Talking Sense: Political Hyperbole On The Medical Frontier
By NOELLE NICOLLS
khalilanicolls@gmail.com
WHEN politicians train to be politicians, one of the first lessons they learn is about the use of hyperbole, the art of using obvious and intentional exaggeration to make a point. It is a political tool that Bahamian politicians are very familiar with and use with great frequency (Full disclosure: the media profession is no novice when it comes to the art either)!
With
true hyperbole, however, the extravagant statements are not intended to
be taken literally; they are intended to make a point.
Trouble
is, listening ears often miss the point, and instead come away
believing the exaggeration. While talking heads, on the other hand,
sometimes buy into their own hype, and use intentional exaggeration to
get away with spreading outright lies. Too much hyperbole can really
create one messy affair.
Needless
to say, one has to be astute to weed through the mess. Let us take, for
example, the Stem Cell Research and Therapy Bill, currently being
debated in the House of Assembly, which has been painted as
“revolutionary” by its proponents.
Much
has been said about the benefits that stem cell research will bring to
the Bahamas: $100 million annually, new jobs, spillover effects on all
areas of the economy, lead scientists who will relocate to the Bahamas
and create institutions and centres of excellence, and new medical
treatments for Bahamians. The impressive list goes on.
The
way in which this adventure is being trumped up has certainly made me
weary. For one simple reason: Our politicians have a knack for
trumpeting revolutionary projects that never live up to their promise.
And I would hate for us to venture into another one of those limp
experiments at the expense of matters of real national importance.
Let
us not forget, a few years ago, telemedicine was the revolutionary
technology that was supposed to transform health care in the Bahamas,
“bridging the islands of the Bahamas medically”. The Bahamas was
supposed to become a nerve centre for the Caribbean, using the success
of connecting the Family Islands as the launch pad for a worldwide
breakthrough in the developing world.
The
Free National Movement government launched a tele-radiology pilot
project in two community-based clinics: The South Beach Clinic in New
Providence and Eight-Mile Rock Clinic in Grand Bahama. Radiologists at
Princess Margaret Hospital or Rand Memorial Hospital consulted regularly
with technicians and patients at the two clinics. They used a Picture
Archiving and Communication System (PACS) to store, share and archive
imaging data.
The
idea was to link the entire Bahamas into the PACS system. International
partners could also be plugged in, so a doctor in Nassau would be able
to consult with a radiologist at the University of Miami. The government
was hoping to use the technology to provide other long-distance
services like pre-natal ultrasounds.
The
government also launched a virtual skin clinic in Abaco, which treated
42 patients in its first month of operation. The government eventually
rolled out the programme in Andros, and had plans to replicate the skin
clinic model with paediatric clinics.
The government made some positive inroads with telemedicine, but whatever happened to the promised renaissance?
Recently,
a $100,000 telemedicine lecture lab was launched in the oncology centre
of PMH thanks to a donation from the Bahamas Telecommunications
Company, evidence that the telemedicine dream is still alive, but not
evidence of a revolution.
When
telemedicine was the hot topic, Dr Hubert Minnis, the Minister of
Health at the time, promoted it as a forward thinking project by a
visionary government.
“(Telemedicine)
is extremely futuristic; that is what this Government is all about. It
is not just about today, but it is about tomorrow and tomorrow we will
be able to expand that so that not only will we be taking the Emergency
Room to the Family Islands, but we will be able to expand the service so
that we will be in a position to also take Intensive Care Unit and
other facilities to the Family Islands,” said Dr Minnis in 2007, on the
occasion of the pilot project launch.
Unsurprisingly,
the Progressive Liberal Party government is now framing its interest in
stem cell research in the same light, as catching the wave of the
future.
Oncologist
Dr Arthur Porter, former head of the government’s stem cell task force,
predicted a global “renaissance” in the use of stem cell therapy “over
the next ten years”. He positioned the government as being forward
thinking by getting ahead of the curve.
However,
Dr Porter did not predict he would be embroiled in an international
scandal just six months after his stem cell prophesy. He is currently
being held on an international arrest warrant in connection with an
alleged million dollar kickback scheme in Canada, where he faces charges
of fraud, conspiracy to commit government fraud, abuse of trust, secret
commissions and laundering the proceeds of a crime. Dr Porter denies
all of the charges against him.
