※ This work is a work of fiction. Characters, groups, locations, and events depicted in this work have no relation to reality. Medical knowledge appearing in the work has been reconstructed and adapted for the story.
Chapter 32 - Research Meeting (2)
“Right. The busy first-year doctor. Is it really impossible to work with our team? What do you think of this research?”
Every eye in the meeting room turned toward Sihyeon.
‘Why did the sparks have to fly my way...’
With his current capabilities, it wasn't something he couldn't do, but he couldn't just jump at the offer. Gauging the intentions of Chief Lee Gwang-seop was the priority.
“Well, if it’s a matter of the residents’ welfare, won’t that be naturally resolved by downsizing the ward? If the patient-care loading decreases, they can be utilized as research personnel to that extent,” Kang Byeong-u said with a relaxed expression.
Of course, research and education are also part of a resident’s duties. However, the most important duty was treating patients and developing one's competency as a specialist.
‘In the past, it definitely...’
Although he hadn't attended this meeting back then, he already knew Lee Gwang-seop’s choice.
— This is the data for the study we’re doing with the Research Center this time. Input it by the end of the day and email it to me.
He had spent his spare time during work inputting results into Excel and SPSS.
— Report to me immediately if any clinical trial patients contact you. We have to follow the adverse reaction response manual. Don’t miss any calls during your duty!
He had even been scolded for missing a call from a clinical trial patient while he was busy seeing patients in the ER.
The schizophrenia treatment ASP-9022 and the antidepressant AD-2608. In the end, Lee Gwang-seop had accepted the clinical research regarding both treatments.
‘So this was the situation.’
It must have been difficult to refuse when Kang Byeong-u, a "Royal" among Royals, was pressuring him by holding the number of hospital beds hostage.
“Honestly, Psychiatry isn't a department with emergency surgeries, and if you evaluate patients and input data little by little during the day, I don’t think it’ll be that difficult. Isn't that right, Dr. Cheon Sihyeon?”
Now, that pressure was directed at Sihyeon. He wondered how much the opinion of a lowly first-year mattered, but the trap was clear.
If he agreed, they would ask why the Chief was making it difficult when even a first-year said it was possible. If he disagreed, they would surely criticize the department for being consistently unenthusiastic about research from the Chief down to the first-years.
“Personally, I don’t think performing the research itself is that difficult.”
After thinking for a moment, Sihyeon spoke up.
“W-What do you mean by that! You're saying clinical research is easy?!”
Kim Min-hong, who was listening beside him, let his jaw drop.
‘Yes!’
On the other hand, Kang Byeong-u cheered inwardly. Since the first-year, who had the most duty shifts and practically lived at the hospital, said it could be done, pushing forward wouldn't be difficult.
Just as he was thinking that.
“However, I believe it would be difficult to derive meaningful results from this research.”
Sihyeon’s following words effectively threw cold water on those expectations.
“Meaningful results won't come out? What on earth does that mean? In animal testing, clearly...”
Before Kang Byeong-u could even finish, Sihyeon spoke.
“I’ll explain while looking at the data. Researcher, could you please reopen the slide for the schizophrenia treatment ASP-9022?”
“Pardon? Ah, yes...”
Kang Seo-hyeon, taken aback, put the slide back up.
“Whether our department can participate in this research or not is not something a first-year like me can decide,” Sihyeon said, pausing for a moment to examine the molecular formula and receptor affinity on the screen.
“But as a doctor, I believe I must point out that the design of this research is flawed.”
— There's a problem with the research design?
— How can a first-year point that out?
— It looks fine to me...
The meeting room began to buzz.
“What exactly are you saying the problem is? I’m curious about the intent behind your pointing it out. I understand you’ve just started your residency, but do you even have any research experience?”
Kang Seo-hyeon did not hide her discomfort, her voice dripping with sarcasm.
“I—I only answered as I thought because the Director asked for a first-year’s opinion.”
“......”
“If you specifically single out a first-year to ask and then criticize me for having no experience... If I overstepped, I’m sorry.”
Sihyeon put on a face as if he were about to burst into tears at any moment.
