Cuba has the drug that prevents the amputations in the diabetic foot as well as the drug that makes lung cancer reversible, however, it will take a long time for the FDA to approve these medicines in the United States. Meanwhile, thousands of Americans can be amputated and die. Thousands of Americans will pass away by lung cancer for the simple fact that the embargo prevents going to cure to Cuba where there are all the conditions of hospital care. A serious solution would be for Congress to make a humanitarian exception for diabetic foot patients and lung cancer so that they could make the trip to Cuba that is only 90 miles away from the United States and could pay for these services with their health insurance. Medicare and Medicaid, by the way, taxpayers would save billions of dollars from the Public Health budget because medical care in Cuba is very economical. Cuba produces unique anti-cancer drugs in the world at the cost of one dollar each. You may took about this with your representatives. Gualterio Nunez Estrada, gualterionunez4@gmail.com , Sarasota, Florida.
Miles de americanos podrian salvarse de amputaciones por pie diabetico y cancer de pulmon si pudieran ir a Cuba a tratarse con sus seguros medicos.
Cuba es la unica en el mundo que tiene la medicina que evita amputaciones en el pie diabetico asi como el medicamente que hace reversible el cancer de pulmon, sin embargo, tomara largos anos para que la FDA apruebe estas medicinas en Estados Unidos. Mientras tanto pueden ser amputados y morir.miles de norteamericanos de cancer de pulmon por el sencillo hecho de que el embargo impide ir a curarse a Cuba donde existen todas las condiciones de atencion hospitalaria. Una solucion seria que el Congreso hiciera una excepcion humanitaria a los enfermos de pie diabetico y cancer de pulmon para que puedan hacer el viaje a Cuba que esta solo a 90 millas de distancia de Estados Unidos y pudieran pagar estos servicios con sus seguros medicos, el Medicare y el Medicaid, de paso los contribuyentes se ahorrarian miles de millones de dolares del presupuesto de Salud Publica pues la atencion medica en Cuba es muy economica. Cuba produce medicamentos anticancer unicos en el mundo al costo de un dolar.
The lithotripsy, LEC, (Greek lithos , stone and Latin terere, grinding), it is a noninvasive treatment using an acoustic pulse to break up kidney stones (nephrolithiasis) and gallstones (stones The lithotripsy was developed at the beginning of 1980 in Germany by Dornier Medizintechnik GmbH, company now known as Dornier Medtech 1, and its use was expanded with the introduction of the HM-3 lithotriptor in 1983. A few years LEC became the standard treatment for calculosis.
Over the years these machines have undergone several technological changes in both the form and the mode of operation, but in general they are based on the same physical foundation. These devices produce a localized, high intensity and externally applied acoustic shock wave, which is responsible for breaking the calculations.
The sedated or anesthetized patient lies on a stretcher with the skin resting on a device with water, located just at the level of the calculation. An x-ray or ultrasound system is used to locate the stone and know where the treatment should be carried out. The process in general takes about one hour. A urethral stent (small and tubular medical device) can be used at the urologist’s discretion. The stent facilitates the passage of the stones by soothing the obstruction and by allowing passive dilation of the ureter.
The passage of stone fragments and their release may take a few days or a week and may cause mild pain. Patients can be recommended to drink as much water as they can during this time and they are also advised to examine the fragments in order to analyze them. The LEC is the least invasive treatment of the procedures to treat kidney stones; However, the rate of total stone removal is very low compared to other methods that are more invasive, such as ureteroscopy , manipulation with laser lithotripsy or percutaneous nephrolithotomy . In the same way it has been detected that the levels of calculations that are being treated, for example, the calcium oxalate stones monohydrate and cysteine, may become resistant to treatment with LEC.
The LEC can generate some collateral damage. Shock waves as well as cavitation bubbles formed by the agitation of urine can lead to capillary damage, renal or subcapsular parenchymal hemorrhage . This can generate long-term consequences such as kidney failure and hypertension. In general, the complication rate of the LEC is between 5 and 20%.
The first treatment by Extracorporeal Shockwave Lithotripsy was applied by Chaussy University of Munich, Germany, in 1980 and in Cuba this treatment was started on March 28, 1986 by Larrea Masvidal at the «Hermanos Ameijeiras» Hospital in Havana.
The lithotripsy, LEC, (Greek lithos , stone and Latin terere, grinding), it is a noninvasive treatment using an acoustic pulse to break up kidney stones (nephrolithiasis) and gallstones (stones The lithotripsy was developed at the beginning of 1980 in Germany by Dornier Medizintechnik GmbH, company now known as Dornier Medtech 1, and its use was expanded with the introduction of the HM-3 lithotriptor in 1983. A few years LEC became the standard treatment for calculosis.
Over the years these machines have undergone several technological changes in both the form and the mode of operation, but in general they are based on the same physical foundation. These devices produce a localized, high intensity and externally applied acoustic shock wave, which is responsible for breaking the calculations.
