Ricky, you don't want to admit it but I think you've been had. Cuba sure isn't Saudi Arabia, but quite frankly, I thought you were smarter than that. I really did. As much as we butt heads on Redscape I at least thought you would have the good sense to know when you're being played like a fiddle. From what I understand here, the Cuban Government shows tourists the Cuba they want to show the tourists. Else those Canadian dollars stop rolling in.

However, I am not entirely surprised that you have started yet another of your famous "article fights" to wriggle your way out of answering the actual question. Epidermology? Are you serious? Come back to us when you have some evidence that doesn't amount to your typical academic rehashing. And take into account that even "smart people" with a PhD or an MD can be dead wrong at times. You have this tendency to trust anything that comes from anybody with a PhD (if they already agree with you). You went to college, right? Did they not teach you the difference between first and second-hand sources?

Again, as for Cuba being a less closed society with a higher standard of living than us gullible Americans think (gullibility is quite a common disease here on Redscape, but if we want to cure it a Cuban hospital probably isn't the best place for it), perhaps you should ask Amnesty International or the Human Rights Watch, instead of a journal of Epidermology.

Oh shit I should not have said that. Get me my umbrella, it's about to rain political journals! (probably from equally-misinformed authors).

Here's a blog from a second year medical student from Canada.

You're slipping, Ricky: your tertiary sources you like to throw in our faces are usually PhD's with tenure....

My personal experience is limited to having a Cuban doctor visit a member of my diving group at our hotel on isle of Pines when she became ill.

Did you not understand our point above? Did it not occur to you that the doctor they sent you is the kind of doctor they wanted a Canadian to see? If you were a typical Cuban, you may not have gotten such preferential treatment (or perhaps any treatment at all).

Here is the Wikipedia entry.

http://en.m.wikipedia.org/wiki/Health_care_in_Cuba

The article cites proponents of both sides of the issue, but one study that praised Cuba's health care system also noted severe problems. In opposition , Dr. Hirschfeld's view (based on spending 9 months in Cuba) appears to document typical problems in Communist states with quotas set for health care results and interference by the government in health care, manipulation of infant mortality rates, and inability of foreign researchers to document empirically results claimed by the government.
It just does not add up--it does not make sense that Cuba would have extraordinary health care results when their facilities are substandard , drugs are scarce, basic supplies are scarce, and they're essentially selling its doctors to other countries for hard currency. Why on earth would we want to replicate such a system even if somehow it is delivering these great results (and that is questionable because it really does not make much sense)?

Please note that I am for single-payer health care in the US. Socialized medicine appears to be the most efficient way to provide health-care in wealthy countries. But Communist medicine...no. Even if the trains run on time under a totalitarian state...we need to find another way of making the trains run on time.

Well Freeman, I'm not suggesting that Cuba's health care system serve as a blue print. My original comment that precipitated this debate was ...

Cubans do not live in squalor. I've seen how they live first hand, and the world press have shown much of what life is like in Cuba. Its a helluva lot nicer than the 4 "banana republics". (Have you travelled anywhere?)
The children all read and write, and no one is hungry. Health care is free and of a high quality.

At which point Hacker interjected with a request for anecdotal information which he feels trumps genuine sources of information.
Hacker

Wow that's interesting. But have you ever gone to Cuba and broken your leg or contracted a disease of some sort?

Freeman3

It just does not add up--it does not make sense that Cuba would have extraordinary health care results when their facilities are substandard

You say this is counter intuitive? Isn't it also counter intuitive to know that the US health care system is the most expensive in the world and has such poor outcomes relative to much more efficient but less costly systems?
I think the most important thing about the Cuban results is understanding how much can be done with so little money...

Having read the criticisms most are about the inefficiencies of the communist system, and the negative effects of the US economic embargo. And the criticism of the use of abortion to reduce infant mortality rates, because high risk pregnancies are not allowed to come to term. This does seem harsh, but if you have very reduced resources, should they be spent on very unlikely cases? This seems like a form of triage, albeit a troubling sort.
And I think the point i want to make is best made in your link by a source that is admittedly one of the most quoted and relied upon by in the United States.

