Renowned cardiologist warns of Korea’s hubris, complacency

Jang Yang-soo

Professor in Department of Cardiology, Yonsei University College of Medicine

Jang Yang-soo, one of the most renowned cardiologists in Korea, developed the nation’s first vascular stent in 1998. He received the Prime Minister’s Award in 2016 for his contribution to the development of innovative health technologies.

Over the past 20 years, many Korean doctors have visited China to share their knowledge of modern surgical techniques and research methods as the once-secluded country embraces change. But for how long will they do so?

Renowned cardiologist Jang Yang-soo was one of the popular lecturers who traveled to China. Since 1991, he went to medical schools in many different cities, including Beijing, Nanjing and Shenzhen, to share his know-how of treating coronary artery patients – until they stopped inviting him five years ago. “They are so good at it now,” Jang, a senior cardiovascular professor at Severance Hospital in Seoul, said in an interview. “They stopped calling me probably because they thought there would not be much to learn from me anymore.” “Doctors in China were learning fast, and I could see their improvement every time I visited there. They said it was not just Korean doctors they learned from but also Americans and Japanese.” This is just one of the many signs of a medical power shift in Asia: China is catching up fast to Korea and even to Japan. Although it is still unclear how much money China spends on medical R&D specifically, the country now makes up 20 percent of the world’s total R&D expenditures, the second largest only after the United States (27 percent), according to the 2016 Science and Engineering Indicators report released by the U.S. government.

“Many Chinese doctors we used to teach have grown into towering figures whose influence now goes far beyond their country. Their global network, especially in Southeast Asia, is getting stronger every year,” Jang said. “Squeezed between China and Japan, which has invested in research and global network for decades as a medical powerhouse, Korea is in a bind.”

It is no secret that Korea needs to spend more money on improving research infrastructure and collecting original clinical data. Such process, however, takes a long time. Thus, the best the country can, and should, do is to facilitate more collaboration among experts in different medical fields. For example, China has been trying to systematically integrate its traditional medicine into the West’s modern medicine, encouraging the two expert groups to work together. Korea, on the other hand, completely separates them. Such efforts by the Chinese government have borne fruit, most notably when Tu Youyou, chief professor at the China Academy of Traditional Chinese Medicine, became the first Chinese scholar to win a Nobel Prize in medicine in 2015 in an acknowledgement of her discovery of artemisinin, a drug that helps reduce the mortality rate from malaria. Many experts said her achievement stems from her effort to combine Chinese traditional herbal medicine with modern-day science. “The Chinese government has tried to establish a scientific basis for its traditional medicine and has achieved commercial success in doing so,” Jang said. “The same would be difficult to achieve in Korea because they don’t cooperate.” He reckons that Korea is lagging far behind in terms of maximizing its potential as its doctors and regulators remain ignorant of the necessity of more cooperation at home and abroad. “Many medical professionals from different fields and hospitals are reluctant to collaborate, and the system is not designed to encourage it. The culture for academic collaboration isn’t mature yet,” he said. For other countries, Korea is an attractive potential partner for cooperative research, thanks to its excellent online network system, ideal population size and inclusive national healthcare system. “I believe Korea can be very successful, but only if the country uses its huge potential,” Jang said.

Killing both imitation and innovation

Among Korea’s imported medical devices, vascular stents topped the list last year with 120 billion won ($108 million). The situation could have been different, had the government established the right system to preserve its stent industry in 1998 when Jang developed the nation’s first vascular stent. Even though he possessed the potentially lucrative stent technology, the Korean medical insurance policy, which sets certain prices for some medical devices such as stent, prevented local firms from entering the market. Such policy is still in place today. “The stent technology could not flourish here because local companies were not allowed to compete in price,” Jang said. “Think about it. Even if they developed their own stent that is as good as the original product, doctors would not have used it because they were already used to the old one and the prices were almost the same.” The failure of his stent business proved to be ominous for the future of Korean stents. The global market size of vascular stents has since increased to an estimated 10 trillion won, according to the Korea Institute of Science and Technology. Jang said he has tried for years to convince the government to ease the regulations, only to be rejected. It is a policy mistake that the government still refuses to admit. History shows, however, that many innovations come from imitation; examples abound, from Japanese cars to Korean smartphones. The government’s inconsistent funding is another impediment to medical research. During his term as the director of the Cardiovascular Genome Center at Severance Hospital from 2001 to 2011, Jang, one of the first Korean doctors to study cardiovascular genetics, found some important facts, including CDH13 polymorphism’s contribution to the development of coronary vascular diseases. But none of his discoveries turned into a commercial products, due partly to such funding issue. “Foreign companies later studied our discoveries in an effort to develop products,” he said. “This is one of the biggest regret of my career, and it is a big loss for Korea.”

Launching the next-generation drug-eluting stent

A vascular stent is a metal or plastic tube inserted into a blood vessel to keep the clogged pathway open. Although a drug-eluting stent containing cobalt and chromium has proved to be safer than a bare-metal stent, it still shows long-term complications and cannot be used for patients allergic to the elements. Over the past five years, in cooperation with medical device company Koswire, Jang has developed a titanium-dioxide-coated stent, which is safer and suitable for such allergic patients. “The Ministry of Food and Drug Safety is now checking the approval status,” he said. “The final result is expected to come out in February.” Clinical trials showed, he noted, that the new stent causes almost no stenosis, an abnormal narrowing of a passage in the body, in one year. “Although the data for the device’s long-term safety for the human body are not yet available, animal tests show it is safe,” he said. Upon the stent’s safety approval, Jang plans to export it to the European and American markets.