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Health/Medical Title: The Cuban Health System at the Dawn of Détente President Obama’s visit to Cuba this week once again focused the eyes of the world on the island nation. After the initial rapprochement in 2014, several major U.S. outlets highlighted the country’s health care system, unique to the Third World, and one which, according to an article in the New England Journal of Medicine, “has solved some problems that ours has not yet managed to address.” Sound heretical? Not to those who have studied it. Cuba’s health performance Cuba, a country of 11 million people, has achieved health outcomes that are the envy of the Third World. It has one of the lowest infant and young child (under age 5) mortality rates and longest life expectancies in the Americas, outperforming the U.S. on all three of these indicators (although the maternal mortality rate is still considerably higher than that in rich countries). This year, Cuba also became the first nation in the world that, according to the World Health Organization, had eliminated mother-to-child transmission of HIV and syphilis. How has a Third World country, subjected to decades of economic sanctions, accomplished this? Part of the answer lies in the post-revolutionary government’s establishment of a comprehensive, universal health care system — structured around primary and preventive care — with a network of physicians, nurses and home health workers generally living in the same community as their patients. To ensure adequate staffing for this initiative, the government invested heavily in medical education, which resulted in Cuba having nearly three times as many physicians per capita as the U.S. This also enabled the country to send a self-reported total of 130,000 of its own health professionals to provide low- or no-cost medical care to patients in other Third World countries, with nearly 37,000 working in 70 countries as of 2008. Cuba was among the first to respond to the past year’s Ebola epidemic, sending more doctors to Sierra Leone than any country besides Great Britain. The country’s universal vaccination programs eradicated many previously commonplace childhood and tropical diseases, including polio, measles and diphtheria. Many of the vaccines, as well as other medications, are manufactured by a domestic pharmaceutical industry that was developed, in part, in response to the U.S. embargo. This biotechnology sector employs about 10,000 people and manufactures most of the medicines used in the country, including 33 vaccines, 33 cancer drugs, 18 drugs to treat cardiovascular disease and seven drugs for other diseases. At one point, Cuba was the leading provider of pharmaceuticals to Latin America and also supplied medicines to several Asian countries. Its medical infrastructure is also relatively advanced, with 22 medical campuses and academic journals in all of the major medical specialties. Much of the progress made in improving the well-being of the Cuban population also traces back to policies independent of the health care sector, including universal education, guaranteed nutrition, clean drinking water and modern sanitation. Perhaps more important were the Cuban government’s egalitarian economic policies that dramatically reduced the wealth inequalities that had existed prior to the revolution. An extensive body of research shows that income inequality is closely associated with, and likely a critical determinant of, population health, and Cuba is no exception. The U.S. embargo What makes Cuba’s health advancements all the more remarkable is that they were achieved under more than five decades of a stifling economic embargo. In 1962, three years after the Cuban revolution, the U.S. instituted the embargo to cripple Cuba’s economy, in the hope that the pain inflicted on the Cuban people would spur them to overthrow the government. (The embargo was just one of several methods employed by the U.S. to do away with the Cuban government; the Kennedy administration-initiated terrorist campaign “Operation Mongoose“ was another - which makes the Obama administration’s touted removal of Cuba from the U.S. list of state sponsors of terror grotesquely ironic.) In a comprehensive 1997 report documenting the impact of the U.S. embargo of Cuba, the American Association for World Health (AAWH) observed that it was “one of the few embargoes of recent years ... that explicitly include[d] foods and medicines in its virtual ban on bilateral commercial ties.” The report found that the tightening of the embargo during the 1990s had resulted in shortages of drugs, water treatment supplies and food, leading to malnutrition and waterborne diseases, among other problems. The AAWH concluded that “[a] humanitarian catastrophe [resulting from the embargo] has been averted only because the Cuban government has maintained a high level of budgetary support for a health care system designed to deliver primary and preventive health care to all of its citizens.” Amnesty International followed the AAWH report with its own 2009 analysis of how the embargo had affected the “economic and social rights” of the Cuban people. The