Chapter 31: Contributions to International Policy Issues

Chapter 31: Contributions to International Policy Issues

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Description

Dr. Hortobagyi begins this chapter on his work with international organizations by explaining why he has such firm professional connections in Hungary and Europe as well as in North and South America, and Latin America. He then talks about the Breast Health Global Initiative (which he co-founded) and a major project: developing guidelines for the treatment of breast cancer, taking into account the realistic availability of resources. Dr. Hortobagyi explains, for example, that in some areas of Africa, a physician may perform a mastectomy as a diagnostic procedure, and the samples must be sent to far-off labs for study, with results coming back after six months. Dr. Hortobagyi explains how the BHGI set about creating guidelines for minimal levels of care for breast cancer where possibility for care is extremely limited. Methods include using physician extenders as well as training women from the local community to give care. The Initiative has also developed research projects to study how to implement the guidelines. Guidelines were developed, discussed, published, and then republished in three different versions after more public discussion. Dr. Hortobagyi describes how fascinating it has been to participate in this project and he hopes it will force governments to rethink their obligations to their populations.

Identifier

HortobagyiGN_05_20130315_C31

Publication Date

3-15-2013

Publisher

The Making Cancer History® Voices Oral History Collection, The University of Texas MD Anderson Cancer Center

City

Houston, Texas

Topics Covered

The Interview Subject's Story - Professional Service beyond MD Anderson; Contributions Activities Outside Institution Global Issues –Cancer, Health, Medicine Professional Practice The Professional at Work Understanding Cancer, the History of Science, Cancer Research The History of Health Care, Patient Care Patients, Treatment, Survivors

Creative Commons License

Creative Commons Attribution-Noncommercial-No Derivative Works 3.0 License
This work is licensed under a Creative Commons Attribution-Noncommercial-No Derivative Works 3.0 License.

Disciplines

History of Science, Technology, and Medicine | Oncology | Oral History

Transcript



I wanted to ask you. You had mentioned at one point that your international work was very, very important to you, and I'm wondering if you would talk a bit about that. I'm curious if that dovetails with some of these policy interests you were mentioning as well.

Gabriel Hortobagyi, MD:

Well, that’s sort of another aspect of my schizophrenic life or mind. We talked about the fact that I spent my earlier years in Hungary. Of course, I maintained or developed a number of professional relationships in Hungary and throughout Europe over the years—over the last few decades. So many of the European oncologists consider me as European. All right? So, I'm very frequently invited as a guest speaker, as a visiting professor, as a coordinator or chair of meetings and sessions, as a co-leader of international studies in oncology, and so on. Then I spent another part of my youth in South America, and because of my languages, the South Americans or the Hispanics throughout the world also consider me as part of them. So, I have the same relationships with them. And of course, part of that means that I frequently get called about could you come as a consultant to the Ministry of Health or to such-and-such campaign, or could you help us develop guidelines for our country or whatnot. So over the years, in addition to my work in North America and my involvement in a number of organizations within this country and Canada, I have had similar involvements—mostly at the level of policy but also at level of education and research—in Europe and in Latin America. I have some other activities in Asia, but they are less prominent there and less involved. So as a result of that I am very familiar with what is going on in that part of the world—so Europe, North and South America. And then you start to work with organizations such as the WHO, the UICC, UNESCO, so on and so forth, and then you meet people from less privileged areas of the word—Africa, Southern Asia, et cetera.

Tacey Ann Rosolowski, PhD:

So then two different things happened almost as an outgrowth of that, and we talked about the development of the Charter of Paris in one of our sessions and about the rights of patients with cancer and the hope to influence policy in a variety of regions around the world to enhance the level of care for patients with cancer without necessarily a direct intervention, hands on. Then from a different perspective, I was one of the founders of what has come to be called the Breast Health Global Initiative. And we did that initially with the support of the Komen Foundation and with a dear colleague and friend, Ben Anderson, who is a surgeon from the University of Washington and the Hutchinson Cancer Center in Seattle. Our purpose was to develop this as a demonstration project and to bring together the constituencies to develop guidelines for treatment of breast cancer in various parts of world, taking into consideration the reality of the resources available in different parts.