The sedated or anesthetized patient lies on a stretcher with the skin resting on a device with water, located just at the level of the calculation. An x-ray or ultrasound system is used to locate the stone and know where the treatment should be carried out. The process in general takes about one hour. A urethral stent (small and tubular medical device) can be used at the urologist’s discretion. The stent facilitates the passage of the stones by soothing the obstruction and by allowing passive dilation of the ureter.
The passage of stone fragments and their release may take a few days or a week and may cause mild pain. Patients can be recommended to drink as much water as they can during this time and they are also advised to examine the fragments in order to analyze them. The LEC is the least invasive treatment of the procedures to treat kidney stones; However, the rate of total stone removal is very low compared to other methods that are more invasive, such as ureteroscopy , manipulation with laser lithotripsy or percutaneous nephrolithotomy . In the same way it has been detected that this rate depends on the type of calculations that are being treated, for example, the calcium oxalate stones monohydrate and cysteine, may become resistant to treatment with LEC.
The LEC can generate some collateral damage. Shock waves as well as cavitation bubbles formed by the agitation of urine can lead to capillary damage, renal or subcapsular parenchymal hemorrhage . This can generate long-term consequences such as kidney failure and hypertension. In general, the complication rate of the LEC is between 5 and 20%.
The first treatment by Extracorporeal Shockwave Lithotripsy was applied by Chaussy University of Munich, Germany, in 1980 and in Cuba this treatment was started on March 28, 1986 by Larrea Masvidal at the «Hermanos Ameijeiras» Hospital in Havana.
La litotricia extracorpórea por ondas de choque, LEC, (del griego lithos, piedra y del latín terere, triturar), es un tratamiento no invasivo que utiliza un pulso acústico para romper los cálculos renales (litiasis renal) y los cálculos biliares (piedras en la vesícula o en el riñón).La litotricia fue desarrollada a comienzos de 1980 en Alemania por Dornier Medizintechnik GmbH, empresa ahora conocida como Dornier Medtech 1, y su uso se expandió con la introducción del litotriptor HM-3 en 1983. A los pocos años la LEC se volvió el tratamiento estándar para la calculosis.
Con el transcurso de los años estas máquinas han sufrido varios cambios tecnológicos tanto en la forma como en el modo de operación, pero en general todas se basan en el mismo fundamento físico. Estos dispositivos producen una onda de choque acústica localizada, de alta intensidad y aplicada externamente, la cual es la responsable de que se rompan los cálculos.
El paciente sedado o anestesiado se recuesta sobre una camilla con la piel apoyada sobre un dispositivo con agua, ubicado justo al nivel del cálculo. Un sistema de rayos x o de ultrasonido, se usa para localizar la piedra y conocer dónde se debe llevar a cabo el tratamiento. El proceso en general toma cerca de una hora. Un stent uretral (dispositivo médico pequeño y tubular) puede ser usado a discreción del urólogo. El stent facilita el paso de las piedras al calmar la obstrucción y al permitir la dilatación pasiva del uréter.
El paso de los fragmentos de las piedras y su liberación puede tomar algunos días o una semana y puede causar dolor leve. A los pacientes se les puede recomendar tomar tanta agua como puedan durante este tiempo y además se les aconseja realizar un examen de los fragmentos para poder analizarlos. La LEC es el tratamiento menos invasivo de los procedimientos para tratar los cálculos renales; sin embargo, la tasa de eliminación total de los cálculos es muy baja en comparación con los otros métodos que son más invasivos, tales como la ureteroscopia, manipulación con litotricia por láser o nefrolitotomíapercutánea. De igual manera se ha detectado que esta tasa depende del tipo de cálculos que se estén tratando, así por ejemplo, las piedras de oxalato cálcico monohidrato y de cisteína, pueden llegar a ser resistentes al tratamiento con LEC.
La LEC puede generar cierto daño colateral. Las ondas de choque así como las burbujas de cavitación formadas por la agitación de la orina pueden llevar a el daño de capilares, hemorragia del parénquima renal o subcapsular. Esto puede generar consecuencias a largo plazo tales como insuficiencia renal e hipertensión. En general la tasa de complicaciones de la LEC se encuentra entre el 5 y 20%.
El primer tratamiento mediante Litotricia extracorpórea por Ondas de Choque se aplicó por Chaussy Universidad de Múnich, Alemania, en 1980 y en Cuba se inicia aplicación de este tratamiento el 28 de marzo de 1986 por Larrea Masvidal en el Hospital «Hermanos Ameijeiras» de La Habana.
On my last visit to Santiago de Cuba I met with many young people from 15 to 20 years old and they told me they did not watch television, listen to radio, or see any foreign program. I never saw them reading a newspaper, only on rare occasion Cuban TV, although they were always absorbed texting on their phones. The people who said they heard some radio and TV programs are 35 years old and older and those who said they heard overseas broadcasting are over 60 years old although in this group there are a few listeners of these broadcasts that come through AM or the short wave . I saw no one on the street reading the newspaper. People from 0 to 45 years old represent 56% of the population of Cuba.TV Marti is not seen in Santiago de Cuba, although Radio Marti enters with clarity and power only some people of 60 years or more said to listen to their newscasts, the majority said they do not listen to the station because they are not interested. Usually the topic of conversation among Cubans revolves around the possibility of business and barter and everyone asked me when American tourists would come because they represented a business opportunity far superior to that of European tourists or other nationalities who roam the city, especially Germans and Italians and many Asians.