report documented numerous instances in which Cuba was unable to import a range of medical supplies, including HIV and psychiatric medicines, vaccines and syringes, medical devices, diagnostic equipment, condoms, and pediatric nutritional products. The U.S. has long been isolated from the rest of the world on its policy towards Cuba. Every year since 1992, the United Nations General Assembly has voted overwhelmingly (188-2 was last year’s tally) in favor of a resolution calling on the U.S. to end the embargo. Nevertheless, the New York Times could still claim in an editorial last year that it was not the U.S. but Cuba that suffered from a “beleaguered international standing.” Pressure to privatize? Whether Cuba can maintain these achievements after relations with the U.S. are fully normalized remains to be seen. It is likely that the diplomatic — and, crucially, economic — opening will not come without considerable U.S. pressure to privatize Cuba’s state-owned industries, including the health sector. To gauge the implications of such a move, Cubans need look no further than the U.S. experience to realize that a fragmented, for-profit health care system would likely reverse many of the achievements of its own universal model. ========== www.huffingtonpost.com/en..._56ddfacfe4b03a4056799015 Anna Amendrala, Huffington Post what makes the medical prominence of Cuba all the more surprising to those who view a free market as an essential driver of scientific discovery. Cuba is very poor, and yet the country has some of the healthiest, most long-lived residents in the world — as well as a medical invention or two that could run circles around U.S. therapies, thanks to government investment in scientific research and a preventive public health approach that views medical care as a birthright. The island nation, hemmed in by a 54-year trade embargo with the U.S., can’t exchange goods with one of the world’s largest economies and the largest medical market. Still, the country is an unlikely global leader in public health and scientific investment. “If people knew about these cutting-edge treatments coming out of Cuba, people would want to have them,” said Pierre LaRamée, executive director of the Oakland-based Medical Education Cooperation with Cuba, which advocates for Cuban medical inventions in the U.S. and publishes an international, peer-reviewed journal focusing on Cuban health and medicine. “All of these arcane rules and restrictions related to the embargo that are designed to block commerce with Cuba are keeping Americans from having access to these treatment opportunities,” LaRamée said. The White House is continuing to lift trade restrictions between the U.S. and Cuba. The most promising change yet came Tuesday, when the Obama administration announced that American dollars will now be usable in financial transactions in Cuba. The administration is also easing travel restrictions, allowing individuals to visit Cuba for “people to people” educational tours, whereas before Americans were only allowed to make such trips as part of a tour group. However, most transactions between Cuba and the U.S. are still prohibited, which is why Cuban drugs face additional regulatory hurdles for testing and marketing compared to other drugs developed overseas. The Treasury Department’s Office of Foreign Assets Control has authorized the importation of some Cuban medicines in the past, but only enough to conduct research and clinical trials, according to a spokeswoman for the Treasury. Perhaps the most well-known Cuban innovation is the vaccine CimaVax. Invented by researchers at the Center of Molecular Immunology (CIM) in Havana, CimaVax targets a growth factor in cancer cells in a way that can arrest the spread of the disease. It can be used as both a treatment for lung cancer patients and a preventive measure for people at high risk of the disease. A reported 5,000 patients worldwide have been treated with CimaVax. It has no known side effects, and the shot costs the Cuban government $1 to make. The New York-based Roswell Park Cancer Institute is evaluating CimaVax for use in the U.S. It’s also trying to get clinical trials underway to replicate Cuban scientists’ findings, per U.S. Food and Drug Administration regulations. More Americans die from lung cancer than from any other type of cancer, which is why many people are eager for CimaVax to hit the U.S. market soon. Here are three additional medical innovations that the U.S. could benefit from if relations between the U.S. and Cuba continue to thaw. 1. More cancer treatments Cancer is not one disease, but a collection of hundreds of different illnesses. This makes finding one “cure” difficult, if not impossible. But over the years, scientists have developed a variety of different treatments that can transform cancer into a chronic, survivable condition. About 1.7 million Americans will be diagnosed with cancer this year, and about 600,000 are expected to die of it. In addition to CimaVax, Roswell Park is also investigating Racotumomab and VSSP — two more promising cancer drugs invented by CIM. Racotumomab targets a molecule that scientists believe is found on all cancer cells, which means the drug could one day be effective against blood cancers as well as the solid tumors that accompany diseases like lung, breast, prostate and colon cancer. VSSP, originally designed as a compound to help boost the immune response to vaccines, also appears to enhance the anti-cancer immune response. [...] 