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Science, knowledge and development. Interview to Agustin Lage, director of the Molecular Immunology Center in Cuba.

By Dr Alina Pérez

Alina Pérez: The scientific development of health in Cuba has been focused on the biomedical over the social. How can these two aspects go hand in hand?

Agustín Lage: The division between biomedical and social sciences is artificial. There are no two kinds of science, what there are continual gradients of complexity. The problems confronted by sciences is relatively simple and can be handled managing two or three variables, then reductionist sciences function very well. As problems that confront more variables then the classical focus of science no longer works and then requires a more integral management.

For example, the research done by Carlos J. Finlay to demonstrate that the mosquito was the causal agent of yellow fever has only one variable: there is or isn’t a mosquito. If there is a mosquito then there is yellow fever. If there is no mosquito there is no yellow fever. Therefore, the scientific focus with a statistical process of data functions very well here. Now, if you want to do research on the epidemiology of neuropsychiatric disease these cannot be done with this focus because so many variables act simultaneously that the reductionist focus fails.

From this point of view medicine took a step back in the 20th century. When you read the classics of medicine of the 19th century, as written by Finlay or Louis Pasteur, you can see a social focus in medicine that at some time in the mid 20th century was lost. Then, there was an exclusively biological function as the only way of finding the truth regardless of variables. That gave rise to a kind of medicine that found solutions but was not capable of giving answers to all problems of health of the human populations.

Scientists with a biological and social formation must learn to work closely with them. An example is the research of the team of Molecular Immunology Center to manage lung cancer at a primary level of attention. How to increase survival of patients and quality of life is a complex intervention in health. The introduction of medicines is not the only thing to do. Nutrition must be attended to and psychological support of the family, manage pain. It is a much more complex action than injecting A or B.

In this sense research in our country has special opportunities. When you start to see a relationship between economic and social variable Cuba is always found outside the curves.

We live in a tropical country with few resources and not industrialized and, in this same country, life expectancy is 79 years of age and infant mortality is 4 that is a strange thing.

According to the”wisdom” of the conventional focus of statistical data this should not happen but, however, it is possible. This undoubtedly is a human and political result but also a scientific contribution. How to separate the classical relationship between these economic elements and social variables that have been happening in Cuba for 40 years? It is something that requires scientific questioning, all a fertile field for scientific creativity that should intervene from molecular biology to sociology.

Alina Pérez: How do you think Cuba can focus development of public health based on social determinants of health?

Agustín Lage: I have no answer for that question. It is a very complicated subject for professionals and leaders of health should find answers. For example, we confront a demographic structure of a developed country in the economic context of an underdeveloped country. How public health builds a wise strategy in this context is what we have to find. It is not written in any book. We must build it gradually, identifying what variables to move, what lever to use; but it is a problem, in addition to a moral, ethical, equal moral and sense of duty, it is a very interesting scientific problem with a lot of space for creativity.

Agustín Lage: The tasks facing Cuban public health has no recipes. A critical interpretation of published literature must be made, make our own strategies and that is the management of knowledge and all this knowledge requires a wide range level of cultural viewpoint on the subject. This implies that the 11 million Cubans are not only doctors in sciences that involve an element of circulation of precise knowledge in society that is a science in itself. For example, what is the most important variable in the prediction of infant mortality, according to an international study? The educational level of women. If only one thing can be done to reduce infant mortality give education to the mothers. A determinant of a biologic phenomenon depends on a social and cultural determinant.

Alina Pérez: Do you think that knowledge is an alternative for the economic development of Cuba?

Agustín Lage: You can open furrows with a stick and make a great effort such as any industrial worker and you will obtain very little, because you are doing an activity that requires very little knowledge; the content of knowledge of human activity is what gives it added value.

Economic development in Cuba today is not based on producing more but giving value to human activity since we don’t have natural resources like other countries.

We need to leave the production of services of high added value; we cannot base our development on oil or gas nor in domestic demand like the Chinese do. They are one billion inhabitants and can place a factory anywhere that national demand pulls development.

If we cannot base our development either on natural resources or domestic demand we have to base it on science and technology. That is our lever. That is why it is important to understand that scientific and technological development in Cuba is not a luxury but a necessity for survival.

In this sense the tasks of public health have no recipes. We Cubans must pave our own road.

Alina Pérez: How does Cuban society participate in scientific and technological development?

