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Issue 16 Myung-Hwan Kim, MD, PhD, President of the Asian-Oceanic Pancreatic Association

APRIL 2018

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.

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?

Dr. Kim receiving the Dr. Wunsch Medical Award

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.

“We, as clinicians, should persevere in advancing medicine to improve patient outcome.”

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.

"We must constantly train ourselves in preparation to deliver the evidence-based, up-to-date diagnostic and therapeutic modalities."

Dr. Kim performing endoscopic surgery at Asan Medical Center (photo credit: Munhwa Ilbo)

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.

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.

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.

Dr. Kim and his colleague in discussion

“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.

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.

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.

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