2. A treatment for diabetic foot ulcers When uncontrolled diabetes causes nerve and blood vessel damage in a person’s foot, it can lead to one of the most debilitating complications of the disease: the development of foot ulcers — deep, red sores that can penetrate to the bone. These ulcers can become vulnerable to gangrene (tissue death), and in a worst-case scenario can result in toe, foot or leg amputations. About 73,000 U.S. adults with diabetes had their lower limbs amputated in 2010, according to the American Diabetes Association. Multiple studies of different populations of people who have had their lower limbs amputated show that the procedure is linked to an increased risk of early death, suggesting either that surgery is a trauma many people don’t survive, or that people who submit to this kind of amputation are some of the most vulnerable and at-risk patients in care. Since 2006, Cuba has had a drug for foot ulcers called Heberprot-P that prevents the need for amputations. Invented by scientists at the Center for Genetic Engineering and Biotechnology in Havana, the treatment, which its creators describe as an “epidermal growth factor,” is injected near the affected area and can accelerate the skin’s healing process, closing a wound safely over the course of about three months. By 2013, Heberprot-P had been registered in 15 other countries and used to treat more than 100,000 patients. [...] 3. Treatment for advanced head and neck tumors Surgery is the primary way to treat most head and neck tumors, but these procedures can severely affect people’s ability to chew, swallow or talk. Head and neck cancers make up approximately 3 percent of all cancers in the U.S., affecting about 52,000 Americans every year. Alcohol and tobacco use, as well as human papillomavirus, are major risk factors of the diseases. Nimotuzumab, patented in the U.S. in 1999 by CIM scientists, is a treatment for various head and neck cancers, including squamous cell carcinoma of the head and neck (tumors that form on the mucosal surfaces of the mouth, throat and nose), glioma (brain tumors) and nasopharyngeal cancer. Monoclonal antibodies in the medicine attach to epidermal growth factor receptors on the surface of the cancer cell, thus preventing it from dividing and spreading the cancer. Nimotuzumab has had orphan drug status in the U.S. for the treatment of glioma since 2004 and for pancreatic cancer since 2015. This designation is granted to promising drugs that are not yet licensed in the U.S. Researchers can test the drug for rare diseases in clinical trials, but it’s not available to the general public. [...] Post Comment Private Reply Ignore Thread Top • Page Up • Full Thread • Page Down • Bottom/Latest Begin Trace Mode for Comment # 1.
#1. To: Willie Green, sneakypete, Vicomte13, TooConservative (#0)
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#2. To: A Pole (#1)
I know why,and I suspect Huff and Puff does too,and just doesn't want to publicize it. Back in the 70's when AIDS was considered an epidemic with no known vaccine or cure,the Cuban government did the sensible thing,and put everyone that entered their medical system with HIV in special "villages" (think "leper colonies")where they had no access to anyone from outside the village,and no one from outside the village had access to them,other than medical personnel. I THINK I also read,and may be wrong about this,that the Cuban government was sterilizing people infected with HIV,and aborting the fetus of pregnant women that had HIV. In short,they "starved AIDS to death" by not providing it with new hosts. Which given their lack of funding and lack of medicines,was really the only logical thing for them to do. The word is "triage". Huff and Puff will never admit this because it doesn't fit their vision of "communism is all about hugs and bunny kisses." As for the cancer drugs unique to Cuba,I have serious reservations about that,also. It takes MONEY,EXPENSIVE EQUIPMENT,and VERY highly trained scientists to do medical research,and Cuber just didn't and doesn't have that kind of money or access to the equipment needed. I have no doubt that Cuban scientists and doctors are as smart as scientists and doctors anywhere else,but it takes free access to information and technology to make advances in medicine,and they just don't have it. What I SUSPECT happened is Cuban scientists/doctors were working in a partnership with Soviet,French,Chinese,etc,etc,etc doctors and scientists,and the result was a joint effort. Cuber being communist,quite naturally they are going to take all the credit and stiff everyone that worked with them. Please note it is the Cuban GOVERNMENT making these claims,which is not the same thing as saying the Cuban doctors involved are claiming all the credit for themselves.
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