Remembering when Cuba was on the vanguard of medical research, and today's dismal reality in the time of COVID-19

Setting the record straight

America Arias Maternity Hospital Building (Havana, Cuba 1930s)

Original version: CubaBrief

Cuba today traffics its doctors abroad for the profit of the dictatorship while Cubans in the island do without. In the midst of the COVID-19 pandemic there are shortages in Cuba, and a regime that was slow to respond in a constructive manner leading to protests, and public calls for action. Meanwhile PBS is broadcasting Castro propaganda on Cuba's "vaunted" healthcare system in a program to air Wednesday titled "Cuba's Cancer Hope". 

The hard reality is that Cuba's glory days of "cutting-edge" medicine pre-date the Castro regime.

Carlos J. Finlay, pioneering Cuban doctor

Carlos Juan Finlay, a Cuban epidemiologist, discovered that yellow fever was transmitted from infected to healthy humans by a mosquito vector. Dr. Finlay identified that the carrier of yellow fever was the mosquito Culex fasciatus, today known as Aedes aegypti. Finlay's career began under the Spanish colony and continued into the early years of the Cuban Republic. Dr. Finlay was nominated for the Nobel Prize in Medicine in 1906.

However, he was not the only great Cuban doctor to become internationally renowned.

I know this first hand because as a child my pediatrician in Little Havana, in a modest office near Flagler Street, was Dr. Agustin Walfredo Castellanos, his patients used to call him "El Chino Castellanos". He was twice nominated for the Nobel Peace Prize in 1959 and 1960 by Colombia and Ecuador respectively.

Dr. Agustin Walfredo Castellanos

Dr. Castellanos described "the first practical method of angiocardiography, with which he studied several congenital malformations of the heart. Also, he designed the first automatic angiocardiographic injection device. He also pioneered the method of retrograde injection of contrast material into the aorta which was mainly used to diagnose patent ductus arteriosus."

Reference to Castellanos (1938) and his co-workers in Cuba breakthrough in Angiocardiography

Angiocardiography, according to Merriam Webster is "the radiographic visualization of the heart and its blood vessels after injection of a radiopaque substance.

Dr. Castellanos and his colleagues published the first important paper on the clinical applications of intravenous angiocardiography in the Archivos de la Sociedad de Estudios Clinicos in 1937. Cuban medicine prior to 1959 was not just groundbreaking in basic research, but also in public health.

Cuban doctors in the 1930s provided the breakthrough that made above images possible.

 Professor James W. McGuire and Laura B. Frankel in their paper published in the Latin American Research Review, “Mortality Decline in Cuba, 1900-1959: Patterns, Comparisons, and Causes” found that “Cuba's progress relative to other Latin American countries at reducing infant mortality was even greater from 1900 to 1960 than from 1960 to 1995. During the earlier period, Cuba led all Latin American countries for which data are available at raising life expectancy and reducing infant mortality. From 1960 to 1995, by contrast, it came in fourth and fifth respectively.”

Rodolfo J. Stusser, M.D. in his November 2013 paper, "Cuba’s Long Tradition of Health Care Policies: Implications for Cuba and Other Nations," documented that "in 1958 Cuba had 6,000 physicians, 3,624 pharmacists, 2,260 pharmacies, about 500 laboratories, and 60 drug manufacturers, handling 40,000 different products for 6 million inhabitants."

Numbers don't lie, although the Castro regime would like to disappear them.

Thankfully, Glenn Garvin writing at Reason Magazine has burst one of the propaganda bubbles of the Castro dictatorship and its fictitious "lung cancer cure" reporting that "CIMAvax is far from a "cutting-edge" medicine. The truth is that it barely works at all. As Cuba's Cancer Hope admits in a single throw-away line, "Cuban clinical trials show that it extends life three to five months on average." The five-year survival rate for its users is about 15 percent, roughly the same as that for patients treated with approved U.S. cancer therapies. American oncologists hoot in frustration at patients who want help getting to Cuba to obtain CIMAvax. Says one, quoted in a recent report by Public Radio International: "Without seeing new stats, it's not that impressive… . I am not too worried about people not being able to go to Cuba."

