Where Science Meets Culture: The Art of Health Diplomacy
Posted Nov 30 2010 12:00am
Where Science Meets Culture: The Art of Health Diplomacy
Dr. Jorge Gomez
In this special issue of the NCI Cancer Bulletin, you will read about some of the ways NCI is supporting international collaboration for research, training, communications, and other activities related to understanding cancer and treating patients who have cancer, as well as providing information to those who may be at high risk for developing it. These collaborations are critical to our success—cancer is a problem so immense that we must gather all the ideas so that we can confront the disease in the most comprehensive way possible.
This is one of the reasons that international collaboration in clinical research has become of paramount importance to the United States. But, in addition to forging ahead with partnerships that have data as the chief priority, researchers and organizations should allow time to plan for other aspects of their projects that can produce surprising, long-lasting, and mutual rewards.
Representatives from developed countries who partner with colleagues from less developed nations, where the burden of cancer is often very high, serve as ambassadors. As ambassadors, we need to recognize that our collaborators in developing countries may struggle to acquire the technologies, systems, and information that we take for granted.
Another important consideration is the protocol for our collaboration. Many of the policies and safeguards upheld by NIH and other U.S. federal agencies for the protection of human subjects participating in clinical research, as well as data integrity and monitoring, may be difficult to enforce beyond our borders. We must encourage and promote “best practices” in research outside of this country as we do within the United States.
And, our interactions with foreign collaborators must be respectful of their customs, culture, and the idiosyncrasies of their nations as a whole—at the local, regional, and national levels—as well as of their laws and regulations. Every project affords the opportunity to enhance their research infrastructure and research capacity, such as biospecimen repositories. Moreover, our interactions must be based on our mutual professional respect, where foreign collaborators are an integral component of the team. This should be evident in the planning, implementation, data analysis, and publications.
In short, these collaborations should contribute to science, but they should also strengthen the relationships between countries, increase research capacity for both nations, and serve as a model for others to follow.
The study, which will involve staff at more than 20 hospitals and research facilities in Argentina, Brazil, Chile, Mexico, and Uruguay, has the goal of characterizing the distribution of molecular profiles in Latin American women who have stage II or III breast cancer. These investigators will determine the correlation between the molecular profiles of the tumors in these women and their response to neoadjuvant therapy .
We already know that breast cancer is a collection of many subtypes with different genetic and clinical characteristics. We also know that breast cancer is less common in Latin American women than in women from developed countries. What we learn about the genetics, molecular profiles, and clinical responses of women in this study will help us better understand how to categorize breast cancer, as well as to determine the most effective treatment for different breast cancer subtypes.
The health diplomacy of this project lies in the details. The study design, clinical protocol, informed consent, and case report forms were developed in collaboration with international partners through committees that brought together the disciplines of public health, international affairs, management, law, and economics. The collaborators participated in workshops and webinars and contributed to the development of standardized procedures for biospecimen collection, pathology, biomarker assessment, and evaluation of patient response to therapy.
Although some countries have existing biobanks and IT systems, the five participating Latin American countries will establish these infrastructures in their own countries based on best practices for storing specimens collected in this study, as well as plans and systems for bioinformatics.
In essence, we are enhancing their research infrastructure so that they will be able to conduct clinical trials in the future that incorporate the latest genomic and applied technologies that are becoming standard in the United States and other developed countries.
Improving infrastructure is just one element of good diplomacy in international research collaboration. (See the sidebar for other examples.) The goal is to treat our collaborators as equal partners and provide resources to enhance the development of areas where they may be lacking, such as training or applied technologies.
As we continue to forge these collaborations, the emphasis should continue to be on the science and the potential benefits for cancer patients and their physicians. This is the distinction between elitism and leadership; this is what makes a true partnership.
Assess the capabilities of partners by learning about the local culture, health care, and research networks.
Nurture personal relationships with collaborators to reinforce institutional commitment.
Communicate with cultural propriety. Language is only a technical barrier; the real barrier is how to communicate in a way that respects another country’s culture and customs.
Take every opportunity to train, share, and educate on site.
Leave behind a structure that will continue to serve institutions, investigators, and patients.
Create opportunities to allow exchange of investigators through short visits and at all levels.
Develop plans to manage data and analysis in collaboration with foreign investigators.
Agree in advance on policies regarding publications, authorship, and presentations at national and international meetings. This will help to establish a level playing field and will build mutual trust and respect.
Include travel to meetings in budget planning, as well as money for other forms of collaboration.
Ensure that the appropriate laws and regulations of the country are being followed. Follow the U.S. Office for Human Research Protections rules and regulations, as well as the local IRB policies and regulations.