Patricio González is from Mexico and represents the Mexican Association for the Fight Against Cancer. The idea is to share and help all the people who need it and need information that we have in our organization and in our country.
Interview with Patricio
I am Patricio González I am from Mexico, I work in the Mexican Association for the Fight against Cancer and the idea is to share with you and all the people who require and need it, all the information we have in the association and in our country, thank you very much by the invitation Felipe.
Felipe: The idea is that we go interviewing everyone and then we are going to make work teams, we go to 3 countries and we are going to talk, because the experience of one serves for others. Because the idea is that we can generate this communication and that we are seeing, most of us know each other and have to learn from all of us. Bolivia is joining our network and one of the countries that I love to know, how is the quarantine there?
Patricio: Look, the situation is very complicated here, I think that for each country, right now that we are at home for us, fortunately personally I have been able to do it without any problem because in the association they sent us to work at home and here we are and the situation in Mexico is complicated because there are many people who continue to go out on the streets without need, we are all looking for daily bread, my children are still working, but apparently from what they tell us in the news we have some control over this pandemic, we believe that there are not so many people who have been infected and we have almost 50 deaths in the country since this last month, apparently there are not many, but it is worrisome, the most worrisome are the social and personal issues that are causing the loss of employment and the way of subsistence of many.
Felipe: The world that comes after is probably going to be different. I think that these conversations that we were going to carry out in Costa Rica at our meeting, I think that it is generating a new form of communication that is somewhat more distant but in a certain way closer because seeing us is quite nice thought that we are on the other side of the world. Tell me about Mexico, do you have a presidential system?
Patricio: That’s right, it is a little complicated to talk about how our government works, they are issues in which sometimes as citizens we do not want to talk as much, we do it out of necessity, we have a Presidency, the new President is Manuel López Obrador, he is our president and we have a senate of the republic, a chamber of deputies. The President is the one who dictates the orders and more now he is exercising it in a complicated way for us as citizens, by the same act of the President. When he entered we had the promise that we were going to have something better in our country, we really do not have it and I focus on the people who need health care, we are all being affected, those promises they made to us, that we would to have coverage that everything was going to be free, the drugs that dared to say that we were going to be compared like Canada, the United Kingdom, because none of that has happened and we are getting worse every day, now with the contingency and pandemic everything has become more complicated. 30 days ago the situation for the cancer patient was even more complicated today because they are not receiving care. This unfortunately is leading to deaths of people is the saddest thing, the despair of people who do not know who to turn to, there are no organizations like our association like us that sometimes shake hands, but that we regret because we do not we can do what we want to do.
Felipe: Is there a law that protects cancer patients or is there no law?
Patricio: We have many laws like all countries, Mexico is enrolled in many agreements, sign any treaty to give support to the patient, that is very easy, but when we are going to do it, my rights as citizens sometimes happens to be left with nothing.
Felipe: You are attached to many international conventions such as human and cultural rights.
Patricio: Yes, we are enrolled, but the reality is different when the patient approaches the institution, he will not find even the doctor who can defend him there. When we sometimes go to institutions such as human rights, support is very close, in Mexico more than 50% do not have health care insurance that guarantees free treatment.
Felipe: That is important, how the health system works. Does it have a public system or do they have a private system or do they have several systems?
Patricio: It is almost like a German Monster, here we have private care, you only step a little less than 2% of people to insure medical expenses and we have several subsystems such as the Secretary of Health that attends and supports more than 50% we have the Institute Mexican Social Security who will have a little or more than 40%.
Felipe: Does that work as a Cancer Institute?
Patricio: No, it works as an institution for cancer care to any type of disease, this is paid by the worker when he enters a job, they are registered with the IMSS, they pay employer and individual fees and with that he and his family have access to medical care. And state workers give them similar protection to the IMSS, and oil industry workers also have their own health institute, and the military also has its own care facility.
Felipe: I understand that in Mexico there are states and they have their own governors
Patricio: Each State of the Republic has its own sub-health systems, but everything is very similar, each state has its health secretariat that has a certain autonomy although everything is governed by government orders.
Felipe: Is health in the constitution?
Felipe: Does your President last 6 years? Can you be reelected?
Patricio: No, until now you do not have that right, not constitutionally and hopefully it will not be done.
Felipe: You are 120 million inhabitants. Chile has 20 million, it must be tremendously complex to administer, the public system manages 25% of the population, 48% is private and 29% with different formats, armed forces, public and a lot of mixtures of systems.