Tacey Ann Rosolowski, PhD:

So when I'm invited as a guest speaker to—I don’t know—let's say India and they ask me to tell them about the state of the art of managing breast cancer. Well, I give them a science fiction presentation which would be pretty normal in Atlanta or in Chicago or in St. Louis or whatnot. But for India it is totally unattainable except for the very highest socioeconomic stratum because I talk about drugs that cost $100,000 per person per year, interventions, and machinery that costs a couple million dollars. And the healthcare budget of a country like India—which is not poor but of moderate resources dedicated to healthcare—and it's a fraction of what we spend in this country. So we realized that it was unrealistic for us to do this, and we were not doing a service to anyone except perhaps the fantasies of the physicians and scientists who were listening to us and who were dreaming about maybe one day we can do this. So we brought together a large group of individuals from different parts of the world—most of them representatives of something—either a professional organization or an international agency or a political decision-making organization that influenced healthcare, et cetera. So we brought together about fifty different people and set ourselves the task of dividing the world into three layers based on socioeconomic considerations, and for that we used essentially the WHO's classification of countries of limited, moderate, and high resources. Then based on the expenditures per capita for providing healthcare in each of those regions or groups of countries, we set out to create guidelines as to what would be a realistic minimum level of care for someone with breast cancer. How do you diagnose? How do you treat locally? How do you—what is the minimum you should be able to do as a society to really be able to claim that you provide breast cancer care services to your community?

Tacey Ann Rosolowski, PhD:

After a series of discussions and whatnot, we came out with some guidelines which were published in the periodical literature and broadly distributed throughout the world to governments and eventually have been adopted by a number of organizations. We have had three successive editions of this. In the process we continue to raise funds to try to maintain this organization—on a shoestring, by the way—and also to develop the type of research that nobody else does, which is to develop pilot projects of implementing these guidelines. So are there cost-effective—truly cost-effective methods for diagnosis in a country that doesn't even have a single pathologist? How would you deal with the situation like in some African countries where if you have a lump in the breast, the diagnostic procedure is that if you go to a surgeon, he'll do a mastectomy as a diagnostic procedure and send the breast on ice to the next country where a pathologist will eventually see it, and you’ll get a pathology report back six months to a year later. So we have now about eight or ten of these pilot projects—some of them associating a prosperous institution with a very poor institution in a target country—developing new diagnostic processes that are cheap where individuals who don't necessarily have a medical degree can be trained to do this well and hopefully try to disseminate that. And if successful we might be able to do that on a larger scale.

Tacey Ann Rosolowski, PhD:

We are trying to develop healthcare extenders—so screening not with mammography but simply with physical examination for earlier diagnosis of breast cancer—and we are trying to educate and train women from the local communities in a country to try to supply workforce where it doesn't exist or there are no physicians for hundreds of miles around. Similarly, there are a number of other proposals and projects, and it has been fascinating to develop this. While it is not satisfying to settle for the minimum you can do, we hope that at least it will force governments who feel that it is more important to spend their money on F-16s and B-1 bombers and AK-47s than on the healthcare of their population—it forces them to rethink that they have some obligations to their population. So we are disseminating this not only through the government—because the governments that are guilty of such an approach, of course, will not disseminate this—but also through professional societies: UNESCO, WHO, UICC, and so on. So we hope that this will start to have an effect, and both Ben and I are pretty passionate about that. When I talk about breast cancer in the US, we talk about the tragedy of 230,000 women developing breast cancer and 40,000 of them dying. But the reality of breast cancer is that around the world there will be 1.6 billion breast cancers this year and probably close to 600,000 will die of breast cancer. So compared to that, 40,000 is peanuts. Not to take anything away from the tragedy of the 40,000 dying, but this is a much bigger problem than our provincial problem within the US. So that's the type of issue that I'm very much interested in and hope to have some impact on.

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Chapter 31: Contributions to International Policy Issues

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