For every 10 small private businesses there are at least 9 that are not licensed but are tolerated by the local government that seeks to increase the commercial activity of the city, very intense indeed. The deals are made to order, people call the provider by phone and it goes to your home with the merchandise in a time lapse of ten minutes to half an hour, you can even order food to be brought to the house. So in the order of services you can request therapists, podiatrists, barbers, tarotists who come to the house at the time that suits you.
In many houses there were no radio and in most the radio remains off. People 35 and older are attentive to the national TV news only. The elderly are those who permanently watch the Cuban television channels. In general, women under 60 and over 35 are consumers of foreign soap operas serials that record in a memory. GualterioNunez Estrada, gualterionunez4@gmail.com, Sarasota, Florida.
On my last visit to Santiago de Cuba I met with many young people from 15 to 20 years old and they told me I did not watch television, listen to radio, or see any foreign program. I never saw them reading a newspaper, only on rare occasion Cuban TV, although they were always absorbed texting on their phones. The people who said they heard some radio and TV programs are 35 years old and older and those who said they heard overseas broadcasting are over 60 years old although in this group there are a few listeners of these broadcasts that come through AM or the short wave . I saw no one on the street reading the newspaper
My dear friend Omara Portuondo has just obtained a PhD that honors her career as a professional and as a person with high ethical and human values. Omara Portuondo is a professorship as a professional reference of Cuban art on an international level. I am very happy to be his friend. Walter Nunez Estrada, gualterionunez4@gmail.com, Sarasota, Florida.
Alejandro A. Madorrán Durán
digital@juventudrebelde.cu
«Listening to her we found out that the public baptized is what she is: a diva of this time, her time, because Omara is Cuba» were the words of Miguel Barnet, president of the Union of Writers and Artists of Cuba (Uneac) , to refer to the artistic value of Omara Portuondo Peláez, who received this Wednesday the honorary title of Doctor Honoris Causa in Arts delivered by the University of the Arts (ISA).
During the evening in the aula magna of that house of high studies, Portuondo appreciated the significant distinction I received from the hands of the rector, Alexis Seijo Garcia, who described the contribution to the Cuban culture made by the bride of the transcendental filin as. in so many years
With her distinctive charisma, the diva of the Buena Vista Social Club did not find better words to show her deep joy than to present to the audience brief moments of her prodigious voice, with which she has made infinite emotions vibrate on stages around the world.
To the tribute to the Portuondo, which was attended by the Minister of Culture, Abel Prieto Jiménez, were added to the heartfelt performance of the singer and composer Beatriz Márquez, the soprano Bárbara Llánez, and, on piano, the teacher Digna Guerra, director of the National Choir of Cuba, who interpreted the legendary song Longina, by Manuel Corona.
He also received gifts from the dean of the ISA’s School of Music, María del Rosario Hernández; and of the plastic artist Alicia Leal, who gave him one of her pieces entitled The Bride. The children of La Colmenita also filled the octogenarian with joy.
The musicologist Marta Bonet, president of the Cuban Music Institute, was in charge of reading the words of recognition of Miguel Barnet, who described Omara as «unrepeatable» and that «his gifts aged by a long career are the attribute that it distinguishes it among many singers who ventured into a repertoire of genres as varied as the romantic song, the bolero, the son and the lullaby, to mention the most representative ones.
«His expressive ductility, his diction, his absolute sense of rhythm, as well as his Creole grace, and his drama are enshrined in a perfect arpeggio of perfection. With a vocal instrument of singular qualities, surprising treble and unbeatable humming, Omara has a cleanliness and shine of its own, «the intellectual praised.
Mindfulness meditation along with behavioral activation reduced depressive symptoms in patients with subthreshold depression in a primary care setting, a new study found.
Dr Samuel Wong
Investigators found that the incidence of major depressive disorder in patients who received this combination intervention was less than half that of those who received usual care.
The results may encourage clinicians to consider such group interventions in patients with subthreshold depression, Samuel Y. S. Wong, MD, clinical professor and head, Division of Family Medicine and Primary Healthcare, and associate director of undergraduate education, School of Public Health and Primary Care, Chinese University of Hong Kong, told Medscape Medical News.
«Behavioral activation with mindfulness is a promising intervention that we have shown to be effective in our subthreshold depression population over a short- and long-term period,» Wong said.
The study was published in the March/April issue of Annals of Family Medicine.
Combined Approach
Patients with subthreshold depression have clinically significant symptoms of depression but do not fulfill all diagnostic criteria for major depression. The condition is common in primary care; the estimated lifetime prevalence of subthreshold depression is 10% to 24%.
Research suggests that a significant proportion of patients with subthreshold depression progress to major depression, said Wong. His own research showed that in a primary care setting in Hong Kong, about 27% of patients progress to major depression in the following year.
Behavioral activation is a brief, simple, structured therapy for depression that aims to increase rewarding experiences by encouraging patients to set goals and to engage in social interactions and pleasurable activities.
