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Cuba on ‘cutting edge’ of many areas in health care
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The health care system in Cuba, operated by the nation’s government, offers surprisingly advanced treatment to residents despite otherwise bleak socioeconomic conditions.
Physicians there cut through bureaucratic red tape to deliver inexpensive and innovative health care — considered a human right to all of the Caribbean republic’s 11.2 million citizens.
Regenerative medicine has emerged as one of the more promising fields within Cuba’s health care system.
Doctors perform bone marrow transplants as outpatient procedures — resulting in a 90% reduction in cost compared with the United States and a far lower prevalence of graft-versus-host disease.
Cuban researchers also have extracted key proteins and nutrients from natural products such as scorpion toxins and pigs’ milk to expedite wound healing and limit diseases such as hemophilia.
Intrigued by what’s happening there, several HemOnc Today Editorial Board members who attended the International Society of Hematology (ISH) World Congress last year in Cancun took time to meet with José M. Ballester, PhD, president of the Cuban Society of Hematology and director of the Institute of Hematology and Immunology.
They discussed the striking success of Cuba’s universal health care system despite the fact the state-run economy has been in the doldrums.
Ralph Green
“The fact that Cuba has been able to make progress despite a lack of collaboration with the United States is exciting and interesting,” Ralph Green, MD, PhD, FRCPath, associate editor of HemOnc Today’s red cells and hemoglobinopathies section, said in an interview. “At our doorstep is a country that, per capita, spends a whole lot less than us, yet they are at the cutting edge in a number of areas. They can learn from us, but we can certainly learn from them.”
Regenerative medicine
The first clinical trial in Cuba involving clinical cell therapy with hematopoietic stem cells began in February 2004. Researchers implanted bone marrow autologous stem cells into a patient’s ischemic lower limb, according to Ballester, who presented on bone marrow transplantation at ISH in Cancun.
Results proved successful, as amputation of the affected limb was avoided. The results were so encouraging that, by December 2011, researchers in 10 of Cuba’s 15 provinces were conducting their own clinical trials, Ballester said.
Patients with ischemic lower limb are given 30 to 40 injections of hematopoietic stem cells intramuscularly near the wound, limiting the extent of the gangrene, Green said.
“You can see the line of demarcation on these patients,” Green said. “The toes are gangrenous and they will eventually drop off, but tissue that looked equivocal remains viable, and there is a nice clean area of healing.”
Cuban researchers also are using regenerative cell therapy derived from stem cells for other diseases, including bone and joint lesions, periodontitis, coronary heart disease and ischemic brain injury.
Bone marrow transplants
Although faced with severe financial constraints, the Cuban health care system continues to find ways to perform life-saving procedures, such as bone marrow transplants.
“It’s good and bad, because I think it is safe to assume their level of prudence in safety is not what it is in this country,” Green said.
Cuban doctors began performing bone marrow transplants in 1959, and the country currently is home to four bone marrow transplant centers. Doctors have performed approximately 300 transplants since 1985.
“Patients who undergo bone marrow transplants are treated as outpatients, which is just amazing,” Harry S. Jacob, MD, FRCPath(Hon), HemOnc Today’s Chief Medical Editor, said in an interview. “Their results are significantly better than patients who spend 4 weeks in the hospital facing major morbidities. The obvious reason for this is patients are not exposed to the bad microbes we have in organized hospitals in the United States. Instead, they send people home to their own microbes.”
The cost of bone marrow transplantation there is about one-tenth what it costs in the United States.
Joseph R. Bertino
“I’m impressed by the quality of their medicine,” said Joseph R. Bertino, MD, Associate Medical Editor of HemOnc Today. “They have good physicians, and they are doing a fantastic job considering their constraints.”
Still, oncologists in Cuba are forced to make difficult decisions. For example, bone marrow transplant candidates older than age 45 years often are denied the procedure.
“What do you do with relatively scarce amount of resources?” Jacob said. “They are making significant decisions based on true necessity.”
Natural medicines
Ballester also spoke with his US counterparts about Cuban doctors using natural medicines such as scorpion toxins and pig milk. Scorpion toxins are used as anti-inflammatories and are considered hemostatic.
They also extract coagulation Factor VIII and Factor IX from pig milk, which is rich in protein and can be used for the treatment of hemophilia.
“Their vaccine programs are cheaper than and as efficacious as ours — perhaps more so,” Jacob said. “Innovative and cheap new product development such as scorpion toxins are worth our notice.”
Future collaboration
It remains unclear how long the US/Cuba trade embargo — which limits collaboration between physicians in the two countries — will continue.
“It is the big unasked, unanswered question,” Green said. “In my opinion, it is just a matter of time. Every indication I get is that the Cuban government is shifting away from a communist, socialist economy and toward a more Western capitalist-operated economy. There are private businesses tolerated and — even to some extent — encouraged.”
Although it may take considerable time before the relationship between the two nations can be reshaped and a true relationship fostered, Green said he still can foresee a health care collaboration at the academic level between clinicians in the United States and Cuba.
“I would not have said this 5 or 10 years ago, but I really think in my professional lifetime we are going to see a major political shift there,” Green said. – by Anthony Calabro
Reference:
Hernández-Ramírez P. Abstract #A1053. Presented at: XXXIV Congress of the International Society of Hematology; April 25-28, 2012; Cancun, Mexico.