The past two years have taught us that medical research must cross borders. At the same time, the U.S. and Mexico have distinct health and research systems that are difficult to link up. How might we promote more knowledge sharing in the medical field? How can we use telemedicine to do so? In today’s Knowledge Transfers, we’ll take a look.
Case in point: Universalizing medical knowledge
One recent afternoon, Dr. Rafael Fonseca was busy, as usual, seeing patients. Fonseca is a hematologist (blood doctor) specialized in multiple myeloma (plasma cell cancer) and related conditions. But rather than seeing patients in his office at the Mayo Clinic in Arizona, he saw them on his computer screen: one was in New Mexico, another in Chile, another Mexico, and a final patient in Bulgaria, with her daughter in New Jersey.
The Covid-19 pandemic has accelerated telemedicine, a trend in which Fonseca sees great potential. Telemedicine can “maximize the reach of certain expertise to other countries, including Mexico and Latin America,” he said. This is particularly important in medicine, according to Fonseca, because “the volume of knowledge is so much that it is impossible for someone to be an expert of everything.” According to a November 2021 survey, 40 percent of Mexicans reported to have used video calling to meet with doctors.
In other words, you may be a cardiologist, but medicine is so complex that you can’t possibly be an expert in all things cardiology, so you might choose to focus on heart failure, or arrhythmias, or congenital heart disease. Even within those subcategories, there’s so much complexity that you have to specialize further, say on heart failure associated with a particular disease or the treatment for a particular arrhythmia.
Telemedicine allows specialized experts from around the world to consult on cases, Fonseca said—a patient would need a regular doctor giving continuity of care, but different physicians could collaboratively share their expertise via brief consults.
This interconnectedness between health systems is perhaps so natural to Fonseca because it’s a reflection of his lived experience. Fonseca earned his medical degree at the Universidad Anáhuac in Mexico City before completing his residency at the University of Miami and later his fellowship at the Mayo Clinic Graduate School of Biomedical Sciences.
“When I first came [to the U.S.], I came here really with the intent of going back to Mexico. I thought, I’m going to pursue my training, and then one day in the future I’ll go back and establish a clinical practice in something,” Fonseca said.
Little did he know, Fonseca would quickly become immersed in research and education in the U.S. and in a career at the Mayo Clinic, which has included serving as the director of the Mayo Clinic Comprehensive Cancer Center, associate director for the Center of Individualized Medicine, chair of the Department of Internal Medicine, and, these days, the hospital’s Chief Innovation Officer.
Dr. Fonseca & the state of US-Mexico medical research:
• On brain drain: Dr. Fonseca has thought a lot about the issue of brain drain—when talented students go abroad to pursue advanced education, as he did, and end up building their careers outside of their home countries. “The rationale for how I think about this, at least on a personal level…is that I think the scope of what I do is greater because of the possibilities that exist because of my work here. If at the end of my professional career, I think, gee, maybe you contributed to this new treatment or this new approach, and because of that patients are living longer, or their lives are better—I know that benefit knows no boundaries.”
• On investing in research: To fight brain drain, countries need to strengthen their cultures of research and treat research as key to development—there are certainly doctors and hospitals that do this in Mexico, but we need more, Fonseca said. While he understands why research is often neglected in countries that have long lists of more immediate priorities, Fonseca thinks that such an approach is ultimately counterproductive to a nation’s long-term development. “It is very clear that those that hold the keys of knowledge and of research really hold the keys to the power of the future,” he said. “We need research that drives new ideas, new concepts, that proposes more originality than merely the comparative aspect of research,” he said.
• On medical exchanges: Fonseca doesn’t think that increasing the exchange of medical researchers between the U.S. and Mexico should be about U.S. doctors studying what happens with Mexican patients, or vice versa. Instead, it should be about binational teams working on solutions to shared problems. “I would love 10 years from now to have a much better integration of research capabilities of both countries, and even though there could be different levels of support for what can be done, there is no reason why we couldn’t have a much broader, deeper, diversified and distributed research environment in Mexico,” Fonseca said. “I think there would be a significant appetite for people across the United States to work with that environment.”
Numbers to know:
• 28.1%: The percentage of Hispanic or Latino medical school applicants who identified as Mexican, Mexican-American, or Chicano/Chicana during the 2018-2019 academic year, according to the Association of American Medical Colleges.
• 97: The number of medical schools in Mexico, according to the American College of Physicians as of 2018. In the U.S., there were 142 fully accredited medical schools as of fiscal year 2020, according to the Association of American Medical Colleges.
• 0.4%: Mexico’s research and development expenditures as a percentage of its GDP, according to UNESCO. The U.S., on the other hand, is at 2.7%.
• 4,205: The number of researchers per million residents in the U.S., according to UNESCO. In Mexico, there are 260 researchers per million residents.
Be sure to follow…
Julio Frenk: Julio is the current president of the University of Miami and served as Mexico’s health minister between 2000 and 2006. He tweets about the university, but also about health and science, in English and Spanish. (Bonus: Brenda Crabtree, a Mexican infectious disease expert and HIV researcher, who shares new health research, and often beautiful photos of mountains!)