The Kaiser Family Foundation, a non-governmental organization that evaluated Cuba’s healthcare system in 2000-1 described Cuba as "a shining example of the power of public health to transform the health of an entire country by a commitment to prevention and by careful management of its medical resources"

freeman3

Socialized medicine appears to be the most efficient way to provide health-care in wealthy countries. But Communist medicine...no. Even if the trains run on time under a totalitarian state...we need to find another way of making the trains run on time

I agree with you. All i was doing was pointing out to those with a black and white view of the world that even communism has been able to improve the lives of citizens in states like Cuba in some areas. And health care is one of them. (Education the other.)
Moving away from communism without tossing out the lessons learned in running an efficient, results oriented system on a shoe string will be the challenge Cuba has in the future.
However, professing that there are no lessons to be learned, just because they are Communists, is a willfully obtuse and dumb. (I'm not accusing you of that attitude Freeman. That's the attitude that i was orginally responding towards.)

hacker

Epidermology? Are you serious? Come back to us when you have some evidence that doesn't amount to your typical academic rehashing

It's epidemiology.

If i want informed opinion and useful data on Human Rights I'll go to Human rights Watch or Amnesty International. (Although as has been shown elsewhere on this board, at least HRW is a somewhat fllawed group) If I want expert opinion and reliable data on public health I'll still go to places like the International Journal of Epidemiology, the Kaiser Health Institute and WHO.

If you wish dismiss "book larning" and "experts" there isn't a reasoned argument to be had with you.

I was struck by Freeman's link that details that Cuba's infant mortality and life expectancies are better than those of the US. Is that true?

Well,RJ, it's true ...if it's true. But we're talking about a totalitarian state where health care stats are vital to the perceived success of the state--so I'm not certain these statistics are trustworthy, particularly when the explanations (Preventive care, a lot of doctors) seem insufficient given the lack of medical supplies , drugs and poor facilities and a poor population probably barely getting enough to eat.

For example, there are quotas to be met with regard to infant mortality...just like Soviet five year plans....quotas tend to be met in Communist states.

I'm new to the board and I don't have much to say on this topic, but I felt I needed to address this post on the validity of the International Journal of Epidemiology.

JimHackerMP wrote:However, I am not entirely surprised that you have started yet another of your famous "article fights" to wriggle your way out of answering the actual question. Epidermology? Are you serious? Come back to us when you have some evidence that doesn't amount to your typical academic rehashing. And take into account that even "smart people" with a PhD or an MD can be dead wrong at times. You have this tendency to trust anything that comes from anybody with a PhD (if they already agree with you).

I can understand criticizing a lot of academic journals that aren't very reputable, but this is one of the top medical journals in the world. It has an impact factor of 9.197, is published by Oxford (which has high standards), and is ranked the top epidemiology journal in the world.

What does impact factor mean? It is the most trusted academic journal ranking system in the world. Having the highest impact factor in the epidemiology field means that this journal is the MOST cited journal in epidemiology. In addition, it means this journal has more article submissions than most other epidemiology journals, making it one of the hardest to publish in. It is peer-reviewed, meaning that before publication at least three other experts in the field review the article before publication and make sure it's not only accurate, but also important enough to beat out dozens (if not hundreds) of other articles. If you've ever had anything peer reviewed, you'll know that peer reviewers are extremely harsh and generally rip apart any illogical reasoning or shoddy data, so whatever passes through them is high quality.

As for your comment on tenure, most tenured professors are top quality experts in their field and continue to be very engaged in their research. It is true that some tenured professors (a tiny minority) do slack off, but this is because they don't publish at all!! Not because they publish shoddy work. It is almost impossible to publish shoddy work in a journal as highly ranked as the International Journal of Epidemiology whether you're tenured or not.

I agree with you that a lot of "smart people" can be wrong, but in general, when I go to heart surgery, I trust the MD more than JimHackerMP. Similarly, when it comes to medicine in Cuba, I trust the medical experts who publish in the highest ranked journal. If you want to dispute something written by an expert in a field and reviewed by other experts in that field, then show real evidence that they're wrong, not your personal opinion of academia.

