An inviting beach in Nassau, Bahamas.
Dr. Conville Brown, a cardiologist-researcher in The Bahamas, is at the helm of a fascinating worldwide project: He's leading a movement to help accelerate innovation by providing scientists and patients from around the globe with a legal, cost-effective, and ethically rigorous place to conduct medical research, as well as to offer commercial therapies that are already approved in some jurisdictions, but not others. He recently spoke with Editor-In-Chief Kira Peikoff about The Bahamas' emerging ascendance in the scientific world. This interview has been edited and condensed for brevity.
"You don't want to take shortcuts from the perspective of not giving proper due diligence to the process, but you also don't want it to be overwhelmed with red tape."
Tell me about the work you do in the Bahamas – what is the research focus?
We have a couple research opportunities here. Several years ago, we established the Partners Clinical Research Centre, the idea being that we can partner with different people in different territories in the world, including the United States, and be able to perform ethical research as would be defined and adjudicated by an institutional review board and a properly constituted ethics committee. We do all of this with FDA rigor, but in a non-FDA jurisdiction.
By doing this, we want to look for the science behind the research, and want to know that there is a sound clinical hypothesis that's going to be tested. We also want to know that the safety of the human subjects is assured as much as possible, and of course, assess the efficacy of that which you're testing. We want to do this in the same manner as the FDA, except in a more accelerated and probably less bureaucratic manner. You don't want to take shortcuts from the perspective of not giving proper due diligence to the process, but you also don't want it to be overwhelmed with red tape, so that what could be 3 months takes 3 years. A jet ski turns around a lot faster than the Queen Mary.
Why do you think the clinical research process in other countries like the U.S. has become burdened with red tape?
The litigious nature of society is a contributing factor. If people are negligent, they deserve to be sued. Unfortunately, all too often, some things get taken too far, and sometimes, the pendulum swings too far in the wrong direction and then it's counterproductive, so the whole process then becomes so very heavily regulated and financially burdensome. A lot of American companies have gone outside the country to get their clinical trials and/or device testing done because it's too phenomenally expensive and time-consuming. We seek to make sure the same degree of diligence is exercised but in a lesser time frame, and of course, at a much lower cost.
The other aspect, of course, is that there are certain opportunities where we have major jurisdictions, as in Europe, that have determined that a therapy or device is safe. Those services and devices we can utilize in the Bahamas--not as a clinical research tool, but as a therapy, which of course, the United States is not able to do without FDA approval. That could easily take another five years. So there is an opportunity for us in that window to make available such therapies and devices to the North American community. I like to call this "Advanced Medical Tourism" or "Advanced TransNational Medical Care." Instead of somebody flying nine hours to Europe, they can also now fly to the Bahamas, as little as half an hour away, and as long as we are satisfied that the science is sound and the approvals are in place from a senior jurisdiction, then we can legally serve any patient that is eligible for that particular therapy.
Dr. Conville Brown
(Courtesy)
Are you seeing an influx of patients for that kind of medical tourism?
The numbers are increasing. The stem cell legislation has now been in place for two to three years, so we have a number of entities including some large international companies coming to the shores of the Bahamas to provide some therapies here, and others for research. The vast majority of our clientele are from abroad, particularly the U.S. We fully plan to increase the traffic flow to the Bahamas for medical tourism, or preferably, TransNational Medical Care, Advanced and Conventional.
How do patients find out about available therapies and trials happening there?
Advertising in the international arena for something that is perfectly legal within the confines of Bahamas is par for the course. But the marketing efforts have not been that heavy while all the processes and procedures are being fine-tuned and the various entities are set up to handle more than 100 people at a time.
"We were able to accelerate those programs, and do it a lot less expensively than can be done in continental countries, but just as well."
What kind of research is being done by companies who have come to the Bahamas?
We've been involved in first-in-man procedures for neuromodulation of the cardiovascular system, where we inserted a device into the blood vessels and stimulated the autonomic nervous system with a view to controlling patients' blood pressure and heart rate in conditions such as congestive heart failure. We have also looked at injectable glucose sensors, to continually monitor the blood glucose, and via a chip, can send the blood glucose measurement back to the patient's cell phone. So the patient looks at his phone for his blood sugar. That was phenomenally exciting, the clinical trial was very positive, and the company is now developing a final prototype to commercialize the product. We were able to accelerate those programs, and do it a lot less expensively than can be done in continental countries, but just as well. The Bahamas has also crafted legislation specifically for regenerative medicine and stem cell research, so that becomes an additional major attraction.
Do you ever find that there is skepticism around going to the Caribbean to do science?
When it comes to clinical research and new medical devices, one might be skeptical about the level of medical/scientific expertise that is resident here. We're here to show that we do in fact have that expertise resident within The Partners Clinical Research Centre, within The Partners Stem Cell Centre, and we have formed our partnerships accordingly so that when prudent and necessary, we bring in additional expertise from the very territories that are seeking to accelerate.
