• A response to Linda Robinson's article "The Island of Dr. Castro," published in U.S. News & World Report BY JULIÁN ÁLVAREZ A recent article by Linda Robinson, published in U.S. News & World Report, could become a classic piece of misrepresentation of incontrovertible facts related to Cuban science and health care. The journalist attempts to present an "objective" approach to scientific development in Cuba. It is possible for an experienced reader to recognize the genuine facts that characterize the Cuban sciences and which she herself enumerates: * A heavy investment in the scientific field * The establishment of the scientific complex west of Havana with a dozen research centers equipped with state-of-the-art technology. * The cutting-edge technological equipment at the Finlay Institute. * The international recognition given to standards and practice in that institute. * The development of the only vaccine in the world against meningitis B and the ongoing research in that field being carried out by Dr. Concepción Campa, director of the Finlay Institute. * The positive results achieved by Cuba, a country that has made notable efforts for 38 years to obtain a highly educated population, in the promotion of science, particularly biotechnology, as an economic base for its development. * The in Cuba large number of doctors and scientists. * The achievements of Cuban medicine, which include the eradication of common infectious diseases such as tuberculosis and measles and the lowest infant mortality rate (7.9) in Latin America, comparable to that of the United States (7.5). * The scientific proficiency of the Genetic Engineering and Biotechnology Center (CIGB) which has facilitated the manufacture of products such as the hepatitis B vaccine, recombinant streptokinase (which dissolves the blood clots that cause heart attacks), skin growth factor (for the treatment of burns), monoclonal antibodies and industrial enzymes, in addition to a further 100 medications and a cattle tick vaccine. * The successes of the Immunoassay Center in producing equipment and reagents to screen for 17 congenital diseases, and the growing expansion of its network of services to Russia, Spain, Ghana and other countries, as well as its distinction as the first institution to have developed and marketed the first self-test for HIV. * The successes of the DALMER company for its marketing of PPG, an anticholesterol preparation that also increases sexual capacity. * The annual figure of 135 million dollars as income from pharmaceutical and biotechnological products. * The interest on the part of some Canadian and European companies in marketing streptokinase, specific monoclonal antibodies used in the detection of tumors, and an antibacterial, antifungal cream called Dermofural, in addition to culture media from the BIOCEN plant. * The clinical stage of a possible vaccine against AIDS. * The acknowledgment that a growing number of persons from many countries travel to Cuba to receive medical care that is not available in their respective countries. This included 1218 Europeans and 92 U.S. citizens in 1996. * Cuban innovations in the treatment of night blindness (retinitis pigmentosa), vitiligo (loss of skin pigmentation) and neurological disorders, as well as its work with drug addicts and utilizing the medicinal springs in specific health centers. * Likewise, there is recognition of the high scientific level of orthopedic treatment in Cuba. * Statements by Dr. Jorge Juncos, professor at Emory University in the United States, referring to the significant contribution made by the Cuban International Center for Neurological Restoration (CIREN) in the field of stereotaxic surgery for the treatment of Parkinson's disease and his confirmation that CIREN is on a par with similar institutions in the United States. Nevertheless, in the article, all these irrefutable facts are tinged with the clear intention of representing Cuba and the Cubans, our policies and our results, as an insurmountable paradox for U.S. citizens. Robinson's focus is obviously based on paradigms of success in the United States (greater success means a better car and a larger house) that are not exactly ours (greater social recognition and pride in the achievements of our people). Therefore she highlights the fact that our scientists go to work by bus or bicycle and that '50s Plymouths are still on the streets of Havana, without even mentioning that Cuba's gross domestic product dropped abruptly by 34 percent when our trade and credit relations with the Soviet Union and the Eastern European countries disappeared along with socialism in those states. Nor is it stated that throughout these 38 years of Revolution, Cuba concentrated all its efforts on offering every citizen, and in particular every child, an all-encompassing, free and equitable public health system and educational opportunities up to the most advanced level, through a nationwide and likewise free educational system. Nor does it state that the remainder of our spending was devoted to creating sources of employment and humanizing agricultural work, and that we never fell into the mortal sin of the poor countries, of attempting to