Agustín Lage: Technical and scientific development is a social event. We must convert it into culture and the only way of doing it is with the participation of people. We must convert science and technology into culture and for this the process must be massive.

Alina Pérez: What are your expectations as for the control of cancer in Cuba?

Agustín Lage: Cancer in Cuba must be reduced although as the first cause of death in the foreseeable future.

We have been unable to move the mortality curve of malignant neoplasia. There is a balance of contrasting forces; on the one hand treatments are increasingly more effective; habits of the population improve; there is a tendency towards a more balanced nutrition; smoking habits have reduced but, at the same time, there are more people above 60 years of age. Then the efficiency of health interventions are countered with the evolution of the demographic situation and the result is that we do not reduce the absolute number of patients.

There are measures being taken such as improvement of early diagnosis of cervix-uterine cancer with surprising results; that is the reason for the importance of a scientific focus in the actions that should have an effect in a few years.

Death by cancer is sensitive to preventive measures but, for example, death by hear diseases is much more. There is a reduction of smoking habits but 10 years are required to reduce the incidence of lung cancer, one of the most frequent.

It has not been possible to reduce cancer since the demographic profile of the country moves to population aging. Efficient measures of health are required and, above all, lead to changes in the style of life that, I believe, is the main factor for the prevention of cancer.

Alina Pérez: What role does social communication have on the prevention of cancer in Cuba?

Agustín Lage: I’ll give you two tasks because you journalists have a very important responsibility together with the medical here.

Prevention is the modification of behaviors and changes in life style. The people believe that to change the conduct is enough so long as you give information and it is not enough. Human conduct is not one hundred percent rational. It is not enough to explain to a person that smoking is bad for their health, as a rational being they should stop smoking. The answer is no, they are not going to stop smoking. It is not enough to offer information; required is actions of many resources of communication, from the use of images to participation of leaders of opinion to modify behaviors.

I believe that the public announcement that Fidel Castro stopped smoking probably had more impact on Cuban smokers than if they had read a book on the risks of smoking. Building referents begins forming models of acting.

Also it is important to work on strategies of social communication that is not merely informing. In forming is not putting the truth to paper but it not the same a guaranteeing that they will be assumed by the conscience of the people. These are two different things. The manner of making social communication depends on the culture. A way has to be found to do it attending to cultural conditions in each context.

Alina Pérez: What to do regarding scientific speculations about cancer in the mass media?

Agustín Lage: The mass media has the power to do good and bad. It depends on the capacity of the people and their culture to critically read the contents; that is why it is so important to develop it.

A critical thought that studies things, that is not entrapped by superstition and superficialities that these reflexive thoughts must build; it is a conquest of culture. It is not delivering a class for that, it is a cultural development in life. We have a population with an interpretive capacity to understand scientific achievements; we can make public health much more efficient than what we have now.

Alina Pérez: Do you agree that poor scientific information is the element that delays evolution of a society of information to a society of knowledge?

Agustín Lage: There is a large amount of information being published but often without quality. I like the phrase of Richard Lewis, a U.S. sociologist when he says: “An excess of irrelevant information is a form of ignorance”. Ignoring is not only ignoring things but being crushed by irrelevant information

The society of information cannot replace knowledge, knowledge is information interpreted. That is why we have to educate people in the interpretation of information.

Alina Pérez: What would you recommend to the scientific communicators and the editorial staff of a journal such as Salud Vida?

Agustín Lage: Induce people to debate about health, to find a way for 5,6,7 people to discuss; each giving their opinion and not do a program with only one source. It is important that people have access to several sources of information and than an atmosphere of debate be generated.

On the other hand, information of itself is not knowledge. As I told you, it is necessary to help interpret data. For this I would invite journalists to come to scientific events, participating in discussion spaces and scientific analyses so they can learn and share it with the public. We should not fear this. Scientific though is a form of thought and so that way of thinking can be acquired by anyone.

In the 70s I said I wanted a Bohemia of science, of low cost, that the people could by in the newsstands and where the great Cuban scientist could write articles; to take this information to everyone. This is the kind of informative operation that we need to develop science and technology.

Alina Pérez: Salud Vida has that objective. We hope to comply with this sense of your expectations and also of the public.

Thank you much for granting this interview.

Translated by the Network in Defense of Humanity

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