“Ah, I didn’t mean it like that...”
Kang Byeong-u and Kang Seo-hyeon both looked flustered.
— Did he really single out an R1 just to bash him for a lack of experience?
— The Director is in the wrong. Totally in the wrong.
— Wow... I can’t stand watching this.
It felt as though the inner voices of the people in the room were audible.
“It’s true. It hasn’t been long since I entered the Department of Psychiatry, and I am woefully lacking in both clinical and research experience.”
Once the buzzing in the room died down, Sihyeon continued, looking straight at Kang Seo-hyeon.
“But I do know that bringing up the speaker’s experience even before hearing their opinion is not an appropriate attitude for a researcher.”
The question had been intended to exploit the typical "will-do" attitude of a first-year resident, but the flow of the conversation had taken a strange turn.
‘That guy...’
Kang Seo-hyeon furrowed her brow. She was boiling with rage at the fact that he was lecturing her on her attitude as a researcher, but if the atmosphere soured any further, the research deal itself might fall through.
“I formally apologize for that. Returning to the main point, I am curious about Dr. Cheon Sihyeon’s opinion on the research. Truly.”
‘I’ll listen first, then debunk everything bit by bit.’
Kang Seo-hyeon grit her teeth inwardly. They had received external consultation regarding the research design. She believed that no matter how much talent he might have, it would be difficult for him to find any flaws.
“In that case, I will share my thoughts.”
Sihyeon’s gaze turned back toward the molecular formula of ASP-9022. In the past, the two candidate substances recommended by the Research Center had ultimately failed to produce results.
— The dropout rate is too high. Mostly due to side effects.
Particularly in the case of ASP-9022, there was an issue with the dosage settings.
Because the starting dose and the titration speed were set too high, a large number of patients dropped out due to side effects before the therapeutic effects could even manifest.
Not long after, the clinical trials were suspended.
‘Since we’re doing this, we must produce results.’
In a way that was different from before.
“First, in the test group of the study...”
Just as the light on Sihyeon’s microphone turned on, a notification sound rang out.
Ding-dong!
[SORA: There is a recommended item.]
‘What item?’ Sihyeon asked back at the unexpected message.
This wasn't a situation where he was seeing a patient, nor was it a situation where he had to distinguish truth from lies. He wasn't lacking sleep, nor was his fatigue severe. However, the moment he checked the name of the item, Sihyeon immediately touched ‘Use.’
[Presence Potion (D) – A self-luminous effect lasts for a short period. Significantly increases the user’s persuasiveness. (1,000P)]
Flash!
He was already the center of attention. Now, a halo lit up behind Sihyeon’s back.
As the effect of the potion kicked in, Sihyeon immediately got to the point.
“In the case of ASP-9022, the starting dose is set at 10mg, increasing by 10mg per week until it reaches 60mg by the sixth week. May I ask the reason behind this setting?”
‘He’s pointing that out?’
Kang Seo-hyeon felt her heart sink. Even during internal meetings, there had been opinions that the maximum dose was somewhat high, and Sihyeon had pierced through to exactly that point.
“In the case of that drug, it produces therapeutic effects by acting on dopamine receptors. To achieve the appropriate receptor occupancy, using that dosage is correct.”
Since it was a dose that hadn't shown specific side effects in animal testing, Kang Seo-hyeon offered her answer without much difficulty. However, the next question that followed deviated significantly from her expectations.
“I understand that you targeted dopamine receptors, specifically the D2 receptor. However, I noticed you set the receptor occupancy at over 93%. I believe that is considerably high compared to other drugs currently on the market.”
“That is...”
Kang Seo-hyeon flinched for a moment.
“By any chance, is this drug... a partial agonist for dopamine receptors? Unless it is, I don’t see any reason to set it this way.”
Good heavens. Her mouth hung open.
‘What kind of first-year level is this...?’
She had heard that the competition for medical school admissions in Korea was overheated and that the medical standards at Samadae Hospital were quite high, but she hadn't imagined it would be to this extent.
She felt as though she were listening to comments from a senior researcher at the multinational pharmaceutical company where she previously worked.