Earlier this month, Castro's Venezuelan henchman was promoting Cuba's "interferon" as a cure that saved "around 3,500 lives in China" declaring Cuba in the vanguard, Caribbean National Weekly called it the antidote for COVID-19, and Newsweek was calling it a "wonder drug." The reality is far more humble. Interferon Alpha-2B Recombinant (IFNrec) was jointly developed with China, but they did not pioneer the discovery of interferon. Interferon research, not surprisingly, was pioneered in Switzerland in the 1950s. Finally, interferon is not a cure but a possible treatment, with risky side effects that in the late stages of the illness can cause more harm than good. The communist regimes in Cuba and in China are profiting off of the desperation of people around the world caught up in a pandemic that spread out of control because Beijing covered it up for weeks. Sadly, many have fallen for this propaganda.

One last point on Cuban medicine, post-1959 who are the great doctors that have made strides in medicine that have led them to be nominated for the Nobel Prize in Medicine? We know that Cuban medical missions have been nominated for the Nobel Peace Prize on three occasions, but President Donald Trump has also been nominated for the Nobel Peace Prize. One need not be a doctor to get that nomination.

The more important question is how many Cuban doctors, educated and trained under the Castro regime, have been nominated for the Nobel Prize in Medicine?

Copying the existing healthcare system in Cuba in the United States would lead to more deaths

Don't buy the hype or the lies.

Cholera patients in Cuba (CNN)

Nicholas Kristof's January 18, 2019 OpEd in The New York Times, "Why Infants May Be More Likely to Die in America Than Cuba" is an irresponsible work of fiction that reproduces false statistics provided by the Cuban dictatorship to justify its 60 year old dictatorship.This is but the latest chapter in a long romance with the Cuban dictatorship by the Gray Lady.

Kristof cites the questions about Cuban government statistics and dismisses them by citing that the World Health Organization and the United Nations have praised the Cuban health care system. He fails to mention that the Pan American Health Organization (PAHO) is being sued for conspiring "with the Cuban government to collect millions of dollars by unlawfully trafficking Cuban doctors to Brazil." (PAHO is the Regional Office for the Americas for the World Health Organization [WHO], and is recognized internationally as a part of the United Nations system.) According to a November 29, 2018 article by Frances Robles, in The New York Times, PAHO "made about $75 million off the work of up to 10,000 Cuban doctors who earned substandard wages in Brazil." 

The Cuban doctors were also separated from their families. The Castro regime feared that if they went to work abroad with their families, the doctors would be less likely to return to Cuba.

Kristof is trying to make the case for a "free, universal health care system", but a question arises: Why look at Cuba's with its questionable data and repressive dictatorship? There are other Latin American countries with universal healthcare such as Costa Rica, and Chile. Their infant mortality rates are good, but not better than the United States. Although, Chile's is almost equal to the U.S. Incidentally, if you believe Cuba's infant mortality rate numbers, than a lecture needs to be made to Canada, because America's neighbor to the North also has a higher infant mortality rate then Cuba's (despite Canada having a free, universal health care system.)  The World Bank 2017 infant mortality rates for the following countries are: Canada (5), Chile (6), Costa Rica (8), the United States (6), and Cuba (4).

Not mentioned by Kristof is the study by economist Roberto Gonzalez at the University of Chapel Hill who provides an analysis that explains in detail how the numbers are fudged. The actual estimate of the IMR in Cuba has a median estimate of 9.04 and a range that begins at 5.79 and extends up to 11.16. There is a policy in Cuba to do away with problem pregnancies, which is also a factor for the IMR rate in Cuba and the high rates of abortions. According to sources used by Kristof the IMR in the United States is 5.9.  

However one should take a serious look at the Cuban healthcare system overall.

The real deal on Cuban healthcare

Public health

New Scientist reported on January 8, 2019 in an exclusive report that "thousands of Zika virus cases went unreported in Cuba in 2017, according to an analysis of data on travelers to the Caribbean island. Veiling them may have led to many other cases that year." The Cuban government has also failed to report Dengue (1997) and Cholera (2012) outbreaks in Cuba. Jailing those who warned the world of the threat. Founded in 1956, New Scientist is the world’s most popular weekly science and technology magazine.

In 1997 when a Dengue epidemic broke out in Cuba the dictatorship tried to cover it up. When a courageous doctor spoke out he was locked up on June 25, 1997 and later sentenced to 8 years in prison. Amnesty International recognized Dr. Desi Mendoza Rivero as a prisoner of conscience. He was released from prison under condition he go into exile in December of 1998. The regime eventually had to recognize that there had been a dengue epidemic.   