imitate the consumer society created as a model by the United States. Neither did we commit the error of pouring our scant resources into extravagant articles or the luxury cars that Robinson would have liked to see on our streets. At times, the article attempts to portray as shameful things that are matters of pride for us, such as the ideas and orientations in relation to Cuban science consistently held by our President Fidel Castro. How can somebody criticize a president for that kind of interest? It's more than obvious that the journalist is seeking, unsuccessfully, for lines of attack, when she attempts to draw a simile between contemporary Cuba and the H.G. Wells novel The Island of Dr. Moreau. Must we Cubans passively endure such offenses? How can scientists who have saved thousands of lives with their vaccines, medicines and equipment be compared with impunity to monsters emerging from fantastic tales? How can the Cuban head of state, whose strategic vision has allowed his country, as the journalist states, to "have a cadre of talented, highly trained scientists and modern facilities for developing new vaccines and drugs," be in any way compared to Dr. Moreau? Throughout the entire article, there are attempts to slip in allusions that "claims for the efficacy of [Cuban] products are not backed up by acceptable trials." This obviously depends on the concept of acceptability. If Robinson means rigorous pre-clinical and clinical trials within the strictest measures of good practice, supervised by corresponding state agencies, well...that's what we do in Cuba. If the issue refers to our participation in the international health agencies that regulate and supervise these products, Cuba is an active member and it has been recognized that it meets those agencies' provisions in every way. Proof of the responsible and safe handling of these products is that, contrary to repeated incidents in the United States, in Cuba there has never been a tragedy stemming from the use of medications that were poorly produced or inadequately researched, including blood derivatives, which have produced so many victims in the developed world (including the United States) because of negligence or a lack of certification of the blood utilized. Added to Cuba's system of quality guarantees for its products is an element of which we can be rightly proud: the incorruptibility of our regulating agencies, something rarely seen in today's world. Here are some statistics: Cuba's rate of meningococcal meningitis is 0.5 per 100,000 inhabitants, as a result of the inclusion of the Finlay Institute's meningitis BC vaccine in the national vaccination program; mortality from heart attacks in the emergency care system has been reduced by 13 percent through the administration of recombinant streptokinase, produced by the Genetic Engineering and Biotechnology Center; rejection of transplanted organs was reduced considerably following the application of monoclonal antibodies for that purpose, produced by the Molecular Immunology Center. The heart attack rate in high-risk groups has decreased as a result of the massive utilization of the anti-cholesterol medication PPG. Virtually no babies are born with congenital malformations, due to the national programs administered by the Ministry of Public Health, utilizing systems, equipment and reagents from the Immunoassay Center. We could continue enumerating Cuba's scientific achievements, which are statistical realities of the country's health system and are acknowledged by the World Health Organization. However, other elements of the article, equally insidious, also deserve comment. When journalist Robinson discussed what we call health tourism, she mentioned the treatment of retinitis pigmentosa and the technology developed by Professor Orfilio Peláez for its treatment, with the obvious goal of questioning the efficacy of the treatment. She does not refer specifically to Professor Peláez' treatment, but to ophthalmological surgery to remedy the disease, which is not exactly what is done in Cuba. Why does she engage in this misrepresentation? Why give more weight to nonspecific opinions than to those of the thousands of patients who have improved their vision, or at the very least have halted the deterioration process of this terrible disease? In one paragraph, the journalist talks about exorbitant prices and Cuban institutions "violating accepted procedures." All the innovative procedures we utilize in the Cuban medical field are offered free of charge to Cubans, and therefore, the primary objective of our scientific and medical community is to satisfy our people's needs. We are really not educated in the law of the market - that of selling at whatever cost - but instead concentrate on eliminating ills at whatever cost. How could we "violate accepted procedures" in order to achieve this altruistic objective? Every treatment used on any foreigner in Cuba is already established medical practice in the country. That is axiomatic. Ms. Robinson reserves an attack on the Cuban government for the end, based on statements by Ms. Molina, former member of the Ministry of the Interior, former secretary of the Party Committee in