Mindful meditation emphasizes the acceptance and awareness of present moment emotions, thoughts, and bodily sensations.
Previous research has shown that behavioural activation is effective among people with mild to moderate depression and that mindfulness-based interventions are effective in preventing relapse in patients with recurrent depression.
The new study combined these two approaches.
The study included 231 adult patients from 16 general outpatient clinics who had subthreshold depression, determined on the basis of the patient’s having a score of 5 to 9 on the 9-item Patient Health Questionnaire (PHQ-9) depression scale. The patients had not had a major depressive episode in the past 6 months.
The majority of study patients (93.1%) were women, and most (61.9%) were housewives or retired.
Study participants were not taking medications at baseline.
Investigators randomly assigned these patients to receive either behavioral activation with mindfulness (BAM) (n = 115) or usual care (n = 116).
The BAM intervention consisted of eight weekly 2-hour sessions. The first four sessions included psychoeducation related to well-being, setting short- and long-term goals, self-monitoring of activity and mood, scheduling daily activities, and identifying avoidance and its impact so as to allow patients to be more aware of their decision making.
Sessions five to seven included a half-hour behavioral activation review and a 1.5-hour mindfulness practice that consisted of receiving training in basic mindfulness skills, including body scan (observing bodily sensations in each part of the body) and sitting and walking meditation.
Patients received a compact disc with audio recordings of guided meditation for use at home. They were instructed to practice at home for 10 minutes a day at least 6 days a week after session 5. Home practie sessions were increased to 20 minutes a day after session 6, and to 45 minutes a day after session 7.
Allied healthcare workers, including a nurse, and three social workers served as instructors for the BAM group. These workers received 32 hours of training and 8 hours of supervision.
Patients in the usual-care group continued to receive medical care at general outpatient clinics. They were allowed unrestricted access to medical care for depression or anxiety.
A score of young engineers of the CBM carry out the development of the Imagis – a software that evolves – and the installation of the Network. Photo Author: Juventud Rebelde Published: 03/26/2018 | 10:51 pm
SANTIAGO DE CUBA.- Specialists from the Department of Bioinformatics at the Center for Medical Biophysics (CBM), based in this city, work on the interconnection of 23 hospitals in eastern Cuba to form the eastern network for the transmission of medical images.
The Master of Science Henry Blanco Lores, in charge of the aforementioned Department, explained to JR that this is a new stage of development of the Imagis software, dedicated to the handling and processing of medical images, the result of the scientific work of the CBM, which for more than 15 years has been at the service of the national health system.
The version 2.0 of Imagis, supported on a distribution of the Linux operating system, said the expert, will be the basis of the idea, with the sponsorship of a Belgian non-governmental organization, and under the collaboration project VLIR-Universidad de Oriente, plans to deploy 170 machines throughout eastern Cuba.
The expert explained that the young and specialized group that he runs has started installing a professional server, personal computers, tablet and printers in health institutions in Santiago de Cuba, Holguín, Granma, Guantánamo, Las Tunas and Camagüey, which will be linked to five important hospitals in the capital of the country.
The work of installation, which will occupy them throughout 2018, has been initiated by the city of Santiago, which they hope to convert into a sort of polygon test of the potential of technology, and since February they simultaneously reach the province of Holguin
Blanco Lores stressed that with the new network will be possible for radiologists, neurosurgeons, pulmonologists, cardiologists, oncologists, and other specialists, access to images of ultrasound equipment, digital X-rays, computerized axial tomography, magnetic resonance and other imaging techniques taken in any of the connected hospitals.
By allowing radiologists and the specialists themselves to visualize the images in a short period of time, the diagnosis and subsequent decision-making becomes more agile and precise, facilitates the discussion of cases and operationalizes the workflow in the services of Imaging of health institutions.
Given its great potential for the processing of images, Imagis allows comparing different studies of a patient, assessing the lesion from different positions, calculating the angle and thickness of the cut, visualizing three-dimensional structures or tissues and performing volumetric reconstructions, which makes it an ideal tool for case tracking.
The system also offers the option of storing the images on a CD, DVD or flash memory, which besides guaranteeing the patient to have their studies, allows the creation of a database of great value for medical teaching and research.
By constituting a national tool, developed and supported by our own specialists, Imagis multiplies the possibilities of using this type of software without the country having to pay for the corresponding licenses for its use, as it should do in case of importing it.
The system has another of its strengths in the ability to adapt to national needs; In fact, knowing that beyond the network, not all health institutions have machines with great benefits, CBM specialists have created a version for tablet, based on Android and the Imagis Web, which does not allow the exploitation of all the potentialities of the software, at least makes possible the basic operations for the visualization of the images within any of the browsers currently in use.
The young specialists of the CBM assume the assembly, maintenance and repair of faults that the technology may present, as well as the training of medical personnel linked to the use of the software, awarded in the National Exhibition Forjadores del Futuro, of the Technical Youth Brigades.
The Eastern network of transmission of medical images had as background a similar one created between hospitals of the Heroic City in 2001 and counts on the endorsement of having facilitated the training of the Cuban collaborators who work in the Centers of High Technology in the Bolivarian Republic of Venezuela and other Caribbean countries.
