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Straits Times
4 days ago
- Health
- Straits Times
S'pore researchers to study stem cell transplants in brain for Parkinson's disease in novel trial
Researchers involved in the project include (from left) Professor Lim Kah Leong, President's Chair in Translational Neuroscience at the Lee Kong Chian School of Medicine; Associate Professor Prakash Kumar, head and senior consultant at the department of neurology at the National Neuroscience Institute (NNI); Professor Louis Tan, NNI's director of research; and Professor Tan Eng King, NNI's deputy chief executive officer for academic affairs. ST PHOTO: NG SOR LUAN S'pore researchers to study stem cell transplants in brain for Parkinson's disease in novel trial SINGAPORE - Researchers from the National Neuroscience Institute (NNI) are embarking on a ground-breaking project to transplant stem cells into the brains of those with early Parkinson's disease, in a bid to stop the disease in its tracks. Planning for the first-of-its-kind trial in Singapore is still under way, pending regulatory and ethical approvals. Researchers are hopeful that the phase one trial for the novel approach can begin in late 2026, with five to eight patients who are younger and facing complications with their current treatments. The project is being funded under a $25 million research grant awarded on May 28 to the institute by the National Medical Research Council for five years to study Parkinson's disease. The programme is called Singapore Parkinson's Disease Programme, or Sparkle. An estimated 8,000 people in Singapore live with Parkinson's disease, which happens when dopamine-producing cells in the brain progressively die. As dopamine levels fall, patients present symptoms such as tremors and stiffness, and slowed movement appears. There is no known cure for the neurodegenerative disease, which leads to difficulty with walking, balance, coordination and even speech. The idea of replacing brain cells killed off by Parkinson's with stem cells has been around for about four decades. The hope is that the transplanted cells, which have the ability to evolve into different types of specialised cells, can then start producing dopamine, reversing the condition. But progress was held back by ethical considerations and technical hurdles. Professor Tan Eng King, principal investigator for Sparkle and NNI's deputy chief executive officer for academic affairs, said that in the past, stem cells from embryos and foetuses were used, raising ethical concerns . There were also mixed results, as some transplanted cells did not end up producing dopamine, and led to adverse side effects like involuntary limb movements. With advancements in cell therapies in recent years, scientists are now able to convert a patient's own normal body cells, such as skin or blood cells, into stem cells. Using a patient's own cells is a better approach as it reduces the risk of the body's immune system rejecting the transplanted cells. Prof Tan said NNI has collaborated with Duke-NUS Medical School, Lee Kong Chian School of Medicine and A*Star to develop a proprietary method of converting a person's normal cells into stem cells. The therapy is currently undergoing final approval by the US Food and Drug Administration before it can be used for the trial. He added that researchers from other countries are also studying similar stem cell approaches for Parkinson's disease. The most successful group will be the one 'that is able to create a stem cell source from using a patient's own cells that contains almost 100 per cent dopamine-producing cells and nothing else', said Prof Tan. 'This is a very challenging endeavour and it is not something that anybody can do. We have developed the expertise, and we think that potentially, we can be one of the pioneers,' he added. After the stem cells are transplanted, patients on the trial will likely be monitored for about two years to evaluate the safety and effectiveness of the approach. Other than the stem cell trial, another initiative under Sparkle is an early screening programme in the community to identify those at high risk of developing Parkinson's disease. Prof Tan said he is optimistic that the screening programme can be rolled out by the end of 2025, and reach 10,000 people over the age of 55 in the next three to five years. Currently, in Singapore, there is no screening available to detect those at risk of developing Parkinson's disease. But Prof Tan said that based on previous research done by NNI, those who suffer from a loss of sense of smell, have rapid eye movement sleep disorder (where people act out their dreams) and a particular gene variant have a higher chance of developing the disease. The screening will involve a questionnaire, after which those whose results warrant a closer look will be invited to go for more detailed examinations like brain scans. Those who are identified as having a high risk of developing the disease will be introduced to interventions, including making lifestyle changes in areas such as exercise and diet. Prof Tan pointed out that Singapore has one of the highest life expectancies in the world. 'If you can reduce the risk of developing a neurodegenerative condition, then you can increase the amount of years that you can spend in healthier living,' he said. Join ST's WhatsApp Channel and get the latest news and must-reads.
