Cuban health care: consider the source.

I am writing to protest the egregious misrepresentation of the Cuban health care system presented by P. K. Drain and M. Barry in their Policy Forum, “Fifty years of U.S. embargo: Cuba's health outcomes and lessons” (30 April, p. [572][1]). The most serious flaw in the Policy Forum is its unquestioning faith in the legitimacy of Cuban government health data. By basing their conclusions solely on official government sources, the authors imply that the health sector in Cuba can be analyzed apart from the rest of the government apparatus. As a result, the health sector is portrayed as an oasis of humanitarianism and egalitarianism that is completely unaffected by the surrounding problems of authoritarianism, repression of information, and grave human rights abuses that have characterized the Castro regime for most of its 50-year history. A small but compelling array of recent publications ([ 1 ][2]–[ 5 ][3]) in the social sciences, as well as numerous informal reports ([ 6 ][4]–[ 10 ][5]) by dissident journalists and physicians, have successfully challenged these assumptions by documenting the myriad ways Cuba's systemic problems have become embedded in the organization and delivery of health care. The results of these inquiries are decidedly unflattering to the Cuban government and reveal a health system rife with corruption, authoritarianism, inequality, falsification of data, and human rights abuses. Any scholarly attempt to assess the true state of health conditions in Cuba, or the health impact of the U.S. trade embargo, should begin with a discussion of the way these systemic problems distort empirical research. 1. [↵][6] 1. O. E. Chepe , Cuba: Revolucion o Involucion? (Editorial Aduana Vieja, Valencia, Spain, 2007). 2. 1. E. Kath , Social Relations and the Cuban Health Miracle (Transaction Press, New Brunswick, NJ, 2010). 3. 1. K. Hirschfeld , Health, Politics, and Revolution in Cuba Since 1898 (Transaction Press, New Brunswick, NJ, 2007). 4. 1. K. Hirschfeld , Cuban Affairs 2, 1 (2007). [OpenUrl][7] 5. [↵][8] 1. A. Lago , Can. J. Psychiatry 39, 129 (1994). [OpenUrl][9][PubMed][10][Web of Science][11] 6. [↵][12] 1. M. A. O'Grady , “Cuban doctor pays a high price for truth,” Wall Street Journal, 31 March 2006. 7. Video testimony from Darsi Ferrer, dissident physician ([www.youtube.com/watch?v=jgXP6AFo7lc][13]), in the documentary “Cuba y los Elefantes” (Instituto Politico para la Libertad, Lima, Peru, 2009). 8. CNN story on Darsi Ferrer [in Spanish]; [www.youtube.com/watch?v=8r0U7u6sTd4][14]. 9. 1. D. Mendoza, 2. I. Fuentes , Dengue! (Center for a Free Cuba, Washington, DC, 2001). 10. [↵][15] Generation Y blog ([www.desdecuba.com/generationy][16]). [1]: /lookup/doi/10.1126/science.1189680 [2]: #ref-1 [3]: #ref-5 [4]: #ref-6 [5]: #ref-10 [6]: #xref-ref-1-1 "View reference 1 in text" [7]: {openurl}?query=rft.genre%253Darticle%26rft_val_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Ajournal%26ctx_ver%253DZ39.88-2004%26url_ver%253DZ39.88-2004%26url_ctx_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Actx [8]: #xref-ref-5-1 "View reference 5 in text" [9]: {openurl}?query=rft.jtitle%253DCanadian%2Bjournal%2Bof%2Bpsychiatry.%2B%2BRevue%2Bcanadienne%2Bde%2Bpsychiatrie%26rft.stitle%253DCan%2BJ%2BPsychiatry%26rft.aulast%253DHenderson%26rft.auinit1%253DJ.%26rft.volume%253D39%26rft.issue%253D2%26rft.spage%253D129%26rft.epage%253D129%26rft.atitle%253DTeaching%2Bpsychiatry%2Bin%2BCuba.%26rft_id%253Dinfo%253Apmid%252F8149321%26rft.genre%253Darticle%26rft_val_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Ajournal%26ctx_ver%253DZ39.88-2004%26url_ver%253DZ39.88-2004%26url_ctx_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Actx [10]: /lookup/external-ref?access_num=8149321&link_type=MED&atom=%2Fsci%2F329%2F5992%2F627.2.atom [11]: /lookup/external-ref?access_num=A1994NB87000020&link_type=ISI [12]: #xref-ref-6-1 "View reference 6 in text" [13]: http://www.youtube.com/watch?v=jgXP6AFo7lc [14]: http://www.youtube.com/watch?v=8r0U7u6sTd4 [15]: #xref-ref-10-1 "View reference 10 in text" [16]: http://www.desdecuba.com/generationy