Have you seen a trend toward increasing interest from researchers around the world?
Absolutely. One company, for example, is interested not only in the clinical side, but also the preclinical side--where you can have animal lab experiments done in the Bahamas, and being able to bridge that more readily with the clinical side. That presents a major opportunity for parties involved because again, the financial savings are exponential without compromising standards.
"A person who is 75 and frail, he doesn't want to wait to see if he will make it to 80 to benefit from the agent if it's approved in five years. Instead he can come to our center."
Where are some of these researchers from?
The United States, the Czech Republic, Russia, Canada, and South America. I expect significantly more interest once we promote the idea of European products having a welcome niche in the Bahamas, because we accept federal approvals from the U.S., Canada, and the European Union.
What do you think will be the first medical breakthrough to come out of research there?
One of the biggest killers in the world is heart disease, and we have the opportunity to implement a number of cardiac protocols utilizing stem cell therapy, particularly for those with no options. We just completed a state-of-the art medical center that we fashioned after the University of Miami that is getting ready for prime time. The sky will be the limit for the cardiac patient with respect to stem cell medicine.
Second, we are extremely pleased to be involved with a company called Longeveron, which is looking at how one might age better, and age more slowly, particularly with the administration of young blood and mesenchymal stem cells to frail, elderly candidates. Healthy young men have their mesenchymal stem cells harvested, expanded, and then administered to frail, elderly individuals with a view to improving their Frailty Index and functionality (feeling younger). There is a lot of interest in this arena, as one could imagine.
And herein lies the classical scenario for the Bahamas: Longeveron is now recruiting patients for its phase IIB double blind, placebo-controlled clinical trial at multiple sites across the U.S., which will add some two to three years to its data collection. Originally this work was done with NIH support at the University of Miami's Interdisciplinary Stem Cell Institute by Dr. Joshua Hare, and published in the Journal of Gerontology. So now, during the ongoing and expanded clinical trial, with those positive signals, we are able to have a commercially available clinical registry in the Bahamas. This has been approved by the ethics committee here, which is comprised of international luminaries in regenerative medicine. Longeveron will also be conducting an additional randomized clinical trial arm of same at our Centre in The Bahamas, The Partners Stem Cell Centre.
Can you clarify what you mean by "registry"?
In other words, you still have to fit the eligibility criteria to receive the active agent, but the difference is that in a placebo-controlled double-blind clinical trial, the physician/researcher and the patient don't know if they are getting the active agent or placebo. In the registry, there is no placebo, and you know you're getting the active agent, what we call "open label." You're participating because of the previous information on efficacy and safety.
A person who is 75 and frail, he doesn't want to wait to see if he will make it to 80 to benefit from the agent if it's approved in five years. Instead he can come to our center, one of the designated centers, and as long as he meets the inclusion criteria, may participate in said registry. The additional data from our patients can bolster the numbers in the clinical trial, which can contribute to the FDA approval process. One can see how this could accelerate the process of discovery and acceptance, as well as prove if the agent was not as good as it was made out to be. It goes both ways.
"We would love to be known as a place that facilitates the acceleration of ethical science and ethical therapies, and therefore brings global relief to those in need."
Do you think one day the Bahamas will be more well-known for its science than its beaches?
I doubt that. What I would like to say is that the Bahamas would love to always be known for its beautiful beaches, but we would also like to be known for diversity and innovation. Apart from all that beauty, we can still play a welcoming role to the rest of the scientific world. We would love to be known as a place that facilitates the acceleration of ethical science and ethical therapies, and therefore brings global relief to those in need.
Rakhi Patel is among an increasing number of health care professionals, including doctors and nurses, who maintain an active persona on Instagram, TikTok and other social media sites.
“Health care professionals are quite prevalent on social media,” said Mercer Gary, a postdoctoral researcher at The Hastings Center, an independent bioethics research institute in Garrison, New York. “They’ve been posting on #medTwitter for many years, mainly to communicate with one another, but, of course, anyone can see the threads. Most recently, doctors and nurses have become a presence on TikTok.”
On social media, many health care providers perceive themselves to be “humanizing” their profession by coming across as more approachable — “reminding patients that providers are people and workers, as well as repositories of medical expertise,” Gary said. As a result, she noted that patients who are often intimidated by clinicians may feel comfortable enough to overcome barriers to scheduling health care appointments. The use of TikTok in particular may help doctors and nurses connect with younger followers.
When health care providers post on social media, they must bear in mind that they have legal and ethical duties to their patients, profession and society, said Elizabeth Levy, founder and director of Physicians for Justice.
While enduring three years of pandemic conditions, many health care professionals have struggled with burnout, exhaustion and moral distress. “Much health care provider content on social media seeks to expose the difficulties of the work,” Gary added. “TikTok and Instagram reels have shown health care providers crying after losing a patient or exhausted after a night shift in the emergency department.”
