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United States–Cuba Research Collaborations: Opening Bridges for Gastroenterology

2017; Elsevier BV; Volume: 152; Issue: 6 Linguagem: Inglês

10.1053/j.gastro.2017.03.011

1528-0012

María T. Abreu, Oriana M. Damas, Felipe Piñol Jiménez, Roberto Cañete Villafranca,

Cuban History and Society

The American policy toward Cuba is rapidly evolving. Given its proximity to the United States, it is natural to imagine collaborations between our 2 countries. The Cuban health care system and biotechnology industry are quite advanced. In the current commentary, we describe the training of Cuban gastroenterologists and the structure of gastrointestinal care in Cuba. The aim of this commentary is to create awareness of the richness of the intellectual resources of our colleagues in Cuba and the potential for future collaborations. The restrictions on travel to Cuba have until recently limited the contact most Americans have had with the island and its people. Yet many Americans are fascinated by its neighbor only 90 miles from Florida In December of 2014, President Obama liberalized travel to Cuba (available at: www.treasury.gov/resource-center/sanctions/Programs/Documents/cuba_faqs_new.pdf), with cultural, educational, and academic exchange among the approved reasons Americans may travel to Cuba. The Cuban health care system has been recognized for its unequivocal successes including its emphasis on primary care and prevention.1Khemlani A, World Health Organization. Cuba: WHO praises efforts and contributions to health education and prevention. Agencia Cubana de noticias- Latin Post, 2014.Google Scholar, 2Loewenberg S. Cuba's focus on preventive medicine pays off.Lancet. 2016; 387: 327-329Abstract Full Text Full Text PDF PubMed Scopus (7) Google Scholar Of pregnant women, 95% receive prenatal care, which results in an infant mortality rate of 50 years of age. The challenge remains providing colonoscopies to patients with positive tests. At present, most patients present with more advanced adenomas or cancers. The country has also provided hepatitis B vaccination trough their primary care network since 1995. As alluded to, Cuba has a vibrant biotechnology industry that has developed various vaccines and other technologies. Some of the best known research institutes in Cuba include the Center for Genetic Engineering and Biotechnology (Centro de Ingeniería Genética y Biotecnología [CIGB]), the National Center for Scientific Investigations (Centro Nacional de Investigaciones Científicas [CNIC]), the Center for Immunological Studies (Centro de Inmunoensayo [CIE]), and the Institute of Tropical Medicine ‘Pedro Kouri’ (Instituto de Medicina Tropical Pedro Kouri [IPK]). In addition to a fecal immunochemical test for occult blood, they have developed a hepatitis B vaccine.12Jain A. Mathur U.S. Jandwani P. et al.A multicentric evaluation of recombinant DNA hepatitis B vaccine of Cuban origin.Trop Gastroenterol. 2000; 21: 14-17PubMed Google Scholar Unfortunately, the cost of publishing papers is frequently a barrier to dissemination of their work. Despite these challenges, several recent biotechnology developments like Heberprot-P, an epidermal growth factor, for diabetic foot ulcers and CIMAvax for lung cancer have gotten the attention of US academia and pharma and are currently in clinical trials in the United States. There are many wonderful opportunities to partner with Cuba to perform collaborative research. The physicians and scientists are highly trained. The finite number of hospitals offering diagnostic and therapeutic options means that it is possible to obtain prevalence data for specific gastrointestinal conditions. The same is true in hepatology wherein serum from patients with hepatitis B or C is sent to 1 institute for testing. All institutions have a uniform process for ethics board approval. The perception from Cuban doctors is that their patients are willing to participate in clinical studies if it will help to increase knowledge. Of course, the important limitation of Cuban health care is the limited financial resources, thereby restricting access to equipment and medications for patients. Cuban patients have generally not been exposed to expensive medical interventions. In the United States, it has become difficult to recruit inflammatory bowel disease or hepatitis patients who are naïve to biologic medications. By contrast, Cuban patients have generally not received any expensive medical treatments and may therefore benefit from the opportunity to participate in clinical trials. Finally, as exchange with Cuba becomes more commonplace, we can imagine scientific exchange and shared postdoctoral training programs. It is our hope that medicine and science will lead the charge of normalized relations with our Cuban colleagues.