the Neurology Institute in Havana, former deputy to the National Assembly. She apparently "sensed" the "evil" of the Revolution when she was replaced as director of the International Neurological Restoration Center (CIREN), due to her extreme ineptitude in organizing a scientific institution and because of the way she was poisoning relations with the country's other scientific institutions, as well as falsely projecting the image of faulty ethics in the medical and scientific activities carried out by that center. It is known and it has been published, whether or not this interests Linda Robinson, that four years after Ms. Molina was replaced as CIREN director, we are still researching the transplant of embryonic mesencephalic cells, and this research has been approved by our top scientific agencies and the corresponding ethics committees. That technique, which is still experimental in nature, has only been used on Cubans and on two patients from other countries who insisted on being part of the protocol. All of these procedures have been done free of charge, as is logical in the experimental phase. Starting in 1994, once Ms. Molina was replaced, CIREN assumed, in addition to international health services, the care of hospitalized Cubans. Thirty beds were designated for that purpose, and over 1000 patients have been treated there. Those patients are very satisfied with the care they received, flagrantly contradicting Ms. Robinson's insinuations regarding our government's alleged refusal to care for Cuban patients in our facilities. Since March 1994, about 70 professionals in different disciplines have left CIREN, many of whom are now abroad, and they have left for diverse motives and interests. None of them have encountered obstacles in their attempts to leave the Center or leave the country. That was not the case in the times of Ms. Molina, who attempted, on all levels of government, to block any desire of this kind on the part of any worker from the Center. (The files contain numerous letters issued by Ms. Molina with this objective.) Finally, in an attempt to misrepresent, Ms. Robinson quotes Dr. Jorge Juncos, a prestigious neurologist at Emory University, attesting to the scientific excellence of our research into stereotaxic surgery, especially related to Parkinson's disease. She subtly places these statements between two paragraphs which allude to the insidious allegations offered up by the Center's former director, with the obvious intent of attributing to the latter the achievements mentioned by Dr. Juncos. But the fact is that only after Ms. Molina's exit from CIREN did Cuba begin holding an annual event with the participation of the world's greatest experts on Parkinson's disease and especially its treatment. These events have strengthened scientific ties and have generated joint research protocols whose most recent result is the realization of the first subthalamotomies in Cuba (still in the experimental phase) for the treatment of Parkinson's, which represent an advance over the classical techniques utilized until now. When Ms. Molina was replaced as director, she was given an office for her scientific work, the possibility of continuing on as a surgeon and of continuing to participate as a full member of the institution's Scientific Council. As befits the conduct of the Revolution, she was never harassed or left out; on the contrary, she was given every personal consideration, even beyond what she deserved and despite hr conduct at the helm of CIREN. The image created in the article of policemen watching her front door can only be interpreted as a truculent tidbit aimed at deliberately twisting the truth. The fact is that today the International Neurological Restoration Center is an institution with great international prestige, because of its research and results in the treatment of Parkinson's disease and Alzheimer's disease. This prestige also stems from its creation of a complete technology and procedures to stimulate neuroplasticity and recover important functions of the nervous system, restoring useful lives to thousands of people from all over the world who have been incapacitated by neurological disorders. The Cuban scientific community, whose values are diametrically opposed to those which Ms. Robinson tries to exalt in her article, is not ashamed of getting to work by bus or bicycle, or of living through the same difficulties as the rest of our people when there is a shortage of soap or deodorant. We know that our personal merits and the satisfaction of living every day in a country without political corruption, without drugs, without poverty and without illiteracy fulfill our spiritual aspirations. We also share the conviction that our material well-being will be linked to that of our entire people, which will improve in line with our contribution to the national economy and to the solution of our country's major problems. We will help our country resist and overcome the almost all-powerful country which has not managed and will never manage to bring to its knees a people conscious of their duty and proud of their example. Shawgi Tell Graduate School of Education University at Buffalo [EMAIL PROTECTED]
