As Cuba-US Relations Thaw, Potential Medical Advances Grow

Marcia Frellick

July 07, 2015

Recent US steps toward normalizing relations with Cuba after 5 decades may open doors in both countries to medical advances.

In December 2014, President Obama reestablished diplomatic relations and eased travel restrictions. In April of this year, Congress removed Cuba from its terror list, and this month, the two countries are expected to resume diplomatic relations and reopen embassies in both countries.

Mark Rasenick, PhD, professor of physiology, biophysics, and psychology and director of the biomedical neuroscience training program in the University of Illinois at Chicago College of Medicine, travels to Cuba at least once a year and has testified before Congress on medical partnership possibilities.

He told Medscape Medical News that some collaborations will be seen very soon, but new treatments and products will be available only if and when the trade embargo is lifted.

One area in which Cuba can contribute expertise is brain mapping, Dr Rasenick said. Because widespread magnetic resonance imaging is generally cost-prohibitive in Cuba, Cuban scientists have had to develop very sophisticated algorithms using electroencephalograms.

"This would be great for rural medicine," Dr Rasenick said. "With this $10,000 piece of equipment, you could create the image and send the data, and someone could process it at a more sophisticated center to indicate whether the patient needs to be transferred. That's ready right now, and the US could use it."

Advanced Wound Care in Cuba

Another benefit for the United States could be access to Heberprot-P, recombinant epidermal growth factor, a novel drug developed at Cuba's Center for Genetic Engineering and Biotechnology for complex diabetic foot ulcers. It is touted in the 16 countries where it is registered as a one-of-a-kind wound treatment and has proven benefits for avoiding amputations.

"The data look pretty impressive. They inject it directly into the wound," Dr Rasenick said. The treatment is of great interest in the United States, where 73,000 lower-limb amputations are performed on patients with diabetes each year.

But access has hit a wall because, although the US Treasury Department agreed last year to allow trials here, even if it is proved safe and effective, it could not be sold here without lifting the trade embargo.

Lung Cancer Vaccine

One example of a new collaboration is a US clinical trial for a Cuban-developed vaccine called CimaVax for non-small cell lung carcinoma.

The vaccine primes the immune system to attack epidermal growth factor, a natural hormone that can feed tumors.

Roswell Park Cancer Institute in Buffalo, New York, is working with Cuba's Center for Molecular Immunology to bring the treatment to the United States. It has been available free to the public in Cuba since 2011 and has also been approved in Peru.

Candace Johnson, PhD, president and chief executive officer of Roswell Park, told Medscape Medical News she hopes phase 1 trials will be able to start in the United States by the end of this year.

Among its benefits are few adverse effects and low cost, at about $1 per vaccine. Although it has been found effective in extending survival in people who have advanced disease, Dr Johnson said, they would like to evaluate its efficacy in preventing tumor recurrence in early-stage lung cancer. Far down the line, she would also like to see it tested for preventive capabilities, she noted.

What Cubans gain in the collaboration will be broad acknowledgment of their innovation, she said, something that has not been widely available on the world stage.

Learning How to Do More With Less

Cuban healthcare focuses on prevention and has one of the best physician–patient ratios in the world (6.7 physicians per 1000 people compared with 2.4 in the United States). One of the things the United States can learn from Cuba is how to more effectively spend healthcare dollars, according to Lee Dresang, MD, professor at the University of Wisconsin School of Family Medicine in Madison.

Cuba's high adult literacy rate (99.8%, according to UNICEF) has translated into a high health literacy rate, Dr Dresang said, so Cubans have much to share about how they teach patients how the health system works and how to engage in their own health.

Alternative medicine in Cuba is integrated into all levels, from clinics to hospitals, partly out of necessity because of a lack of resources, Dr Dresang said. Hospitals routinely offer acupuncture, for instance. Here, formal medical systems have been slow to embrace it.

Cuba also has many more primary care doctors than specialists — 70% vs 30% — whereas the opposite is true in the United States, he noted. That naturally shifts the emphasis to prevention.

The World Health Organization recently declared that Cuba is the first country to eliminate mother-to-child transmission of HIV and syphilis. Cuban Health Minister Roberto Tomas Morales Ojeda, MD, credited the advance to the country's strong focus on primary care.

Cuba, which has universal care, spent $1800 on healthcare per capita in 2013, whereas the United States spent five times that ($9100), and life expectancy in the two countries is the same, according to the World Health Organization.

Dr Dresang has studied Cuban medical models and said their family physicians often live in or near the population they are assigned to serve, "sometimes above the office where they see patients."

So instead of waiting for someone to access the health system, Cuban doctors proactively contact their patients, often making house calls, and make sure they receive vaccinations and services such as blood pressure checks.

Family physicians typically spend half a day every week accompanying their patients who are referred to specialists to learn from the specialists and learn what happens to their patients after their primary care.

"There's much less opportunity for people to fall through the cracks," Dr Dresang said.

He hopes one of the immediate benefits of this new collaboration will be more opportunities for learning at the early stages of education. He had taken groups of students to Cuba before tighter restrictions on such trips a decade ago. With the latest moves toward easing restrictions, he hopes such trips can resume.

Dr Rasenick, Dr Johnson, and Dr Dresang have disclosed no relevant financial relationships.


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