“Yes, that’s correct. While general antipsychotics work by inhibiting D2 receptors, this drug actually activates D2 receptors at low doses. Therefore, we were inevitably forced to set the final dose high...”
“That is exactly the part I wanted to address.”
The audience’s attention focused on Sihyeon’s words.
“Given the profile of this drug, there is a high possibility that akathisia and dystonia will appear at the current dosage.”
Following his explanation, several professors slowly nodded their heads.
“What is he talking about?”
“I... don't know either.”
On the other hand, the majority of researchers and residents tilted their heads in confusion. Even the seniors, Kim Min-hong and Choi Ji-hun, were equally bewildered. Meanwhile, Sihyeon mentioned another issue.
“And just as concerning as the high dosage is the excessively long half-life. It appears to be around 96 hours. Is that correct?”
Half-life. This refers to the time it takes for the concentration of a drug administered into the body to drop by half; the longer it is, the longer it remains in the body. It meant that if drug side effects occurred, the patient would have to suffer from them for a long time.
“The side effects I mentioned earlier could potentially persist for up to a month. If even a single such case occurs, it will be difficult to proceed further with the research.”
“......”
Once Sihyeon finished speaking, Kang Seo-hyeon could no longer find the words to continue. The same went for the previously high-and-mighty Kang Byeong-u.
‘With the current research plan, it will be difficult.’
The probability of a candidate substance being developed into an actual pharmaceutical product and brought to market is one in a thousand. If it succeeds, it’s a literal jackpot, but probabilistically, it’s closer to gambling.
When asked which drug is the most effective among existing schizophrenia treatments, the majority of experts point to Clozapine.
However, few know the fact that Clozapine was developed in the 1950s. For well over half a century, no drug has emerged that surpasses its effectiveness.
It was collateral evidence of how difficult it is to develop drugs that act on the nervous system.
“I think we should end today’s meeting here. It seems that further review is needed internally at the Research Center.”
In the end, with Lee Gwang-seop’s mediation, the meeting came to an inconclusive end.
“Dr. Cheon, today was very impressive.”
“Thank you, Professor.”
As they were leaving the meeting room, Jin Cheol-yeong spoke while patting Sihyeon on the shoulder.
“Thanks to you, we’ve managed to postpone a real headache,” Lee Gwang-seop chimed in.
Receiving praise from two senior professors at the same time was something he had never experienced in the past.
Ding-dong!
[System: Chief Lee Gwang-seop’s trust in the user has significantly increased.]
[System: Professor Jin Cheol-yeong’s trust in the user has significantly increased.]
“Since it’s late, Chief, please take the department members out for dinner. Have a beer, too.”
“Thank you, sir!”
The golden card Lee Gwang-seop handed to Kim Min-hong boasted a brilliant appearance.
‘I think I’ve made it through one round for now.’
But letting his guard down was forbidden. Since Kang Byeong-u had made up his mind to do something, there was no telling what other task he might cook up.
……
Bang!
Kang Byeong-u slammed his hand down on his executive desk irritably.
“Why does everyone say it’s impossible before they even try? Have they tried it themselves? Huh? Have they?!”
“Ah, Dad...”
“‘It’s residents have too much work, so we can't.’ ‘There might be side effects, so we can't.’ Honestly, these people are like those who won't make soybean paste for fear of maggots!”
“......”
Regardless of whether Kang Byeong-u fumed or not, Kang Seo-hyeon was ruminating on the words Sihyeon had spoken earlier in the meeting room.
“...He might be right.”
“What do you mean by that?”
“What that resident said earlier. The part about the dropout rate increasing due to side effects.”
“Are you actually concerned about that? Everything was already tested in the pre-clinical stage and judged to be appropriate—what would a kid like him know! No doubt he was just making excuses with half-baked knowledge because he didn't want to work.”
Kang Byeong-u brushed it off as if it were nothing, but Kang Seo-hyeon’s expression remained uneasy.
‘Half-baked knowledge? No, that was definitely...’
Those were comments that would only come from someone who not only knew the pharmacological characteristics of the new drug but had also experienced research in the actual field.