Sally Jacobs, PRIPublished 7:33 p.m. ET Jan. 9, 2018 | Updated 6:12 a.m. ET Jan. 10, 2018.
George Keays is not a rogue kind of a man. A Colorado real estate agent and grandfather of three, the 65-year-old practices yoga and meditates regularly. But the U.S. government, he says, has left him no choice but to break the law. If, that is, he intends to stay alive.
Keays has stage 4 lung cancer. As his treatment options appeared to be dwindling this fall, he went to Cuba for a vaccine treatment despite a federal law that prohibits Americans from going there for health care. Now, with President Trump’s recent tightening of the regulations governing travel to Cuba, it has become much harder to travel there. But Keays needs more of the vaccine. This spring, he’s going back.
“I am not looking to break the law. But I am not looking to die, either,” Keays declared. “People with stage 4 cancer, like me, should be allowed to try whatever they want to stay alive, whatever they think will work. The last thing they need is the government on your neck over some archaic regulation saying just take what is available here and die.”
Keays has abundant company. In the two years since relations between the U.S. and Cuba were normalized under President Barack Obama, a growing number of lung cancer patients traveled to Cuba for a vaccine called Cimavax, and more recently, a newer vaccine, Vaxira. These patients are an elusive group. None of those who went apparently provided their real reason for going to Cuba when applying for a visa, nor did many of them declare to U.S. customs officials that they were bringing multiple vials of the vaccine into the U.S. on their return. Few even tell their doctors they are taking the injections for fear they will refuse to treat them further.
“I can only see it as compromising him because now he has a patient on a drug that is not approved by the FDA,” said a patient in Florida named Larry, who asked that his last name not be used. Larry has gone to Cuba twice for the vaccine — both times without telling his doctor because, “He might be afraid he would be sued, or he might stop treating me.”
Just how effective are the vaccines they’re smuggling into the country in their small refrigerated lunch boxes is unclear. Neither of the vaccines prevents cancer; rather, they are a kind of immunotherapy that prompts the body’s immune system to battle the disease in patients with non-small cell lung cancer. In January, the Roswell Park Comprehensive Cancer Center in Buffalo, N.Y., launched a clinical trial of Cimavax with Cuba’s Center of Molecular Immunology, which developed the vaccine. It is the first such joint venture between the two countries since the Cuban revolution.
Roswell is now doing research to determine if they want to do a similar trial with Vaxira. It will take years for either of the drugs to receive any final approval.
For many patients, including some who were not accepted into the Roswell trial, travel to Cuba has become a much-talked-about option. So popular has the practice become that patients on Internet support groups routinely trade anecdotes and travel tips about their Cuban journeys. Until, that is, Trump threw a wrench into the process.
Major changes for patients going to Cuba
The change in regulations governing travel to Cuba that went into effect in November altered one of the most popular categories of travel to Cuba initiated by Obama, known as “people-to-people,” which allowed travelers to go to Cuba on their own. That’s how many Americans have been quietly going to the island for medical care, even though doing so is prohibited under the U.S. embargo against Cuba. Now, people in this category must travel with an organization and have a guide present.
Americans can continue to travel on their own to Cuba for the purpose of professional research or to provide “support for the Cuban people.” But given that travelers in those categories are required to maintain a full schedule of activities, it’s likely that neither will be a good option for cancer patients.
At the La Pradera International Health Center in Havana, where most American cancer patients go for treatment, Dr. Anabely Estévez García felt the impact of the new regulations in her inbox as soon as Trump announced back in June that the changes were in the works. American patients began canceling their plans in a flood.
“We can not go at this time,” a Texas man emailed García on the day of Trump’s announcement. “President Trump changed everything today. It is not possible to go directly from here. Keep us in touch.”
A patient in New York on the brink of travel wrote that she had decided “to wait a little longer. Now, it will be harder to get there as our President has made it impossible to travel alone.”
Nancy Kelly, 71, a California patient who traveled to Cuba for Vaxira this past spring, emailed that she was worried about the new regulations, too. How would she replenish her vaccine supply when it ran out in October? She decided not to go herself but sent a friend to Cuba to pick up more for her.
“It was important to get back to Cuba before Trump’s restrictions went into effect,” sighed Kelly. “With the new restrictions, I would need to go through a third country. The problem is that the vaccine has to be refrigerated, so, if you were on a long flight, that was going to be a problem.”
The tighter regulations are only part of what is keeping patients from going. Another factor is the State Department advisory issued this past September warning American citizens not to go to Cuba due to alleged assaults against American Embassy staff. Investigators have yet to determine exactly who or what was behind the assaults, and the staff in Havana has been significantly reduced. For some travelers, it’s all just too much.
Since relations between the U.S. and Cuba were normalized at the end of 2014, the number of patients going to the plush La Pradera clinic at the city’s edge had risen steadily. In 2016, 50 Americans came for treatment. Last year, the number of inquiries about the vaccines tripled over the previous year, while 47 patients had already made the journey to Cuba in the first eight months of 2017, according to García. Now, the numbers have plateaued.
