Multidisciplined ResearchersSat, 09/05/2015 - 13:54
Q: You have been involved with this institute for the past 22 years and directed it since 2007. What have been your greatest achievements during this time?
A: When I began working at INNN, my personal goal was to become an active participant of the institute’s research system and the National Coordinating Commission of the National Institutes of Health and High Specialty Hospitals (CCINSHAE) in order to continue my trajectory within the National Research System (SNI). This research eventually led to the creation of the INNN’s clinic for multiple sclerosis as, at the time, we noticed a rise in the number of patients suffering from this disease both in Mexico and in Latin America. Later, I was appointed Director General of INNN by its board. The objective of this clinic is to provide appropriate care to patients through a multidisciplinary approach including rehabilitation, support groups, and neuropsichiatry. I also established several research lines such as neurocysticercosis, an extremely common disease in our country and currently, our clinical laboratory for neurodegenerative diseases is expanding its research lines to include Parkinson’s disease, and dementia, among others. In addition, having worked in the Education Division. We manage to standardize all the specialties in the institute to assimilate UNAM Faculty of Medicine’s post-graduate studies and now we are incorporated as part of this campus. We have created 31 different post-graduate programs besides our specialties, including a nationally recognized specialty in neurology created in collaboration with CONACYT. This division has grown enormously and it is still growing. INNN’s greatest strength and advantage is that we can cater to all specialties related to neurological sciences, including clinical, biomedical, and even sociomedical. Our students are able to develop a multidisciplinary and integral approach to neurology. We also have courses on neurogenetics, neurochemistry, and neurophysiology, as well as laboratories on inflammation, neuroimmunoendocrinology, and immunology, among others.
Q: What is the cause of for the increase in multiple sclerosis?
A: There is no specific reason at the moment, but we believe it to be a genetic problem. Mexicans are a mixed race with genetic material from many sources. We have perceived that Mediterranean genes experience a susceptibility to this disease, while Amerindian genes seem to confer certain protection. We are still studying different origins according to the subtypes of multiple sclerosis in Mexico, which is the result of cumulative efforts over many years including research on an endogamous community in the Lacandon Jungle, where this phenomenon appears to be nonexistent. The reason for this may be that this population’s genes are purely Amerindian, or may be influenced by epigenetic factors such as the surrounding environment. This population also frequently suffers from intestinal infections and there is a hypothesis that suggests that infections of this type confer certain protection from other immune diseases, such as multiple sclerosis. There are new medicines being developed to treat this disease, the only problem is that they are too expensive for the majority of the Mexican population.
Q: What are the main challenges that the institution is facing nowadays?
A: The institute provides medical attention to individuals who do not have social security of any kind, but we also receive patients with social security who desire to be treated at the National Institutes of Health. We have a scale of six different ways to reimburse treatment costs. Out of our entire patient base, 85% belong to the first three possibilities, which means that they are able to cover less than 15% of the real cost. The INNN must provide high quality treatments and care for all patients without taking into account their economic means. While our mission is to provide quality care, all National Institutes of Health were created for scientific research, distinguishing us from other health institutions. INNN has one of the highest research levels in proportion to its number of researchers, as we have the greatest amount of members of the SNI due to the high number of research topics on the central nervous system. Both Europe and the US have declared 2015 the Year of the Brain, with the aim of educating society and improve care for chronic non-communicable diseases related to the brain. As the country is facing an epidemiologic shift, the INNN is facing a demographic transition, meaning we must re-evaluate and innovate our schemes. The average age of our researchers is between 40 and 50 years old, so we expect an extremely bright future with young researchers that are producing promising research and will continue to do so for the next ten to 15 years.
Q: Are you receiving patients from Seguro Popular? What other collaborations does the institute have?
