Mark Richard Kho, MD is a General Surgeon and Surgical Oncologist, a VP for Medical Service Operations at the Manila Doctors Hospital, and an educator at the University of the Philippines College of Medicine-Philippine General Hospital. The interview we had in his clinic was interrupted by calls from worried patients and relatives of patients, trying to find words of reassurance or ways to beat cancer, the disease described in a New York Times bestseller book, and titled as such, as the Emperor of All Maladies.
Sunfu: Are you into research Dr. Kho?
Yes, having had to spend about 2 years doing actual bench work in a basicscience/cancer biology lab in California as part of my Surgical Oncology fellowship training, where at least 100 PhDs work within the campus. Being in the academe here in the Philippines, research is indeed a key thrust,along with training and service. But what research we are involved in ishardly cutting edge as we don’t have the infrastructure support for suchkind of research in our country. It is hard to match the billions of dollars the US government pours into cancer research annually thru its National Cancer Institute. Still, US researchers are clamoring for more dollars. We of course do not only need logistical resources, but human resource as well, and with our diaspora, we have a dearth in this area. So Basic Science research may not be for us, as we do more of clinical research focusing on the local setting.
Sunfu: I think you may have the most well-appointed private clinic here in the Manila Doctors Hospital (MDH) and judging by the looks of this place, you must be getting a lot of support for your private practice.
I do and am so grateful for the challenge and the opportunity to participate in the MDH vision. And thank God for it as well, because at the PGH where resources are already scarce, we are hardly compensated for all medical, administrative, training and research work. MDH, under its new and dynamic management at the time when Metrobank Foundation came in, was one of the first to provide much needed support for private practice to physicians by renting out clinic space and access, rather than the old modus of selling clinic privileges requiring millions of pesos in initial capital from physicians. And with the ever-increasing demand of the acquisition of new and capital-intensive medical equipment, the MDH management principle of plowing back whatever earnings from hospital operations creates an environment of financial sustainability, growth and better health care service to our needy community.
Sunfu: Should we have medical research in our country?
Yes, because the Filipino profile is different, our diets and locale are different, and we need to have the data to compare ourselves with other populations. The challenge is in prioritizing research over service with our limited resources. A quick albeit temporary solution will have to come from the philanthropic or business sector of society in providing the much-needed funding. The more permanent and appropriate solution is to have government and/or legislated funding. Essential to this is making health care a major budget concern.
Sunfu: Was your training abroad helpful?
Definitely, honing one’s competence can only be helpful. To be formally trained in places where skills and technology are at the forefront of my field gave me confidence and proficiency. Such a learning experience gave me a richer perspective, and sometimes perhaps an even vastly different perspective, as these medical centers outside the Philippines have a different profile from the patients we managed as students/residents in medical school.
Sunfu: If there is a patient who has the money, should the patient go to the US for treatment?
For the more common cancers like breast and colon cancer, like what all your interviewees in your company website have said, we have the available the standard treatments as they have abroad. Perhaps the machines are not as fancy or the “latest” models as the machines they have, but the bells and whistles of the machines may not add anything if what we are talking about is the survival of the patient. The bigger problem most of the time is whether the patient has the resources to go through the whole treatment cycle. What we lack here in the Philippines is the option of providing the patients the chance of participating in clinical trials due again to the lack of research funding.
Sunfu: What did the young physician, Dr Mark Kho, not know that you know now as a more senior doctor?
After medical school, I did surgery residency for 5 years, then another 5years of Surgical Oncology training in the US, and it’s been 19 years since I came back. There have been a lot of advances in drug development andsurgical techniques. And with all these years of experience, you learn better patient management. Also, because of the increase in patient interaction and relationships developed, there is a corresponding increase in one’s sense of empathy.
Sunfu: What do you tell your son who is training to become a doctor?
As my dad who was a surgeon often told me, I would tell him that as he increases his knowledge base and skill set, and as he becomes more competent, empathy should always still be there. Expertise without empathy will make him fail as a doctor.
Sunfu: Dr. Mariano Kho, your late father the surgeon, what did you learn from him?
I learned a lot from him. He was my doctor, teacher, mentor, and friend who always had my back. I miss him a lot, and his most empathic advice to me was to be of service to others and to remain true to what I trained to be, which is to be a medical doctor and surgeon, to not be distracted in the end by other additions such as politics and running for positions and government posts. Being called for administrative and academic work is a bonus which enhances my service to the community to which Dad has therefore encouraged me to take up to the task. He always reminded me that I am first and foremost a healer who can provide some comfort to his fellowman.
Sunfu: But since you are in your 50s, are you not tempted to go wholesale rather than retail? Won’t you affect more lives if you do good work as an administrator or maybe a policy adviser?
Sure, but then precisely because that temptation is there, that is why my father believed he must warn me about shifting focus. It is an art to manage one’s time, and as one who can be called on by patients almost any time, there is already not enough time in a day. But that is my identity, that of a surgical oncologist. There is a lot of temptation to move on, to leave my practice and direct patient care behind, but I know this is what I trained for and this is who I am. So as much as I can still do with my steady hands and good eyes, I will do so. On the other hand, I have been so fortunate to be able to help, in the little time and small ways that I have, in administration and policy making at MDH, the University of the Philippines and the Philippine College of Surgeons.
Sunfu: What did you learn as an administrator of a hospital?
When you are in administration, you see the complexities and difficulties of running a hospital. Since my parents and siblings and some in-laws are doctors, people say that we can already man a brand new hospital without any nuances. But now I see it at the vantage point of being in administration, and you realize that a medical degree even combined with an MBA may not mean much. It doesn’t mean you can run a sustainable enterprise, which is necessary to be a good hospital. It takes investment in time, bold effort, sharp managerial skill, a lot of common sense, patience, luck and opportunity.