First of all, this is interesting stuff about peer-reviewed articles.
For purposes of the discussion, the authors don't really submit any data, themselves. They examine the data about the Cuban health care system and assert that some of its lessons can be applied elsewhere. In reading the article I note that they find that Cuba has had success against infectious diseases, has a good doctor to patient ratio (with an emphasis on primary doctors serving local neighborhoods), and good response times for treating heart attack patients. But they also note Cuba's lack of success against smoking, which given the large reduction of life expectancy due to smoking would go against increased life expectancy figures.
The authors of the study are two doctors from America and one from Cuba. It's a bit curious to me why a Cuban scientist would be needed for the article, particularly since it is essentially a puff piece for Cuban medicine. There is no indication that the US doctors even visited the island, talked to Cuban doctors, or talked to Cuban patients. The article relies on Cuban statistics and say they have been reviewed and that there is no evidence that they have been tampered with. But the article does not put any evidence of how this assessment was made (they say there are no discontinuities or smoothing, etc). Other than that, there is no indication of the statistical analysis done to try and ensure the accuracy of this data review. I am not sure how a peer review could assess this since no data regarding the assessment was provided. Did they really number crunch data since 1970 to try and ensure the data was good? The authors cite to the raw data but they don't provide any evidence as to the statistical analysis they made of the data. Given that such analysis is the whole ballgame that's troubling. I would expect tables and charts with probabilities of the data being accurate. I did not see anything.

Still, rather than just suppose that Cuban statistics must be suspect because they come via the Cuban state, how about someone actually substantiate it? I did see a link to a book claiming that Cuban stats were (perhaps no longer are) more reliable than Soviet ones based on noting that they don't just record successes: https://books.google.co.uk/books?id=LPP ... cs&f=false

Or we agree to move on, because it's actually a polarised debate on which no-one is likely to move much, and any 'evidence' either way will be treated with automatic suspicion.

I can't speak to how good the Cuban healthcare system is, as I was not unfortunate enough to need it. I did get a dodgy tummy from some lamb I ate that meant I had to find and buy a generic pepto-bismol, which was easy near the Havana Hilton. But that's no different to finding a pharmacy in or near a big city hotel anywhere else, and meaningless as any more than anecdote.

I can believe though that it is good compared to Caribbean nations and that it's not as good as claimed when compared to Western systems, but with varying degrees of difference, and some measures by which they may indeed be better.

I agree to most of this though I tend to doubt Cuba is better than advanced western systems in any means of delivering care. Best in the Caribbean? Likely.

@ danivon

thanks for moving the discussion forward! I think you're right that we won't get very far and to a certain extent some posters have been talking past each other. The journal article doesn't claim that Cuban system is necessarily applicable to the US system, only to low and middle-income countries.

@ freeman3

Thanks for addressing the data in the article. I won't argue with you on whether Cuban data is the most reliable or not, which I don't think will get us anywhere. I think the authors make good arguments, though, that the data is more accurate than most of what we get from other Caribbean and African countries.

I'll second that it's probably the best in the Caribbean and I think that's enough to say there are some lessons to be learned for how poorer countries can improve their healthcare systems.

freeman3 wrote:I agree to most of this though I tend to doubt Cuba is better than advanced western systems in any means of delivering care. Best in the Caribbean? Likely.

Well, if people have avoided getting care in the US because of insurance issues, but can get the same in Cuba easily, would that not count? Obviously it may not he as accessible as some European countries, and perhaps Obamacare has altered that somewhat, but it is at least a possibility?

freeman

But they also note Cuba's lack of success against smoking, which given the large reduction of life expectancy due to smoking would go against increased life expectancy figures

.
You shouldn't make assumptions, without checking the credibility of the assumption.
Japan has the highest life expectancy in the world, and one of the the highest smoking participation rates for men.

http://www.ncbi.nlm.nih.gov/pubmed/17420610

Very well, allow me to explain.

I can understand criticizing a lot of academic journals that aren't very reputable, but this is one of the top medical journals in the world. It has an impact factor of 9.197, is published by Oxford (which has high standards), and is ranked the top epidemiology journal in the world.

OK I understand. As you tend, Ricky, to misspell a lot of things in your posts and, on occasion, avoid punctuation entirely, I thought you meant a doctor with a slightly different field than that. If you are using Firefox, my advice is to turn on the function that shows the red squiggly lines where something is or could be misspelled.

Now, Danivon:

Or we agree to move on, because it's actually a polarised debate on which no-one is likely to move much, and any 'evidence' either way will be treated with automatic suspicion.

Well, the thing is that when I post sources of my own, or even raw data (and cite exactly where it came from, direct links and all) it is equally dismissed by certain members because the Redscapers reading it have already made up their minds. And that's how we end up in a "source fight". At the end of the day, some of these sources have either been indirect rehashing of others' rehashing, or so indirect that they are little better than "anecdotes" themselves. Has anybody but me noticed that?

