Manuel Díaz-Rubio, honorary president of Spain’s Royal Academy of Medicine, traces the history of Spain’s medical community over the last few decades, and emphasizes the importance of the pharmaceutical industry to the careers of doctors and physicians across the world.
You were head of Hospital San Carlos’ gastroenterology unit for 36 years; what were some of the most important achievements during this period?
Spain’s healthcare system has evolved dramatically over the last 40 years. In previous times, everything in health was organized around universities, and treatment and teaching were two distinct disciplines. During the 1960s and 1970s, there was a systematic transformation in Spain in which hospitals were created exclusively for treatment. Therefore, university hospitals had to make substantial effort to adapt to this new situation. Essentially they had to focus on patient treatment and less so on teaching. This created a revolution; medicine during these decades was not very specialized in Spain. For example, surgery was just general surgery, medicine was internal medicine and so on; therefore the most important challenge that my generation had to face was to take specialized services to the university and to big hospitals. I call it the generation of the Specialized Services Heads because we had to show to our professors a different way to do medicine without leaving aside the basics like internal medicine in my case. We had to start studying a specialization, such as gastroenterology, and technology also slowly was integrated. The appearance of endoscopic techniques revolutionized our specialization and during the 1980s, other techniques like echography and magnetic resonance appeared, transforming our studies.
Additionally, new worldwide contributions to medicine like the discovery of Hepatitis C or Helicobacter Pylori, meant facing several conceptual changes. During my career, the gastric ulcer was a prevalent disease. Today it is rare and can be cured in one week; 40 years ago, people died from this condition. This represents a conceptual change in practicing medicine. It means a change in mentality, using more observation and practice, and removing the belief that everything can be done with money. It is true that money is important but the most wonderful tool that a doctor has is the observation of science and his patients.
From that moment, we started working in motility and motility studies. San Carlos was the first hospital with a service that included techniques such as esophageal manometry, the PH esophageal metry and they have since been developed in all hospitals. The start was difficult because of the medicine panorama at that moment.
Some people say that the economic recession has affected the amount of research done here in Spain. Is there a brain drain of talent to other countries? What else is needed in order to recover these students and professionals?
This question can be answered from different perspectives. I think Spain was greatly influenced by France and Germany before World War II. Since then, influence has come more from the United States. Before the War, an internal medicine treaty might have had as many as 12 to 14 volumes; Americans presented the same knowledge in just two volumes. We went from an encyclopedic to a synthetic mindset in medicine. This change was outstanding because after the War students tended to go to the US or UK over France or Germany. The US has become a very strong country in research and this has forced Spanish doctors to learn how to do research differently, starting in the 1960s. Spain started to publish in international journals of high impact and we started to become recognized for our publications. I think this supports the idea that we are in fact producing high quality science and the number of publications by Spaniards in international publications is increasing.
Indeed, the number of publications is high, but at the same time Spain has a low number of patents. Why is there this discrepancy?
I think that the originality of research in Spain is not how people perceive it to be; the original idea is what is worthy and I think that in this regard, Spain is limited. Nevertheless, when Spaniards are in different and more competitive environments for research like the US, they do develop ideas and initiatives. Why do they only develop these ideas when overseas? It is not only about the money, but also about the actual environment and the work group that surrounds them. A talented individual’s potential can be reduced if they do not have anyone with whom he or she can exchange ideas and opinions.
What do you think about the position of scientists in the formation of scientific policy?
Studies and research preparation are constantly increasing, and the idea that younger people have a future in research is very high. The Spaniards bet on being researchers. It is also true that there is a negative economic connotation that might convince a young researcher to choose other career paths; they abandon the research field because they do not have enough economic warranties to make a living out of it.
You were president of the Royal Academy of Medicine from 2008 to 2012; how did you get involved?
I was elected as an Academic in 1993. Much later on, I realized that the Academy had a very important role in Spanish society and that working and having new ways of interpreting the Academy constituted a challenge. Spain has great history but no one has maintained this historical spirit among the medical or general society. Preserving the historical spirit is fundamental for development especially in countries like England, France or Germany. Without historical familiarity, people do not have direction, and Spain has this problem. People here live for the moment rather than looking at the past or future. Therefore I found it fascinating to become involved with an institution with almost 300 years of history. I also thought I was in the capacity to face the challenges to bring about change after 300 years.
In the four years I spent here, the most important challenge that I noticed was to interact more with people and society, all of whom need to know that the Academy is a meeting point, for science and for all types of professionals and for society in general.
The slogan of the Academy is “art with nature collaborating for health”. In what way is that present in the activities of the Academy?
We collaborate with all types of institutions. We do events and we prepare all kinds of reports as well. For example, if there is a case in the tribunal in which they want the opinion of the Academy, they ask us for a report. Therefore, it is a meeting point for the society.
How can the Academy collaborate with hospitals, pharmaceutical companies or institutes for improving the research capacity in Spain?
We collaborate by incentivizing the encounter between all actors. There are people or institutions that are separated and unrelated, so we put them together, we elaborate projects, sessions, debates and most of the times those activities end in commitments and important agreements.
You also have experience with Prix Galien, an institution close to the heart of Focus Reports. What opportunities does Prix Galien hold in terms of opening up greater awareness and recognition for outstanding work in medicine in Spain and worldwide?
I think Prix Galien is an outstanding opportunity and a great idea. I think that the nature human beings is flawed due to our individualistic personalities. Individuality can make a person achieve many great things; but, in fact, human beings need collaboration with other human beings and institutions. The same thing happens with businesses, institutions, countries, and so on; by themselves they will not progress because no one is better than anyone. All of us are better when we are together.
How do you think Spain’s healthcare system and pharmaceutical industry is likely to evolve in the coming years?
I think that the pharmaceutical industry has a spectacular future because of the incredible developments of medicine now and in the future. Humans can live to over 100 today thanks to the help of medicine, a good healthcare system, and a research system in the pharmaceutical world that offers everything necessary to achieve these objectives. Therefore, the role of the pharmaceutical industry is fundamental; but I think that the industry has a great challenge to communicate to society the difficulty and the costs of researching a new drug and the need for pharmaceuticals to have profit in a certain period of time so they can continue research. Politicians and authorities of the healthcare system have to realize this need of the pharmaceutical industry and, at the same time, the industry also has to make an effort to reduce all possible costs. In my opinion, the pharmaceutical industry should make efforts with less fortunate countries. While many companies dedicate a percentage of their profit to countries in the Southern Hemisphere, the diseases present in those countries are proportionally more prevalent than the ones in the Northern Hemisphere. The pharmaceutical industry in Spain has supported doctors and their studies. There has been a great investment from the industry in terms of education. Maybe this information will not please the politicians, but it is a valid argument in terms of the support that medical education has received from the pharma industry. It is also true that the industry has its own interests; no one does something without a motive except for charity. Essentially, the medicine sector owes a great debt to the pharmaceutical industry. Of course, the whole industry and doctors like myself owe a huge debt to our patients because they are the center of our efforts.
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