A: Recently, Seguro Popular replaced our molecular imaging unit and agreed to replace our linear accelerator for radioneurosurgery which is extremely expensive but will benefit a large number of patients. This linear accelerator will allow us to provide non-invasive treatments for brain tumors and other neurological diseases. At this point we receive patients aged under 18 from Seguro Popular who require treatment for brain tumors, and we hope to expand access to adults in the near future. Our institute does not treat children but we are collaborating with the National Institute of Pediatrics when needed. We are now installing a state-of- the-art NMR spectrometer funded in part by the Fundación Gonzalo Río Arronte – which has greatly supported us over the years – with the other half of the funds donated by Beneficencia Pública. One of our main goals is to keep the institute at the forefront of treatments and medical devices.
Q: Mexico is currently facing a lack of specialists in many areas – is this the case for the INNN?
A: This is a serious problem but while we may need more data on this topic, we have perceived a small lack of specialists in neurosciences. The main problem is not the absence of specialists but the fact that those with specialized skills are concentrated in Mexico City, Guadalajara, and Monterrey. There is a High-Specialty Hospital in Tapachula, Chiapas, which has excellent resources and equipment but few doctors wish to relocate to this area. Rural areas lack private hospitals and clinics, so physicians are unable to earn competitive salaries, which reduces interest in those regions. On the other hand, hospitals in Mexico City have many specialists that strong competition exists for every single job.
In my opinion there are enough neurologists to combat these diseases yet science has become extremely reductionist, with specialists for each disease, including multiple sclerosis, amyotrophic lateral sclerosis, dementia, and cerebrovascular diseases. Since the field has become reductionist, the general sentiment seems to exist that there are not enough specialists even though qualified neurologist is not necessary to diagnose any of these diseases. Specialists are often necessary to make a precise diagnosis or special treatments but this is not always the case.
Mexico is undergoing an ‘incomplete’ epidemiologic transition and demographic shift: because we are still facing infectious diseases, as well as maternal and infant health problems, common to developing countries, but we are also facing illnesses typically associated with developed countries such as dementia and Parkinson’s.
Q: What would you suggest to tackle the problems arising out of the shifting epidemiological profile?
A: At this point, the health sector must focus on prevention and improve access to healthcare. It is well-known that several factors influence the development of cerebrovascular diseases, all of which are related to obesity and the lack of physical and mental activity. The Ministry of Health is currently implementing several prevention campaigns and removing unhealthy food from schools, but these strategies should be continued and expanded. The Mexican population must become aware of the correct strategies to prevent these diseases, which include changing their eating habits and increasing physical activity. Nowadays there are good programs to promote healthy habits to school children which is an essential step to preserving the health of the Mexican population. Within the institute we are providing programs to prevent these diseases including one that offers continuous education for physicians in order to help them provide external consultations to prevent diabetes, obesity, and hypertension. We also have various programs in other areas, including 14 support groups for several diseases, one of which is for families of patients with dementia to help them manage the constant stress and violence they face.
Q: How are you collaborating with other institutions to extend your research?
A: The regulations of the National Institutes of Health restrict us from providing several services. Currently, the external resources we get are related to our research areas and come mostly from CONACYT and some private companies or foundations. On the other hand, we are able to provide some services like the Positron Emission Tomography (PET) scans, which are much less expensive in the INNN than through a private institution. Providing external services is not prohibited by current regulations, but these modifications aim to increase the services available for private hospitals and create agreements with private insurers to increase availability of funds. On the other hand, every institute is able to provide different services for the private sector, for example the National Institute of Public Health performs surveys for private companies. This topic is still under evaluation, and while we at the INNN have been slightly more restricted, there are projects that we are interested in developing including biomedical markers for some diseases.
Q: What are your priorities for 2015?
A: This year we want to finish the construction of the new linear accelerator and NMR spectroscopy units, and some of our newest infrastructure. We also plan to develop our research areas and improve the quality of our services. Last year, INNN celebrated its 50th anniversary and our goal is to continue growing in research, education, and care.