I can understand criticizing a lot of academic journals that aren't very reputable, but this is one of the top medical journals in the world. It has an impact factor of 9.197, is published by Oxford (which has high standards), and is ranked the top epidemiology journal in the world.

In which case I would gladly take it in. But the fact of the matter is, we're all equally vulnerable to misinformation, no matter where it originates. Anyone who thinks he is the one in the room most capable of seeing through the bull**** is probably the most full of it himself.

I do not prefer "anecdotal" information to "sources"; I'm simply used to the sources which have been employed in recent posts to being no better than anecdotal evidence themselves, as I just stated. If I get a little anecdotal myself, I've at least usually backed it up in the past by some sort of reference. My own preference is for sources of hard data. I realize in a case such as an article from a medical journal that's rather a tall order, as raw medical data would go over the heads of anyone who isn't a medical doctor (MD that is) myself included. Which, by the way, begs the question: how many of you are medical doctors? And isn't that article intended to be read more or less by other doctors, as opposed to "laymen"? And would the current education or carer path of someone reading the article (are they a medical doctor or not) therefore affect that person's interpretation of that article? I think those questions are perfectly valid, don't you?

Ricky, you have used anecdotal information yourself: your explanation of how great the Cuban medical response was to your diving team's accident or whatever. That was an anecdote meant to "prove" it, wasn't it? I am not implying you're wrong (even though I said I "suspect" you've been "had") but I believe my reply was particularly valid: that some governments on this Earth do precisely that, make it "look good" for the tourists, to keep the Canadian dollars (and Euros, Swiss francs, whatever) rolling in. So forgive me for my (obviously wrong) assumption that the journal's article was irrelevant. Mea culpa.

STILL, however, I'd like to see something from Human Rights Watch or Amnesty International. Or, even better, Doctors Without Borders might (this is an assumption on the latter) might give a decent report. But as the expression goes, "Be careful what you wish for."

I agree with you that a lot of "smart people" can be wrong, but in general, when I go to heart surgery, I trust the MD more than JimHackerMP. Similarly, when it comes to medicine in Cuba, I trust the medical experts who publish in the highest ranked journal. If you want to dispute something written by an expert in a field and reviewed by other experts in that field, then show real evidence that they're wrong, not your personal opinion of academia.

Touche. And rest assured I will not be doing heart surgery on you, even just as a joke if you passed out. But personally, should I need heart surgery, I'd still rather get it done at GBMC or Johns Hopkins, than at a hospital in Havana. I'll delve deeper into the report anyway. If I do not understand it in its entirety well, I'll admit that. But then again, see my question above, (is there a doctor in the house? even one?)

Do forgive me for being of the opinion that "smart people", people with doctorates, or professors with tenure, deserve a healthy dose of skepticism as much as someone not fitting the aforementioned categories. Around here it's less a "healthy dose" and more of an "overdose". Personally I have changed my opinion on things and find Redscape better than other message boards/blogs/etc with which the internet abounds. But we are all fallible. Personally I feel there are some people who are "thintelligent" instead of "intelligent" in the general public, and many of them have letters before or after their names. But forgive me if I dared to feel skepticism towards the latter, in an effort to avoid the former.

As far as my personal opinion of academia, you misunderstand me. I do not have a negative opinion of academia, people with doctorates or professors with tenure.

In this very thread, it seems that I am *not* the only member to have presented a dose of skepticism toward the conditions in which Cubans live being as high as you have presented, Ricky. Which, by the way, you used anecdotes to "prove". Stuff you saw with your own eyes; but again, it at least seems like you were keeping your eyes open to the obvious, when even that source of stimuli would have benefited from a healthy dose of skepticism itself.

If you wish dismiss "book larning" and "experts" there isn't a reasoned argument to be had with you.

I do not wish to dismiss either. See above. I like reasoned arguments, and that's probably because I'm used to there being, here and there on Redscape, arguments to which the word "reasoned" is less applicable. I'm sorry if I was *too* skeptical, or ended up being skeptical of the wrong thing, but do you understand what I'm trying to say here? If not, I can clarify if you'll permit me the anecdote.

By the way, how did this thread become about Cuban health care, when it began---if I understand correctly---as one intended to discuss the merits/demerits of the recent U.S. policy change toward Cuba? Not saying we do not have the freedom to digress as we see fit, but I've noticed, lately, we get wildly off topic...