1. Dr. Kim, you are a world-renowned
gastroenterologist and a respected member of the medical community. What was
your reason for attending medical school? Can you please share with us what
motivated you to become a physician?
- Frankly speaking, I originally
applied to the medical school because of my parent’s recommendation rather than
of my own decision because back in the 70’s, medical doctors had a stable
occupational status and received high respect from the community. Although I
entered medical school upon my parent’s recommendation, I now value my work as
both a clinician and a clinical researcher, specializing in gastroenterology
with sub-specialties in pancreatobiliary diseases and cancers. Both pancreatic
and biliary cancers are notorious for high mortality rates even with the most
up-to-date treatments. As a clinician who works with patients with such high
mortality rate, I sometimes feel pressured being on the front line of saving
their lives, but I feel a stronger motivation to fight for my patients under
the gravity of it all.
2. As a successful physician with
nearly 40 years of experience, can you share with our readers some of the major
achievements and outcomes you have accomplished during your professional life?
Also, were there any difficult moments you had to overcome during the path of
your career?
- I truly enjoyed and had a great
privilege to work as a clinician for many years. I have to admit that it wasn’t
always an easy road but with the great Asan Medical team, we made a progress in
researching and developing many pancreatobiliary related studies. One of our
achievements was establishing the Kim Diagnostic Criteria for diagnosing
autoimmune pancreatitis (AIP) that led to further development of the
international consensus diagnostic criteria for AIP. Throughout my career, I
have been very fortunate to make small contributions in advancing the field of
pancreatology in Korea. With great appreciation, my contribution was
recognized, and I received Dr. Wunsch Medical Award from the Korean Academy of
Medical Sciences in 2008.1 As a clinical doctor who works directly with
patients every day, I felt honored to be acknowledged for my clinical practice.
Receiving such a reputable award, I find greater responsibility and opportunity
to develop Korea as a global leader in the field of clinical medicine.
Not all significant achievements
come with ease, and there were various obstacles that I had to overcome
throughout my career as a physician. Encountering adverse events during my
medical practice was one of the most challenging moments in my career. Although
I am a veteran clinician with many years of experience, adverse events are
sometimes unavoidable even with the foremost caution. There are doctors who may
advise that such events occur in every 10,000 patients with approximately 0.01%
possibility. Despite the approximated statistics, from a patient’s perspective,
the possibility of the event happening is 100%. Being mindful of patients’
feelings and emotional stress, I am always meticulous with treatments and
procedures in an effort to minimize any negative outcomes. I can’t emphasize
enough that no matter how skillful or attentive a clinician may be, these
events are inevitable. Even with these unavoidable obstacles, We, as
clinicians, should persevere and continue advancing medicine to improve patient
outcome.
3. Dr. Kim, you have been a
professor of gastroenterology at University of Ulsan College of Medicine and a
director of Center for Pancreatobiliary Diseases at Asan Medical Center. How do
you view yourself as an educator? What are your principles or philosophies as a
teacher?
- I always emphasize to my
colleagues and young faculty members that modern medicine needs to take a
multidisciplinary approach. A clinician should always consider all areas of
medicine when treating his or her patients. Young clinicians make a common
mistake in limiting their scope of specialties. It is important for clinicians
to broaden their abilities to collaborate with different specialties in
treating their patients. Modern medicine is evolving fast. Having an open-minded
view and working with various experts from different medical fields are
necessary to provide effective treatments to patients.
My second philosophy in medical
education is that doctors must be ready to provide the best diagnostic and
therapeutic options for patients. From a patient’s perspective, it is not only
very disappointing but also frustrating when one receives an outdated and
suboptimal treatment while a better treatment method exists in the field. I
believe that all patients are entitled to receive the most effective and the
most recent treatments and as healthcare professionals, we must constantly
train ourselves in preparation to deliver the evidence-based, up-to-date
diagnostic and therapeutic modalities.
As a senior faculty member in a
university hospital, I have always tried to be a good mentor for training
fellows, and recently joined young colleagues. My duties as an educator are: to
motivate and guide fellows in training to become physician-scientist in the
world of academia, to support them in overcoming certain obstacles in the
practice and clinical research and to encourage them to achieve their
individual success in their field of study.
4. You have become the president of
Asian-Oceanic Pancreatic Association (AOPA). What are your key roles,
responsibilities, and principles of leading the Asia’s largest pancreatic
society? Can you also share with us the main goal and mission of the AOPA
meetings?
- It is my great honor and privilege
to serve as president of the Asian-Oceanic Pancreatic Association (AOPA). The
AOPA encourages the advancement and sharing of knowledge regarding pancreatic
diseases and promotes a public interest in pancreatology. Another important
mission of AOPA is to attract and support young researchers in continuing their
research and clinical study of pancreatology.
In that respect, my main
responsibility as president of AOPA is to promote clinical, translational, and
basic research in pancreatology and to organize scientific meetings cooperating
with eminent pancreatologists across the world. I also offer opportunities for
clinicians and researchers to exchange up-to-date clinical and research study
results.
