As Cuba-U.S. Relations Thaw, Medical Researchers Still Struggle to Connect

News from Cuba | Thursday, 19 February 2015

When Sergio Jorge Pastrana has big files to download he waits until he leaves his island nation. As foreign secretary of the Cuban Academy of Sciences he has a front-row seat to cutting edge research, but the country’s limited bandwidth capability is a constant reminder of the U.S. economic embargo against Cuba which has hobbled the import of computer technology along with modern medical research tools.

The embargo, dating back to the Kennedy-era, is still in place but scientists in both nations are carefully tracking Pres. Barack Obama’s recent comments on the thawing relationship between the two countries. Obama has already moved to normalize relations and establish an embassy in Havana, but overturning the embargo would require an act by the U.S. Congress. In his State of the Union speech on January 20 the president urged Congress to “begin the work of ending the embargo.” Lifting the ban, scientists say, would usher in a new era of opportunities, especially in medicine.

The embargo has crippled Cuba’s medical sector since the U.S. set up the economic barrier in the early 1960s. Although the export of medical supplies to Cuba is legal, extensive restrictions limit such sales. “As a matter of [U.S.] policy, the sale of state-of-the-art technology in this sector is not authorized,” according to a 2011 United Nations report. As a result, Cuba is often unable to acquire certain medical supplies for research or forced to seek out pricey alternatives. The embargo prevents U.S. companies from conducting business in Cuba and blocks most Americans from readily traveling there or spending money as tourists. U.S. law also dealt a serious blow to Cuba’s medical work by fining third-party countries for carrying out business with the Caribbean nation. And in the early 1990s the U.S. expanded the embargo, prohibiting foreign subsidiaries of its companies from trading with Cuba. Many U.S. biomedical researchers cannot work with Cuban scientists because U.S. research is typically supported through federal grants, and such monies cannot be used to support Cuban-American science partnerships.

Cuban scientists are often unable to maintain much of their medical scanning technology without spare parts from companies linked to the U.S. They cannot readily download large data sets or even buy certain medical textbooks. Cuba's National Institute of Oncology and Radiobiology, as of the 2011 U.N. report, did not have a flow cytometer-technology that can be used to study cancer cells-because U.S. company Becton Dickinson and Co. refused to sell it to Cuba once it learned from an intermediary who would be using the machines. And until several months ago Cuba had been unable to acquire a modern high-powered MRI machine.

The day after the State of the Union speech, Pastrana told Scientific American, “This is a very good step-encouraging the government to come help him put an end to the embargo,” but he cautions, “it remains to be seen how far that can go with Republicans.” While the embargo is still in place, for instance, the U.S. National Institutes of Health has not received guidance about how the White House’s moves to normalize relations will affect research possibilities and funding.

Cuba’s medical researchers have not been completely isolated. Despite the embargo’s limitations, a small number of U.S. scientists have partnered with their Cuban counterparts using private or foundation funds. And last year the American Association for the Advancement of Science (AAAS) and the Cuban Academy of Sciences pledged to work together to further research on cancer, emerging and infectious diseases, brain research and drug resistance. Yet little money is available to support that initiative. Lifting the Cuba embargo, Pastrana says, would certainly strengthen work in those four research areas.

Blockade to progress

Some of the difficulties of Cuban-American partnerships have been glaringly apparent. Few airlines offer flights to Cuba. There have been cumbersome visa issues and restrictions on what American scientists can do while in Cuba. Thomas Rothstein, an American researcher who has partnered on cancer vaccine research with a scientist in Havana for the past five years, says, “You can’t just buy a ticket and get on a flight and go down there next week. It’s the same in the other direction. For American scientists traveling to Cuba it’s been generally limited to traveling to conferences.” And when Rothstein’s Cuban counterpart visits him in New York at the Feinstein Institute for Medical Research, Rothstein says he doesn’t usually know until the last minute whether U.S. officials will approve the Cuban visa for the researcher from the Center for Molecular Immunology in Havana.

Cubans have developed certain work-arounds. In the absence of high-caliber MRI machines the country has focused on alternative imaging of the brain, says Pedro Valdes-Sosa, general vice director for research at the Cuban Neurosciences Center. He was born in the U.S. and studied neuroscience in New York City, but to further brain research in Cuba his team has focused on a lower tech approach-using electroencephalography (EEG) to trace brain impulses and hunt for abnormalities in neural oscillations. By measuring the brain’s electrical activity via a series of electrodes placed along the scalp and linked to computers, researchers can noninvasively observe brain activity. “It’s not the best scenario because we are missing more advanced techniques Valdes-Sosa says, but it’s a combination of necessity and choice. We’ve found it’s very effective.” As for the Internet connectivity issues, Valdes-Sosa says people often send his group disks with data by mail. Then, when researchers in Cuba want to submit papers to a peer-reviewed journal, he says, they often send their submissions in on a hard disk. Data and revisions will then be sent back, by disk, to Cuba. “This,” he says, “may take months.”

Lifting the embargo, according to proponents of a thaw, would be a boon for businesses that have been forced to curtail their offerings in the island nation. Since 2003 more than three dozen companies, including Philips Electronics of North America Corp., have faced penalties due to violations of the travel embargo, according to the Congressional Research Service. The change could also mean more consistent medical scanning options for research. Direct imports of medical supplies from the U.S. have remained rare, and sometimes Cuba has run up against difficulties even getting spare parts. At one point, CT scanners, angiography and ultrasound equipment from Philips-technologies common in health care facilities around Cuba-were lying idle, leaving patients with few options for three years, according to The Lancet Neurology. In December 2009 the journal reported that Philips, in an effort to comply with U.S. regulations, had “not provided any maintenance or technical support since 2006.” Philips has subsequently resolved those issues in line with U.S. regulations, the company told Scientific American in an e-mailed statement. The company has “delivered new medical equipment to hospitals in Cuba for the benefit of the Cuban people,” the company said. But Valdes-Sosa says maintenance for medical technologies in Cuba still remains an uphill battle.

For the countries to really work together, scientists say, the embargo will need to be lifted. Last year the international community got a glimpse of what such cooperation could look like. In response to the Ebola crisis in west Africa, Cuba joined the U.S. in sending hundreds of personnel to help. “When our countries have moved beyond their animosities and their differences, as with the Ebola response in west Africa,” Pastrana says, “the results have been outstanding.”

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