Sunfu: Conglomerates are entering the hospital industry, is this good?
It is a difficult question to answer as the experience is quite new and we are not privy to all the motivations and intent of these events. Certainly, the systems efficiency is increasing. Capital investment capability is also becoming more robust as more conglomerates enter the industry, enhancing the sophistication in negotiations and bulk pricing, so that acquisition at good prices means more opportunities to buy better and modern equipment. But of course, as we see business people contributing greatly to the success of running hospitals, one also appreciates the need for medical doctors to be an integral part of the mix. This brings to mind the phrase used by Secretary Hillary Clinton, that “it takes a village”. I believe that to succeed in anything, it takes the whole society to come together.
Sunfu: Cancer is such a big disease, so much funding is devoted to it. Yet there is no cure for it.
I agree, for most stage IV cancer there is none yet. But for earlier stages of cancer, statistics all point to our improving the rate of cure and survival. Some cancers are in fact easily treated, and yet there are some that still baffle modern medicine. Cancer is indeed heterogeneous. We are continually trying to fully understand tumor biology which determines the aggressiveness of a particular cancer. We are certainly moving forward, but we are not yet there.
Sunfu: If there is something you can change in the Philippine health care system,what will it be?
I believe there should be a better understanding of health care delivery from the point of view of limited resources and priorities. There seems to be a misalignment sometimes. For example, the DOH thru Philhealth and PCSO provides free medicines and funding for breast cancer chemotherapy,but not the same for surgery when in fact, the primary cure for breastcancer is surgery. So why is that not getting the support it should? Of course there is also not enough effort and resources in prevention, but that is a whole different area. We may need more technocrats rather than politicians in healthcare, or at least better policy makers with proper mindsets and correct motivations.
Sunfu: If you were not in medicine, where would you be?
I actually don’t know. I can’t imagine not being a medical doctor. I am not an arts person. So I may have ended up in something to do with math, life sciences, business or maybe engineering.
Sunfu: There is a lot of attention given to alternative medicine?
Yes, and that is so sad. We have always tried to educate people about the fallacies and myths of alternative medicine, and the overwhelming advantages of evidence-based medicine. Many practitioners of alternative medicine do not have a license to lose like medical doctors, and they do not have to publish their claims in peer-reviewed journals. It seems to be an easy way to make money. They are unfortunately more easily accepted by patients who can be frustrated over standard treatments and also because they are not required by law to inform the patient of the non-benefits of supplements and side effects of their claims. It is sad since there is a notion that they can do something when in fact patients’ desperation is taken advantage of.
Sunfu: There are so-called cancer centers in China that sell themselves as having the cure for cancer. What do you think of them?
That’s another problem. They are draining the already meager resources of those in our country, but they are really not offering anything truly proven to be any more effective than standard treatment. What they are claiming to be new such as cryotherapy for metastatic cancer, has actually been studied for years and disproven. If you go by the evidence, we can be sure they do not help the patient in any unique way that we cannot offer here. If they have developed something truly worthy, they should share it to the major centers in their country and centers of medicine around the world, to save more lives. Sell it at a price even, as most new discoveries are. But they are not doing that. Instead, they are making misleading claims and selling false hopes. We can do that too, except we are bound by the ethics of the profession and respect for human dignity. In the long run, they also damage the Philippine health care industry by depriving us of our resources that should have stayed in the country towards industry viability, which would not be so bad if what they were selling were classified as either experimental, non-standard or outright fantasy.
Sunfu: We don’t have a chance with medical tourism?
I don’t think we have yet the right attitude for this. We have the people and the know-how. But we don’t have the infrastructure of the Thais and the Malaysians or of say a Dubai Healthcare City, which by the name alone tells you it is massive. Or a Mayo Clinic in Rochester, Minnesota, which is over an hour’s drive from the metropolis, yet can attract talent and become one of the best hospitals in the world. So how is it done? By the government providing the right framework and policies and investing in resources to make talent to want to go to them, and stay with them. There is an over-reliance on the private sector to promote medical tourism when this is more of a government initiative. If say, one of the big casinos here near the airport can be converted to a health tourism hub, imagine the boost. Unfortunately, it is not yet in our sphere of the possible in the minds of our authorities.
Sunfu: Any books you have read that you would like to share with our readers.
I think being in the medical profession inevitably gets you an overload of reading journals and medical books just to keep up to date. So, I cannot be naturally averse to reading, but with the nature of my work and time I don’t own much, I may be more of a video and news magazine-type of person. I enjoyed The Emperor of All Maladies by Siddhartha Mukerjee as it goes through the history of cancer and its treatment from which I have gathered viewpoints helpful in my practice. I appreciate the writings of Malcolm Gladwell like Blink and Tipping Point and the novels of Dan Brown till the Lost Symbol, but missed reading Inferno, but will definitely watch the film version. Biographies such as Steve Jobs by Walter Isaacson I also liked, as it revealed how an out-of-the-box thinker can change the world, although you also read about his mistake in going into alternative medicine to beat cancer. He deserved better, as he could have been cured through early surgery and still be alive now. And to share with your readers his controversial yet eloquent last words about books, surgery, the insignificance of the pursuit of wealth and what matters most in life,“…When a person goes into the operating room, he will realize that there is one book that he has yet to finish reading – (the) Book of Healthy Life.. (so) treasure love for your family, love for your spouse, love for your friends. Treatyourself well. Cherish others…”