A study conducted in Beijing, China and published last year found that TikTok is the world’s most rapidly growing video application, amassing 1.6 billion users in 2021. “More and more patients are searching for information on genitourinary cancers via TikTok,” the study’s authors wrote in Frontiers in Oncology, referring to cancers of the urinary tracts and male reproductive organs. Among the 61 sample videos examined by the researchers, health care practitioners contributed the content in 29, or 47 percent, of them. Yet, 22 posts, 36 percent, were misinformative, mostly due to outdated information.
More than half of the videos offered good content on disease symptoms and examinations. The authors concluded that “most videos on genitourinary cancers on TikTok are of poor to medium quality and reliability. However, videos posted by media agencies enjoyed great public attention and interaction. Medical practitioners could improve the video quality by cooperating with media agencies and avoiding unexplained terminologies.”
When health care providers post on social media, they must bear in mind that they have legal and ethical duties to their patients, profession and society, said Elizabeth Levy, founder and director of Physicians for Justice in Irvine, Calif., a nonprofit network of volunteer physicians partnering with public interest lawyers to address the social determinants of health.
“Providers are also responsible for understanding the mechanics of their posts,” such as who can see these messages and how long they stay up, Levy said. As a starting point for figuring what’s acceptable, providers could look at social media guidelines put out by their professional associations. Even beyond that, though, they must exercise prudent judgment. “As social media continues to evolve, providers will also need to stay updated with the changing risks and benefits of participation.”
Patients often research their providers online, so finding them on social media can help inform about values and approaches to care, said M. Sara Rosenthal, a professor and founding director of the program for bioethics and chair of the hospital ethics committee at the University of Kentucky College of Medicine.
Health care providers’ posts on social media also could promote patient education. They can advance informed consent and help patients navigate the risks and benefits of various treatments or preventive options. However, providers could violate ethical principles if they espouse “harmful, risky or questionable therapies or medical advice that is contrary to clinical practice guidelines or accepted standards of care,” Rosenthal said.
Inappropriate self-disclosure also can affect a provider’s reputation, said Kelly Michelson, a professor of pediatrics and director of the Center for Bioethics and Medical Humanities at Northwestern University’s Feinberg School of Medicine. A clinician’s obligations to professionalism extend beyond those moments when they are directly taking care of their patients, she said. “Many experts recommend against clinicians ‘friending’ patients or the families on social media because it blurs the patient-clinician boundary.”
Meanwhile, clinicians need to adhere closely to confidentiality. In sharing a patient’s case online for educational purposes, safeguarding identity becomes paramount. Removing names and changing minor details is insufficient, Michelson said.
“The patient-clinician relationship is sacred, and it can only be effective if patients have 100 percent confidence that all that happens with their clinician is kept in the strictest of confidence,” she said, adding that health care providers also should avoid obtaining information about their patients from social media because it can lead to bias and risk jeopardizing objectivity.
Academic clinicians can use social media as a recruitment tool to expand the pool of research participants for their studies, Michelson said. Because the majority of clinical research is conducted at academic medical centers, large segments of the population are excluded. “This affects the quality of the data and knowledge we gain from research,” she said.
Don S. Dizon, a professor of medicine and surgery at the Warren Alpert Medical School of Brown University in Providence, Rhode Island, uses LinkedIn and Doximity, as well as Twitter, Instagram, TikTok, Facebook, and most recently, YouTube and Post. He’s on Twitter nearly every day, where he interacts with the oncology community and his medical colleagues.
Also, he said, “I really like Instagram. It’s where you will see a hybrid of who I am professionally and personally. I’ve become comfortable sharing both up to a limit, but where else can I combine my appreciation of clothes with my professional life?” On that site, he’s seen sporting shirts with polka dots or stripes and an occasional bow-tie. He also posts photos of his cats.
Don S. Dizon, a professor of medicine and surgery at Brown, started using TikTok several years ago, telling medical stories in short-form videos.
Don S. Dizon
Dizon started using TikTok several years ago, telling medical stories in short-form videos. He may talk about an inspirational patient, his views on end-of-life care and death, or memories of people who have passed. But he is careful not to divulge any details that would identify anyone.
Recently, some people have become his patients after viewing his content on social media or on the Internet in general, which he clearly states isn’t a forum for medical advice. “In both situations, they are so much more relaxed when we meet, because it’s as if they have a sense of who I am as a person,” Dizon said. “I think that has helped so much in talking through a cancer diagnosis and a treatment plan, and yes, even discussions about prognosis.”
He also posts about equity and diversity. “I have found myself more likely to repost or react to issues that are inherently political, including racism, homophobia, transphobia and lack-of-access issues, because medicine is not isolated from society, and I truly believe that medicine is a social justice issue,” said Dizon, who is vice chair of diversity, equity, inclusion and professional integrity at the SWOG Cancer Research Network.
Through it all, Dizon likes “to break through the notion of doctor as infallible and all-knowing, the doctor as deity,” he said. “Humanizing what I do, especially in oncology, is something that challenges me on social media, and I appreciate the opportunities to do it on TikTok.”
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