Patricio: Yes, it is very complex.
Felipe: Fortunately The Max Foundation has about 603 patients with CML supporting patients and it is wonderful that it supports us and the support of all the countries of Latin America and that without them those 603 patients would be terribly abandoned. We did not know how many lmc oncologists are in Mexico
Patricio: I don’t have the data on the number of doctors, so I can assure you that the number is completely below what is necessary. In addition to that the majority are centralized in the Capital of the Republic and in the States where the specialty hospitals are located.
Felipe: I in Mexico City knew 3 large and beautiful hospitals but in Guadalajara I did not see any.
Patricio: Yes, there is in Guadalajara and very good, it is another city that has a good health system as well as Monterrey, which are one of the richest cities.
Felipe: The distribution of income is not the best, but neither do you have a GINI of 48.06%, it is poorly distributed with $ 10,000 percapita.
Patricio: Yes, talking about an income of $ 10,000 is incorrect, no, it is much less. I almost cut your call.
Felipe: Forgive me for these data, but the GINI says that we are very unequal in all these countries in America, where the richest 10% earn 70% of what the country earns, forgive me but it is the international data. Why don’t they have nilotinib?
Patricio: Yes we do.
Felipe: Those are the data that they bring to us and that may not be consistent with what you know; So they have Imatinib, Dasatinib, Nilotinib, from Imatinib if there is a copy? and there are 6 with ponatinib. But do bosutinib and asciminib have it?
Patricio: No, we don’t have bosutinib and asciminib.
Felipe: The bosutinib and asciminib are in other countries for humanitarian attention.
Patricio: No, not here in Mexico.
Felipe: How is the out-of-pocket expense, when you get a pcr, who pays for it? Patricio not only works for the foundation but is also patient.
Patricio: When it comes to my pcr, I am enrolled in IMSS, now I am already a pensioner, I have been a TMO transplant for 17 years, the critical situation forced me to retire, it is a very low pension, and my doctor asks that a laboratory pay my pcr and many patients are in this same situation, the doctor pleads for the laboratory to pay us and they agree; other people if you have to spend out of pocket that are like $ 250 the cost of a pcr, in others it can be 3 times more
Felipe: Since that is not regulated, there is no price scale, for example imatinib will charge you dearly and in other places it will charge you very cheaply.
Patricio: On the question of studies, yes, it happens, as we say in Mexico, depending on the toad, is the stone. Those with few resources go to cheap laboratories and what they have money goes to expensive laboratories. In medicines, prices are standardized, because pharmacy distributors have very little variation, between one cost and another it can be 5% different.
Felipe: And when we talk about the copies, is the price range low or close to the original?
Patricio: Notice that something very strange happens here, we only have a copy of imatinib, 2 years ago another copy came out that caused a lot of havoc in patients and was rejected, and now we have a Canadian copy and the cost is higher than the imatinib that we know of a lifetime and the others do not have copies.
Felipe: When a medicine arrives, is there an agency that reviews the quality?
Patricio: Yes, we have the drug regulatory agency. They are the ones who authorize the entry of a good regulation so no copies of these drugs have entered.
Felipe: Is there an institution in your country like the National Cancer Institute, a hospital where all cancers are centralized?
Patricio: No, if we have a law for the control of cancer that was recently approved by Congress, nevertheless it is beginning to have the data and in many cases these data are for blood oncological diseases, but all health systems have specific hospitals For the care of patients with hematological characteristics, I believe that there are more than 20 high-specialty hospitals that care for cancer.
Felipe: There is an integration but not so good.
Patricio: That’s right, more than 50% of the patients of the almost 15,000 patients with hematological cancer, half have to spend out of pocket to pay for their care and have access to treatment, in Mexico unfortunately many will die because the cost of Hematological diseases is very high and not within the reach of most.
Felipe: I believe that each one of us has a heartbreaking story of the indolence of the authorities that breaks the soul but is part of our battle.
Patricio: That’s right, it’s a battle. Today I tell you that our boss was at a multiple myeloma conference and we talked about how we have been asking the government for more than 4 years to consider it as a disease that generates catastrophic expenses and has not made leukemias are in the same tenor and we do not see progress and with COVID-19 it has been a palliative so that the inclusion of these diseases authorizes us less. If the government does not support us, none of these patients will have the possibility of overcoming these diseases.