Nowadays
it is hard to take the government seriously, when political leaders
have such a loaded track record of rhetorical dishonesty. And it is
almost impossible to take the government at its word, when it keeps
dangling carrot sticks of some awe-inspiring future that is likely to
have no impact whatsoever on the quality of life for the average
Bahamian.
During
debates in the House, Minister of Health Dr Perry Gomez boasted about
the story of an infant born in Italy, who was recently treated
successfully using stem cell therapy. What Dr Gomez did not say is that
tracheomalacia, the condition that afflicted the child causing her to
need a new trachea, is a very rare condition. The story is touching, but
how relevant is it for the average Bahamian?
Bahamians
are afflicted with common diseases such as diabetes, cancer, heart
disease, kidney disease. All of these are top contenders for potential
stem cell therapies. However, stem cell medicine is still in its
infancy, from commercial and scientific points of view.
In
2011, the company that conducted the world’s first Federal Drug
Administration approved clinical trial using human embryonic stem cells
on spinal cord patients aborted the experiment and left the stem cell
business entirely. Geron, the leading Silicon Valley biotech company in
question, directed its resources towards experimental cancer drugs,
which were much more advanced in their development.
The
company was awarded a $25 million loan from the California Institute
for Regenerative Medicine for the trail, but it returned the money: $6.5
million, the amount it had borrowed so far, plus interest.
The
company determined it did not have sufficient financing to continue its
experiments with stem cells and cancer treatments at the same time. And
despite having spent $150 million over 15 years investing in its stem
cell treatments, it chose to go with its cancer research.
There
may obviously be other factors at play here, but one conclusion that
can be drawn at face value is that stem cell medicine is a bad bet for
Bahamians hoping for a cancer treatment in this generation.
At
best, researchers “estimate that the time lag between research
expenditure and eventual health benefits is around 17 years”, according
to a report by the Welcome Trust, a UK based biomedical research and the
medical humanities firm.
Of
course, anything is possible. At the end of the day, treatment is not
the same as a cure. The promise of stem cell therapy is a cure for
disease.
Either
way, stem cell medicine is a highly specialised niche market in the
medical field and will likely be so for years to come. It seems doubtful
that stem cell treatments for common conditions will become mass market
in the near future, based on reports about the industry. At some point,
they will be available to an exclusive few by virtue of their cost. And
now, they are available to an exclusive few because patients have to
meet “a very strict set of criteria” to qualify for treatment, based on
rigid clinical research trial protocols.
Last
year, when the Bahamas Heart Centre (BHC) in conjunction with Advanced
Innovative Medicine Inc of Orlando, Florida, conducted the Bahamas’
first cardiac stem cell implantation, Dr Conville Brown, BHC director
and CEO said: “The expansion of the patient’s stem cells is a procedure
that generally attracts a price in the region of $20-30,000 just for the
cells. And nobody has put them in yet and nobody has taken them from
the patient yet, so the general price is somewhere easily around the
$40-50,000 range.”
The
62-year-old cardiac patient, who was a medical tourist, had advanced
coronary artery disease. He had already undergone bypass surgery on a
number of occasions, after his first heart attack in 1989. The stem cell
treatment was considered a “last option” before considering a heart
transplant.
Stem
cell research is not your average field of study. It would be
irresponsible to mislead people by hyper inflating the benefits they are
likely to reap with rosy portraits of an uncertain possible future.
There
is another important aspect of the stem cell debate that needs to be
explored. Let us look at our national healthcare needs. If the Bahamas
was to aspire to global dominance in any area of medical research, it
would seem more prudent to fix our eyes on area of medicine that was a)
of great relevance to the Bahamian people, and b) best served by our
natural resources, national infrastructure and areas of technical
expertise.
An
obvious example comes to mind: breast cancer research, considering
Bahamian women suffer from the disease at disproportional rates to the
rest of the world.
In
the government’s speech from the throne, which established its
legislative agenda, it committed itself to “facilitating the Public
Hospital Authority’s acquisition of new cancer screening technology to
ensure that Bahamian women have access to-state-of the art mammogram
machines”. Makes sense.
Telemedicine
is another good example. It was in fact a good idea (even if oversold),
considering we desperately need ways to bring basic and advanced
medical services to the remote corners of our archipelago.
Let
us examine another healthcare example, an overlooked area of need.
