public is today generally more aware and willing to participate in studies. They are also aware that participating in clinical trials lets them be the first to access new drugs.

Medical and research education have also evolved over the years, ensuring continuity of the research legacy laid down by pioneers. Compared to his experience as a medical student where he saw high barriers of entry in the pursuit of medical research, Prof Kua feels that a more supportive and open environment has been established for budding researchers today. With the advent of undergraduate medical research opportunities and mentorship programmes, a growing number of undergraduate students are embarking on research projects. It is a promising development, as it helps them develop their skills and passion, which they can carry into their future careers.

The importance of engaging in research work as a clinician

Juggling the demands of clinical practice alongside a desire for research is undoubtedly a challenging process, requiring sustained commitment and belief in one’s research work. This rings true for Prof Kua, for whom research is a passion that allows him to explore new methods to address current medical issues and challenge the status quo. In particular, he promotes the immense value of translational research—studies that can be directly applied to clinical practice to make a tangible positive difference in patients’ lives. This is the true purpose of research: to enhance patient care, improve health outcomes, and ultimately elevate the quality of life of those it touches.

Collaboration is another cornerstone of Prof Kua’s research philosophy. Through working with diverse, multidisciplinary teams, he has learnt the importance of humility and open communication. He sees research as a collective journey, where each member brings unique expertise to the table. In psychiatry, for instance, it goes beyond medicinal treatment to improving overall well-being, which requires input from a range of disciplines to address the complexities of psychiatric problems. He especially enjoys working with non-medical professionals as he feels that they approach medical problems from novel angles, enhancing the depth and breadth of our medical understanding.

Notably, his interviews with the elderly in Singapore when he was a part of a WHO team studying dementia inspired him to publish “Listening to Letter from America”. The book narrates the wartime stories of the elderly individuals in our community, providing unique and foundational life experiences that would otherwise have been lost . With much focus placed on quantitative data in current research, he advocates the value of qualitative research as he believes that personal narratives bring a unique depth to understanding complex issues which statistics alone cannot capture. Incorporating qualitative data and storytelling into research can differentiate papers in a crowded field, making them more engaging and accessible to readers. The power of research lies not just in the data presented, but also in the stories told—tales that can change lives and inspire real-world impact.

What, then, is the formula for success? There is no shortcut to success it seems, as resilience and persistence, or what he would call “an undefeated mind”, is necessary. In addition, researchers should always be ready to seize every opportunity with tenacity and open minds as they never know where their inquiry may lead.

Towards disease prevention and wellness enhancement

A future where medical research—supported by funding—pivots firmly towards prevention rather than focusing solely on topics of epidemiology and treatment would underline a much-needed shift away from focusing merely on illness to wellness.

Such a pivot would require collaboration across medical and non-medical specialities. Cross-disciplinary research is pivotal to holistic outcomes, where combining diverse expertise can lead to more comprehensive solutions and innovative approaches to patient care.

From an underdeveloped research to a vibrant region where impactful local studies now receive global recognition, medical research in Singapore looks set to continue its trajectory, thanks to the pioneering efforts of Prof Kua and his generation of clinician-researchers.