CBC
14-04-2025
- Health
- CBC
Shut out of medical school, he blames controversial admissions test which experts say lacks evidence
Erik Soby thought he had a shot at getting into medical school last year. The Torontonian scored high on the standard Medical College Admission Test (MCAT) and had an impressive grade point average. But most medical schools in Canada now require another admissions test — called the Casper — and Soby believes that hurdle was his downfall. "That was the one aspect where I was below the average," he said. "So I ended up getting screened out." Medical schools are under a lot of pressure to sort through thousands of applications each year — people vying for a coveted spot and the chance to become a physician. To help narrow down candidates, many medical schools use the Casper, which stands for Computer-Based Assessment for Sampling Personal Characteristics. The company behind the test, Acuity Insights, claims the Casper helps schools predict which students will have career success by assessing "soft skills" — from empathy and ethics to judgment and communication. The test poses video and typed scenario-based questions that ask the applicant to weigh in on a moral dilemma. The questions change every year, but Soby gives an example of what one might look like. "They'd say, 'This company that we're looking to invest in has a reputation of [not believing in] climate change,'" he said. "You're supposed to weigh both sides of the scenario." But Soby says the test is shrouded in mystery — test takers are never given their actual score, never learn where they might need improvement, and have no idea who is rating the test that can have such an impact on their future. On top of that, critics say Acuity Insight's research backing up its claims is poor and unconvincing. "There is no evidence that Casper predicts future performance," said Jennifer Cleland, an internationally renowned researcher in the area of selection to medical school, and professor of medical education research at Singapore's Lee Kong Chian School of Medicine. WATCH | Controversial Casper: "They are selling this tool — and presumably making money from it — and people are using it thinking that it's doing what it says it does." Twelve of Canada's 17 medical schools rely on the Casper test as part of the initial admissions process, many putting a lot of weight on an applicant's score — up to 30 per cent in some cases. Acuity Insights declined a request to be interviewed. A spokesperson wrote that a "wide range of evidence points to the effectiveness of Casper in assessing applicants' non-academic skills" and that medical schools that use Casper in their admissions processes "can identify applicants who will excel not just academically, but also as compassionate and effective physicians." Use of Casper spreading The test was developed by McMaster University's Faculty of Health Sciences and became part of its medical school admissions process in 2010. A few years later it was licensed to a private company — now Toronto-based Acuity Insights — and has received nearly $2.5 million in government funding since 2018 through grants from the National Research Council Canada. Although Casper was originally designed to screen medical school applicants, the company has successfully marketed it to other programs across Canada — from nursing, dentistry and physical therapy to undergraduate programs such as the University of Alberta's bachelor of education program and the University of Western Ontario's engineering school. One of the most common criticisms is the test's lack of transparency. People who write the Casper are never told a score — the company only sends that information to the schools. Instead, test takers are told which of four tiers they fall into, from highest to lowest — relative to other people taking the test at the same time. Acuity says this makes "feedback more accessible." "I think we deserve to know [the exact percentile], considering how much weight it carries going into admissions," said Soby. Go Public has heard from over two dozen medical school applicants who also have concerns. "The process is unnecessarily opaque," wrote one, who said he'd taken the test five times before finally getting accepted to a medical school. "I have endless concerns about the test," wrote another, who said he'd written Casper three times. A student who said he'd taken the test four times wrote that it should "be abolished." The company charges applicants $50 to write the test, and another $18 to submit to each medical school. Applicants also question the training of people who rate the Casper exams. A recent online job posting by Acuity promised raters could earn $30 to $50 an hour. The ad did not list any academic or professional requirements, noting that "applicants from all walks of life" were welcome and raters would get paid 65 cents for every written answer they assess and $1 for every video response. Acuity told Go Public it monitors how quickly raters are scoring responses "to ensure they are spending an appropriate amount of time reviewing the context of each response." The company also said its raters "have differing levels of qualification" which ensures "they represent the patient population students will serve when they become physicians." 