“There are many patients who are suitable for treatment but who do not come for political reasons,” said García, seated in a treatment room at La Pradera this fall. “As a physician, I feel very bad because I believe our vaccine is a good treatment that can extend these people’s lives.”
Because their own doctors are often not involved, patients wanting to go to Cuba must make arrangements themselves. First, they get in touch with La Pradera either through email or one of a number of medical tourism agencies in the U.S. or in Canada. They then send their medical records for evaluation by La Pradera physicians who determine if they are eligible for one of the vaccines, and if so, which one.
Under the Obama-era regulations, accepted patients usually informed the airlines issuing their visas that they were going for educational purposes or under the general people-to-people category. Questions were rarely asked and most flew directly to Cuba.
Patients stay at the La Pradera clinic, a resort-like facility with a swimming pool and fountains, for four days, during which they receive their first of several doses of the vaccine. Each dose consists of four injections — two to the arms and two to the buttocks. One dose costs about $860, so the total cost of the trip, including airfare, lodging and a supply of the medication to take back home, can run well over $10,000.
At P&G Travel in Ontario, long one of the more popular agencies among Americans for booking travel to Cuba, the numbers are both up and down. Since Trump announced in June that he would be reversing aspects of the Obama administration’s overtures to Cuba, the number of Americans booking travel directly from the U.S. to Cuba through the agency has plummeted by 60%. Instead, they’re now going through third countries just like they used to do before Obama’s normalization of relations. Since June, the number of bookings by Americans going to the island from countries other than the U.S. has increased by 30%, according to Tathiana Gonzalez, the agency’s Cuba travel specialist.
“You’re either going to go or not go,” said Gonzalez. “When you’re given a month to live, you go. It’s kind of basic.”
What they are going for is part of the new wave of immunotherapy treatment that works by triggering a patient’s immune system to fight cancer. Cimavax, for example, stimulates the immune system to make antibodies that bind to a protein called epidermal growth factor, or EGF, that cancer cells need to grow, effectively starving the cancer. Vaxira is somewhat different; it triggers an immune response against a molecule specific to several cancers and is intended to ultimately block the cancer’s growth. Only patients who have already received chemotherapy are eligible for the vaccines.
Cubans research a lung cancer vaccine
While Cuba is often recognized for its pristine beaches and throbbing rumbas, it is also home to a burgeoning biotechnology industry. Prompted by the country’s high rate of lung cancer, researchers began work on a lung cancer vaccine back in the mid-1990s. In the most recent of several Cuban trials, patients receiving Cimavax lived about three to five months longer than those who did not. Available to Cubans for free since 2011, it has been given to more than 5,000 patients worldwide.
Cimavax is currently available in Cuba, Colombia, Peru, Bosnia-Herzegovina and Paraguay. Vaxira, which one Cuban clinical trial indicates can extend life by up to two months, is currently undergoing more testing in Argentina. It is available in that country and in Cuba.
Roswell scientists began collaborating with Havana’s Center of Molecular Immunology, which developed the vaccines, in 2011, and scientists from both countries have worked in one another’s laboratories frequently over the years. In the Roswell trial, Cimavax is being combined with a checkpoint inhibitor, which blocks proteins on cancer cells, called Opdivo.
While talk of Cimavax has circulated in American medical circles for years, much less is known about Vaxira. Roswell researchers are currently doing preclinical studies of Vaxira in animals to determine if the vaccine merits a possible human trial. Dr. Igor Puzanov, director of the early phase clinical trials program at Roswell, said that it could take up to a year before a decision can be made on whether to proceed.
“We know what the vaccine is supposed to do,” he said. “It’s just too early to say if it does it.”
Meanwhile, at the Center of Molecular Immunology, scientists are now focused on taking Cimavax to a next step. They are working to extend patients’ survival rate by identifying markers in those who are responsive to the vaccine. Patients with high concentrations of the EGF protein, for example, have been shown to be more responsive to the vaccine than those who do not. Camilo Rodriguez, a clinical researcher at the center who has worked on Cimavax for 15 years, says he believes that eventually, the vaccine might be used on a host of cancers.
“We feel that the vaccine could be very effective against prostate cancer, for example, because those patients often have a high degree of EGF and that is related to the spread of cancer,” said Rodriguez, seated in his laboratory. “Eventually, we feel this could be useful in all kinds of cancer affecting the head, neck, bladder and prostate.
American doctors are not so sure. While some are cautiously optimistic about Cimavax and await the outcome of the Roswell trial with interest, others complain that the vaccine has been oversold and is in sore need of further study. Dr. Robert Doebele, associate professor of medical oncology at the University of Colorado- Denver and a senior editor of the American Association for Cancer Research’s journal Clinical Cancer Research, recalls sitting in a meeting with a dozen other oncologists discussing the best way to market a drug. Someone in the room called out, “Do whatever Cimavax does!”
“We all let out a collective groan,” said Doebele, who is George Keays’ oncologist. “It was hilarious. The fact is that I spend several hours a month answering questions from my patients about this. It’s very prominent on the Internet and patients are understandably desperate to learn about it. But the fact is that we just don’t know if this works yet.”