There are two main government entities responsible for delivering health
care services in the Bahamas: the Public Hospital Authority (PHA),
which manages the hospitals and the Department of Public Health (DPH),
which manages a network of 55 health centres and 59 satellite clinics
across the archipelago.
Every
year, we have a flood of young doctors graduating from institutions
such as the University of the West Indies (UWI) entering the
professional ranks in the Bahamas. And yet, the Department of Public
Health is still chronically short on doctors. It has to import doctors
from around the world to work in the Bahamas.
How
is it that we have so many people entering the medical profession in
the Bahamas and yet we still have to import doctors? Here is a problem
the government might want to invest some time and money into solving.
Junior
doctors, particularly those coming out of the UWI system, are required
to participate in a mandatory internship programme with the PHA. Many of
them are scooped up by the PHA at the end of their internships and
choose to remain in the hospital system, because they are able to
continue understudying experienced doctors and develop new skills in
areas of specialisation.
If
they were employed to the DPH, they would be limited to practising
general medicine, for the most part, and have to take up Family Island
posts, where they would serve as resident experts unto their own.
Here
is a problem that affects the day-to-day lives of Bahamians in an area
of critical need. Our medical professionals, particularly young
professionals, need greater access to training and more incentives to
enter the Department of Public Health’s system.
There,
government has a buffet of healthcare needs to choose from: a shortage
of doctors in public health, a shortage of surgeons and specialists in
the medical profession generally, a breast cancer rate that is out of
control, high rates of prostate cancer in our male population, and a
long awaited national health insurance scheme, among other immediate
concerns. A responsible government would channel its resources and build
human resource capacity in areas of true need for its people.
Sadly,
none of this logic seems to matter because stem cell research in the
Bahamas has a celebrity champion with money to spend.
I
am reminded of the research I did last year about the funeral services
industry. For decades, the government has failed to enact regulations to
bring the industry in order. It is the wild wild west in funeral
services in the Bahamas.
The
lax regulation of sanitation standards, for example, is having a
serious impact on public health. The nonexistent regulation of funeral
service practitioners has given birth to players who employ embalming
and burial practices that dishonour the dead.
The
government has turned a blind eye. Meanwhile, families, according to
members of the industry itself, are “being bamboozled” by the system,
and our dead are being habitually dishonoured. The government has no
shortage of excuses for its failure to act. Apparently, it is waiting on
the industry to come forward with its own draft regulations.
The
whole matter forces us to ask serious questions about how the
government establishes its legislative priorities. Perhaps the funeral
services industry needs to get itself a celebrity backer. Because stem
cell medicine, a priority only for a few private medical companies prior
to 2012, has managed to become a front burner issue for the government
when it was never on the legislative agenda to begin with.
When
the Stem Cell Research and Therapy Bill becomes law, the obvious
question will be how is the government going to set its budgetary
priorities in the health sector?
The
government recently announced a possible new partnership with the
University of Miami, who might help the government with its regulation
of the industry. I am curious to know what kind of government resources
will be allocated to the regulation and oversight of this industry, and
sustaining a relationship with the University of Miami. Will the taxes
associated with the industry sufficiently cover all of the government’s
incurred expenses?
What
frustrates me about how the stem cell debate has evolved is that our
foray into the industry could have gone down without much fanfare or
controversy, with sobriety and restraint, had it been a side project for
which the government was only obligated to get involved in from a
regulatory point of view to ensure public safety and the rule of law.
But
no, the project has become a side show, having been trumpeted as
“ground zero” for the next medical revolution in the Bahamas, based on
claims that have not been sufficiently substantiated.
Stem
cell technology might be revolutionary in the field of medical science,
but it is not at this juncture the revolutionary answer to our
healthcare needs or our economic woes.
The
governing majority has failed us in this debate and so has the
opposition. Both have wasted the people’s time overplaying their hands,
proffering base arguments that have caused more confusion than clarity,
more petty squabbling than true debate.
I
hope discussion ends on this bill quickly, so the government can
proceed to matters of true concern. And I hope any expense incurred by
the people on this stem cell adventure is offset by fees and taxes paid
by those who have the real vested interests.
•
Noelle Nicolls is the Tribune’s Features Editor. She is also a travel
writer, women’s activist and entrepreneur. Follow her on Twitter
@noelle_elleon. For questions or comments, email
khalilanicolls@gmail.com.
August 06, 2013