Upcoming 7th biennial AOPA meeting
will be held on April 25th thru 27th in Seoul, South Korea. The main theme of
AOPA 2018 is “Debates & Challenges in Clinical Pancreatology” with a main
goal to disseminate the best clinical practice in the field of pancreatology
among hundreds of clinicians and professionals from all over the world.
5. You have conducted hundreds of
research and served as an author and coauthor in many research papers. As an
eminent opinion leader of pancreatobiliary diseases, what are some major
changes or trends happening in the area currently? Also, what do you forecast
the major changes would be in pancreatobiliary gastroenterology in the next
five years?
- Recently, there has been a major
change in the field of pancreatobiliary diseases, which increased effectiveness
of surgery. Pancreatic cancer can be classified as surgically resectable tumor,
unresectable tumor, and borderline resectable tumor based on the disease stage.
In the past, we took an aggressive approach to undergo surgical resection for
borderline resectable tumor. According to the recent clinical studies, however,
patients with positive resection margin after surgical resection (R1) have a
significantly poor prognosis compared with those with a negative resection
margin (R0). With an effort to increase the chance of R0 resection, neoadjuvant
treatment (chemotherapy followed by radiation) is performed first before
considering surgical treatment in borderline resectable pancreatic cancer. With
assessing the response to neoadjuvant therapy, we can select the best candidate
for surgery because these patients are at a high risk for harboring occult
metastatic disease and vessel encasement and for undergoing a margin-positive
resection. This recent change has resulted in an increase in the effectiveness
of the surgery and eventually to a prolongation of patient survival.
“Precision Cancer Medicine” has
recently been in the limelight and many researches have been actively conducted
on this area. As to pancreatic cancer, this new trend of research will lead to
personalized cancer medicine, in which the patient will have his or her own unique
cancer treatment plan based on his or her molecular or genetic heterogeneity.
This individualized cancer care also focuses on stromal targeting strategies
and immunotherapy. There is also a growing need for genomics-driven precision
cancer medicine to guide patient selection by predicting treatment response.
In pancreatic cancer, PARP inhibitor
and PEGPH 20 are now studied in patients with pancreatic cancer harboring BRCA
mutation and hyaluronic acid overexpression, respectively. These efforts for the
application of precision medicine will improve the outcome of patients with
pancreatic cancer.
6. We also noted that you serve a
role in medical leadership of various clinical studies developing new drugs.
Asan Medical Center is also a world-renowned clinical study site. Can you share
your experience on how the scientific leadership takes a significant part in
new drug development?
- I believe a clinician has a
significant role in the development of new drugs by evaluating efficacy and
toxicity of new treatment. Clinicians and basic scientists have their own roles
to play in the new drug development respectfully. To translate clinical
observation into clinical science is a distinct role of clinical researcher.
The role of clinician is highlighted in the determination of targeting the
disease and in the process of study design. Also, in the analysis of the
results, even when a study may seem to have no apparent efficacy, a competent
clinician can detect a beneficial individual group by undergoing subgroup
analysis.
Through this process and co-efforts
from the clinicians and the basic scientists, we will be able to find a more
effective treatment option for a specific population. I hope more clinicians
find interest in new drug development and actively participate in the
development of new drugs from the initial step. Asan Medical Center has 2,700
beds for inpatients and are full of faculty members with sufficient clinical
experience. These qualifications make Asan Medical Center one of the best
clinical study sites for a new drug development.
7. WKMJ has readers from over 10
countries globally. Please share your final words with our readers.
- I hope the readers of WKMJ will
look after their health and well-being. I want WKMJ readers to learn the
importance of work-life balance to help reduce the mental stress. Maintaining a
positive attitude and keeping a proactive mindset are critical in this
generation.
Myung-Hwan Kim, MD, PhD
President of the Asian-Oceanic Pancreatic
Association
Director of Center for Pancreatobiliary
Diseases at Asan Medical Center
Dr. Myung-Hwan Kim is the president of the
Asian-Oceanic Pancreatic Association and the director of Center for
Pancreatobiliary Diseases at Asan Medical Center, the largest medical
institution in South Korea. Dr. Kim is the first in Korea to diagnose and
report on Intraductal papillary mucinous neoplasm (IPMN) of the pancreas and
autoimmune pancreatitis. He also performed the country’s first Extracorporeal
Shock Wave Lithotripsy and greatly helped to improve the endoscopic removal
rate of pancreatic stones. A leader in domestic research on gallstones, Dr. Kim
gained global acclaim for his research on autoimmune pancreatitis, regarding
differential diagnosis between autoimmune pancreatitis and pancreatic cancer by
using two-week steroid trial. He also developed the ‘Kim Diagnostic Criteria’
on autoimmune pancreatitis and published related papers in number of
influential SCI (Science Citation Index) journals such as “Gastroenterology”
and “Gut.” Dr. Kim published nearly 200 articles on pancreatobiliary diseases
over the past decade and his research work is regarded as having greatly
contributed to advancing the level of Korea’s clinical medicine.