Dr. Roy S. Herbst, chief of medical oncology at Yale University and a nationally recognized expert in the treatment of lung cancer, shares those reservations. Herbst says that “without seeing new stats, it’s not that impressive.” For the moment, he added, “I am not too worried about people not being able to go to Cuba.”
Like several other doctors of the patients interviewed for this story, Doebele advised Keays not to go to Cuba for the vaccine. One reason for that is that Keays is currently taking Tagrisso, a standard therapy for non-small cell lung cancer. Doebele is concerned that if Keays shows improvement while taking that and one of the Cuban vaccines, it will be impossible to tell which medication was responsible. But Doebele has other worries.
“My biggest concern is safety because of the lack of oversight and regulation. I can’t control what he does; I don’t even know where he’s getting it. Was it even a legitimate clinic where he got it?” said Doebele. “I thought I’d talked him out of it.”
But he hadn’t. Keays did apply to participate in the Roswell trial, as Doebele suggested, but he was put on the waiting list. He became frustrated that he might wind up in the placebo group in the study, and so he decided “to go right to the front of the line. Cuba.”
Keays arrived at the La Pradera clinic in October and was advised that the vaccine most suited to his cancer was Vaxira. After consulting with his family doctor, Boulder internist William L. Blanchet, who was traveling with him, Keays received his first dose.
“Twenty minutes after I received it, I felt a little tired, but that was it,” said Keays. “The next day, I went for an hour run. I felt great.”
If Keays was impressed by the professionalism of the doctors, Blanchet was even more so.
“On paper, this looks very promising,” Blanchet said of the vaccine. “It resonates as being medically sound and potentially a major addition. It’s too soon to recommend it to patients, but I would make them aware of it and let them make the decision. If I was diagnosed with stage 4 cancer, I would definitely go down and have this be part of my therapy.”
One of the other patients at La Pradera when Keays was there was Eduardo Sanchez, of Spain, a lean man with graying hair. Diagnosed with advanced stage 4 lung cancer, Sanchez said he, too, had exhausted most of the treatments available to him. Like most American patients, he learned much of what he knew of the Cuban vaccines on the Internet.
“Unfortunately, in Spain, there is no information about the Cimavax or the Vaxira,” he said. “It’s too early for me to say, but I am very hopeful.”
Questions on how to bring back the vaccine
For advanced stage cancer patients like Sanchez and Keays, going to Cuba can be difficult in itself. The trip is tiring and can be daunting for those for whom the treatment may be viewed as something of a last resort. Now, American patients face an even higher hurdle in the new and somewhat confusing regulations. The question many patients are wrestling with is how to get in and out of the country without getting caught, given the likelihood of greater scrutiny.
Over the past two years, it appears that no one has been apprehended. The U.S. Food and Drug Administration’s “personal importation policy” allows some unapproved medications to be brought into the country, provided there is not an adequate alternative available in the U.S. and the amount does not exceed a three-month supply. But spokesmen for both the FDA and U.S. Customs and Border Protection say there is no record of either of the Cuban vaccines having been brought into the country or seized at the border.
Just how to bring the vaccine into the U.S. is a hot topic on the online health care social network, Inspire, which supports a lung cancer group of about 53,000 members. Judy Ingels, 74, is one of them. Diagnosed with stage 4 lung cancer in 2015, Ingels went on Tarceva and her tumor shrunk somewhat. After she saw a CNN report on Cimavax at the end of 2016, she decided to go to Cuba while she was relatively well and still able to do so. Last spring, she and her family traveled from their home in Santa Rosa, Calif., to Havana, where she received her first treatment of the vaccine. All told, the trip cost about $16,000. That she was breaking the law did not trouble her in the slightest.
“I just didn’t get hung up on it,” said Ingels. “My husband said, ‘When they ask what your purpose is, just don’t mention anything about medicine.’”
Ingels had no trouble carrying an eight-month supply of Cimavax back into the U.S. in a hand-held refrigerated lunch bag. When she told the Transportation Security Administration agent in Florida that she was carrying a vaccine, he opened her bag and poked around but asked no questions.
In the months that followed, Ingels’s tumor shrunk perceptibly, a fact that she attributes to Cimavax. Now, however, her supply has run out and she wants more. Presuming that she cannot travel with a guided group, given her purpose, she is considering hiring one of several professional “mules” who will fly to Cuba to get the vaccine for a fee. Two of them contacted by PRI declined to be interviewed.
“We’re weighing the options,” said Ingels. “We might travel ourselves through the Bahamas. But I have also talked to an individual who has offered to do this.”
Nancy Kelly, who had a friend travel to Cuba on her behalf, was considering a return trip. But when a scan last fall showed that her tumor is growing, she changed her plans — at least for the moment. The change in her circumstance has not dimmed the retired administrative judge’s anger at the government’s imposition of limitations on American patients’ ability to seek the treatment they want.
“I think it’s absolutely outrageous. What Trump has done makes it so much more difficult to go,” said Kelly. “The restrictions that do not permit doctors in different countries to corroborate to help save lives is absolutely terrible.”