Three of the victims of exposure and hypothermia at Mazorra in 2010

 On January 15, 2010 The New York Times reported the confirmed deaths of at least 20 mental patients at the Psychiatric Hospital in Cuba, known as Mazorra, due to "criminal negligence by a government characterized by its general inefficiency," a day later the Cuban government confirmed that 26 patients had died due to “prolonged low temperatures that fell to 38 degrees.”

The 2012 cholera outbreak in Cuba offered another opportunity to see how the Cuban public health system operates. The well being of Cubans is not the first item on their agenda. This was demonstrated in it's response. News of the outbreak in Manzanillo, in the east of the island, broke in El Nuevo Herald on June 29, 2012 thanks to the reporting of the outlawed independent press in the island. Calixto Martinez, the independent Cuban journalist who broke the story was jailed.  The state controlled media did not confirm the outbreak until days later on July 3, 2012. The BBC reported on July 7, 2012 that a patient had been diagnosed with Cholera in Havana. The dictatorship stated that it had it under control and on August 28, 2012 said the outbreak was over. A year later on August 22, 2013 Reuters reported that "Cuba was"still struggling with outbreaks in various provinces.

In July 2013 an Italian tourist returned from Cuba with severe renal failure due to Cholera. New York high school teacher Alfredo Gómez contracted cholera during a family visit to Havana during the summer of 2013 and was billed $4,700 from the government hospital. A total of 12 tourists have been identified who have contracted cholera in Cuba.  

Cuba's two tiered and politicized healthcare system

Cuba has a two tiered health care system one tier for the nomenklatura and foreign tourists with hard currency that offers care with modern equipment and fully stocked pharmacies, then there is a second tier which is for the rest  with broken down equipment, run down buildings and rooms, scarce supplies, a lack of hygiene, the denial of certain services and lengthy wait times. Healthcare professionals are poorly paid and lack food.

On December 28, 2017 the Spanish news service EFE reported that the Castro regime had dismantled a network of medical officials and workers who'd adulterated a medicine for children made at the laboratories of the state-owned drug company BioCubaFarma. They replaced the active substance methylphenidate with a placebo substance in the manufacture of the drug marketed as "Ritalin." The active substance was sold on the black market. Nevertheless, The Miami Herald had an article touting the importance of importing drugs from Cuba on December 14th.

The statistics and numbers that the international community has access to with relation to the Cuban healthcare system have been manipulated by the dictatorship. Katherine Hirschfeld, an anthropologist, in Health, Politics, and Revolution in Cuba Since 1898 describes how her idealistic preconceptions were dashed by 'discrepancies between rhetoric and reality,' she observed a repressive, bureaucratized and secretive system, long on 'militarization' and short on patients' rights. 

The importance of public health transparency
 Sherri L. Porcelain is an adjunct professor who has taught Global Public Health in World Affairs at the University of Miami for more than 30 years. She wrote an important analysis titled U.S. & Cuba: A Question of Indifference? I could not find this article on the ICCAS web site, found it initially at Professor Suchlicki's Cuba Studies Institute, but it is no longer online. This is troubling and what Dr. Porcelain's analysis reveals is disturbing.

"Investment in the health of people includes protecting human rights. This means allowing the health community to speak out and not to be jailed for releasing information about a dengue epidemic considered a state secret, or not sharing timely data on a cholera outbreak until laboratory confirmation of travelers returning from Cuba arrive home with a surprising diagnosis. This causes me to reflect upon my personal interviews where the remaining vigor of public health actions in Cuba exists to fight vector and water borne diseases. Sadly, however, health professionals are directed to euphemistically use the vague terms of febrile illness in place of dengue and gastrointestinal upset for cholera, in contradiction to promoting public health transparency."

Let us hope that this myth of the Castro regime being a health care super power be debunked before any more foreign patients or tourists are negatively impacted or that policy makers in other countries seek to follow Nicholas Kristof's advice and copy the disastrous system in the island. 

Copying the existing healthcare system in Cuba in the United States would lead to more deaths of both infants and adults, but we would never hear about it, because the bureaucracy would cover it up with inflated numbers of how great the healthcare system is. Dissatisfied patients and family members would fear retaliation if they questioned their health outcomes.