'No evidence' But perhaps the biggest concern is criticism from respected academics who say there is no compelling evidence the test does what it claims. After Go Public asked about those claims, Acuity sent a lengthy document, which included a list of eight studies, in support of the Casper. Go Public shared those studies with Cleland — and three other established researchers with experience in medical school admissions, who declined to be identified as they fear professional repercussions. All called the research weak and insufficient to back the company's claims. "I was actually very surprised at how poor the research was," said Cleland. "They were not terribly high-quality studies. They weren't very good." Cleland and the others pointed out that one of the studies doesn't examine the actual Casper test, but a test that's similar. They said another is an overview of existing research and does not provide any new data. Two were conference papers — so did not undergo the rigour of a journal peer-review process — and several did not address long-term outcomes. "It disappoints me that something is so lacking in scholarship, lacking in rigour, robustness and credibility," said Cleland. The researchers also said that several studies are potentially "conflicted" because they were authored by co-founders of the company that is now Acuity or researchers that work for them. Acuity says "industry-funded research" is common practice and that all research involving the company undergoes "full disclosure regarding funding and affiliations." The researchers we spoke to were also concerned that most of the studies were small enough to be scientifically questionable, and hadn't been replicated. Cleland pointed to one study that looked at 31 medical residents and concluded that Casper could predict which ones would have fewer professional issues. "How can you say that with such tiny, tiny numbers?" asked Cleland. "The claim is groundless." Some of the research Acuity Insights sent showed that medical school applicants with higher Casper scores were more likely to be invited for an interview and do well in that interview, and other studies found that Casper can predict who will do well on some assessments in medical school. But Cleland says there was no clear pattern established. "So it predicted performance in one clinical exam, but not the equivalent exam the next year," she said. "You would expect that if something was predicting what it was meant to predict… it would be kind of consistent." There are few studies that track student performance over time, but Go Public examined two longitudinal studies that Acuity did not reference. One examined whether Casper scores and other admissions criteria could predict which medical students might run into professional problems. "Our research did not reveal a significant relationship between Casper performance and the need for professionalism remediation in medical school," said Lawrence Grierson, senior author of that study and an associate professor with the department of family medicine at McMaster University. The other study Grierson worked on also found the Casper test could not predict who would do well on the exam for obtaining a medical licence. "We did not find an association," said Grierson. "It is hard to know why an association appears in some studies and not others. But, taken together, what this means is any declarations of the test's universal effectiveness (at least with respect to predicting future professional behaviour) are overstated." Acuity Insights also sent Go Public its "technical manual," a 148-page document which it says "provides a robust and comprehensive guide on the validity and reliability of the Casper test." The researchers we spoke with point to the fact that the technical manual is not a peer-reviewed study, but a document used — in part — for commercial purposes. The company later sent more research, but some studies were duplicates they'd already sent, several were research papers — not peer-reviewed studies — and one was a student's doctoral thesis. Acuity also points to research that suggests the Casper test can increase student diversity because test results show less racial bias than academic assessments like the MCAT and GPA scores. Soby wrote the Casper test again last August and is waiting to hear whether he'll get into medical school for the fall. Meantime, he's posted a TikTok about his Casper concerns, calling out the fact that applicants don't get their exact score and that raters might rush through responses to increase their hourly wage. He says he wants medical schools to know how the Casper test is affecting people who hope to become doctors. "It's important that those schools see the criticisms," said Soby. "And it's also important that the public sees what's going on."