Keays is running into a similar problem since a recent scan showed that a mass on his liver is growing. Doebele, his oncologist, believes that means that neither the Vaxira nor the Tagrisso is working. Doebele has suggested Keays go off the Vaxira, in part, so that he might qualify for other treatments, but Keays continues to have faith. He’s planning on returning to Havana in the spring for more of the vaccine. Keays intends to apply for a visa under the category of “professional research” arguing that he is a guinea pig for the Vaxira vaccine. He has become, after all, something of an expert on the subject. Over the past two years, he’s tried a wide variety of treatments: two targeted therapies, multiple forms of radiation and a lot of meditation. He’s been on Vaxira now for two months.
In between doctor’s appointments, Keays has been working on a letter to the chairman of the U.S. Senate Committee on Foreign Relations, hoping he might intervene on patients’ behalf. He’s getting other patients to write, too.
“I intend to do whatever I can to expose how these restrictions steal the hope, and possibly, the life, from patients suffering with terminal cancer, as well as other sicknesses that might benefit from Cuba’s advances in medicine,” declared Keays. “The ignorance in this new policy is astounding.”
In the meantime, for patients disheartened by an American government and doctors who seem to offer them only discouragement regarding Cuba, there is one source of potential support: travel agents like Tathiana Gonzalez in Ontario.
Unaffected by the U.S. regulations, Gonzalez routinely forwards dozens of American patients’ medical records to La Pradera, on their behalf, to see if they qualify for one of the vaccines. It’s the only instance in which she gets involved in her clients’ medical needs because, she says, the process is so stressful. She’s the first to admit that she’s no medical researcher, but she notices that some of the cancer patients that she’s helped get to Cuba have lived for years. Like her clients, she waits anxiously for a response from the Cuban doctors: Are they accepted to go, or not?
“It’s such an emotional roller coaster,” exclaimed Gonzalez. “If they’re not accepted, I cry because their cancer is so advanced. If they are accepted, I rejoice! I say, ‘You’re going! You are going to Cuba!’”
This story was reported with a grant from the Pulitzer Center on Crisis Reporting. It was originally published on PRI.org. Its content is separate from USA TODAY.
El glioblastoma (glioma grado 4 o IV) es el tumor cerebral primario más frecuente y maligno. El grado IV, es el grado más alto en la clasificación de los tumores cerebrales de la Organización Mundial de la salud (OMS). Su incidencia es de 3 casos por 100000 habitantes al año.
La gran mayoría de glioblastomas son primarios, es decir, aproximadamente el 90%, aparecen súbitamente y son de nueva aparición (de novo), en pacientes de edad avanzada, sin evidencia clínica o histológica de una lesión precursora menos maligna (glioblastomas primarios). La supervivencia media está entre los 12 y los 18 meses cuando se trata con una resección máxima segura más quiorradioterapia adyuvante. Se conocen como glioblastomas IDH wild type porque no presentan mutaciones en la Isocitrato deshidrogenasa (IDH).
Los glioblastomas secundarios se desarrollan a partir de un astrocitoma difuso de bajo grado (astrocitoma grado II de la OMS) o astrocitoma anaplásico (astrocitoma grado III de la OMS), previamente diagnosticados en el paciente. Se manifiestan en pacientes más jóvenes, tienen un menor grado de necrosis, se localizan preferentemente en el lóbulo frontal y tienen un pronóstico significativamente mejor.
Descrições pessoais de minhas reflexões e descobertas como médico homeopata e cirurgião pediatra depois de 30 anos de trabalho e mestre em gestão empresarial, como idealizador e gestor do IDESUFRAN ( https://www.facebook.com/IDESUFRAN-176071449112233/) incubadora comunitária e tecnológica de Franca, Estado de São Paulo e diretor presidente da Start up, HOMEA - Solução Aplicada em Agroecologia - www.homea.com.br
Descrições pessoais de minhas reflexões e descobertas como médico homeopata e cirurgião pediatra depois de 30 anos de trabalho e mestre em gestão empresarial, como idealizador e gestor do IDESUFRAN ( https://www.facebook.com/IDESUFRAN-176071449112233/) incubadora comunitária e tecnológica de Franca, Estado de São Paulo e diretor presidente da Start up, HOMEA - Solução Aplicada em Agroecologia - www.homea.com.br
Cuba has the drug that prevents the amputations in the diabetic foot as well as the drug that makes lung cancer reversible, however, it will take a long time for the FDA to approve these medicines in the United States. Meanwhile, thousands of Americans can be amputated and die. Thousands of Americans will pass away by lung cancer for the simple fact that the embargo prevents going to cure to Cuba where there are all the conditions of hospital care. A serious solution would be for Congress to make a humanitarian exception for diabetic foot patients and lung cancer so that they could make the trip to Cuba that is only 90 miles away from the United States and could pay for these services with their health insurance. Medicare and Medicaid, by the way, taxpayers would save billions of dollars from the Public Health budget because medical care in Cuba is very economical. Cuba produces unique anti-cancer drugs in the world at the cost of one dollar each. You may took about this with your representatives. Gualterio Nunez Estrada, gualterionunez4@gmail.com , Sarasota, Florida.
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