All language subtitles for VICE S05E09

This week on Vice:

the amazing medical breakthroughs
that are happening in Cuba.

You go from this discernible tumor,

and then after the vaccine,

that's all cleared out.
It's really quite dramatic.

This hospital treats
people with diabetes,

and they have a new drug
that could eliminate 70%

of the diabetes-related amputations.

And then, the ecological threat

to one of the world's
most popular foods.

How long has this been
infected for, do you think?

Months. Once you see it,

you're really very, very late.

Go, go, go!

We are not animals!

Synced and corrected by Aaronnmb
www.addic7ed.com

In 2016,

Barack Obama became the
first sitting U.S. president

to visit Cuba in nearly 90 years.

I have come here to bury

the last remnant of the
Cold War in the Americas.

The shift towards normalizing ties

between the two countries

saw the loosening of trade
and travel restrictions.

But what many people don't know,

is that the thaw in relations

could also allow Americans access

to hitherto inaccessible Cuban medicines

that may transform the treatment

of some of our most widespread
and harmful diseases.

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It's so funny the doctor walked in just,

you know, less than a minute ago,

and she's already taken the...

the baby's heartbeat.

Dr. Sara Gonzalez is a family doctor

in this Havana neighborhood.

She and her team walk door to door

to check in on her patients.

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These neighborhood doctors

are central to the
Cuban healthcare system.

Ay, yi, yi, yi, yi.

Checking in door to door allows doctors

to focus on preventive medicine

by catching and treating
diseases earlier,

keeping costs low,

and contributing to longevity.

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Life expectancy here
matches that of the U.S.,

while Cuba spends less than a tenth

of what we spend on
healthcare per capita.

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While most of Cuba may look
like it's stuck in the 1950s,

their medicine is not.

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Cuba boasts more doctors per capita

than anyone else in the world.

Their infant mortality rate
is better than the U.S.,

and when the Ebola
crisis broke out in 2014,

they sent more doctors to Africa

than any other nation.

As a small Communist country,

their healthcare system
was built out of necessity.

First, the 1963 trade
embargo restricted Cuba

from importing medicines from the U.S.,

and then in the early '90s,

their economic isolation worsened

with the collapse of the Soviet Union.

These unique conditions
furthered the need

to develop their own advancements,

driving them to the forefront
of medical innovation

and inexpensive treatments.

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This hospital treats
people with diabetes,

and they have a new drug that they're
administering called Heberprot,

and the reason it's a
really great drug is because

based on clinical trials,
they say it could eliminate

70% of the diabetes-related amputations.

Diabetes is a serious epidemic in Cuba,

just like in the U.S.,

but doctors here have created a
new, highly effective treatment

that manages one of the disease's
most dangerous complications:

foot ulcers.

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Dr. Jose Fernandez Montequin

is a diabetes specialist.

Can you just explain
what's happening today?

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Heberprot-P is injected
around the site of the ulcer,

stimulating tissue growth

so the foot can start to heal.

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Hundreds of thousands of patients

in more than 20 countries
have avoided losing limbs,

and in some cases, their
lives, thanks to Heberprot-P.

When someone receives an amputation,

how does that affect
their life expectancy?

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So this treatment isn't
just preventing amputations,

it's actually saving lives.

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Despite this drug's impressive results,

the U.S., a country with 30
million people living with diabetes,

is the one place that won't accept it

due to its own
longstanding trade embargo.

And it's not just medicines.

All Cuban products have been
banned for more than 50 years,

including their most famous exports:

sugar and cigars.

We're at a tobacco farm

a couple hours outside of Havana.

Cigars are, obviously, a
huge part of Cuban tradition,

but partly because of that popularity,

there have been a lot of
issues related to that,

uh, with public health.

Lung cancer is the number one
cancer killer in the world.

In the U.S. alone,

there are almost a quarter of
a million new cases annually.

Half of those diagnosed
die within one year.

But there's a new treatment here in Cuba

that doctors say could be life-changing
for many lung cancer patients.

We're here to meet a family.

Their dad has had lung
cancer for a while,

and is on CimaVax, a
lung cancer vaccine.

Hola.

Orelve Sanchez took part

in early clinical trials of CimaVax.

After being diagnosed with
stage four lung cancer,

he was told he would not
live more than a year.

What was going through your
mind when you got that diagnosis?

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When were you diagnosed
with lung cancer?

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Do you think your husband
would be sitting here with us

if it wasn't for the vaccine?

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Orelve has survived more
than ten years on CimaVax.

It's also worked for
thousands of patients

whose cancer fits a specific makeup.

About 20% of the patient population

naturally has high
concentrations of a protein

known as "epidermal growth factor,"

or EGF, which feeds the cancer.

CimaVax triggers the immune system

to target the EGF and
stunt the tumor's growth.

While it isn't designed as a cure,

or used as a preventative vaccine,

it effectively manages
the cancerous cells.

CimaVax was developed at the
Center for Molecular Immunology.

Dr. Tania Crombet is the director
of clinical research there.

How many patients here have
been treated with CimaVax?

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And how has it worked?

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That means that these patients,

against all odds,

have survived the biggest cancer
killer by taking this vaccine.

These results have caught the attention

of cancer researchers worldwide.

This is Dr. Kelvin Lee.

He's the first doctor to attempt

to bring this treatment to the U.S.

So, what brings you down to Cuba?

So, we have been working

with the Center for
Molecular Immunology in Havana

to bring that cancer vaccine up into

Roswell Park in western
New York and Buffalo

to do clinical studies of it,

and to also to do additional
research in trying to understand

how it works, what's the
best way to deploy it,

what are the other potentials.

Dr. Lee and the researchers at CIM

have been collaborating
together for a few years.

Good to see you! How are you?

Before most drugs can
be used in the U.S.,

they must undergo clinical
trials for FDA approval,

and for Cuban drugs, there
are even more obstacles.

Before a trial can be approved,

the U.S. Treasury Department

must grant an exemption
from the trade embargo.

I remember when we first
came back from in 2012,

I was telling our legal team...

They said it was
complicated, and, you know,

"This hasn't been done before,

"and, you know, there are all these
federal agencies to go through."

I said, "You know, if
there's a 20% chance,

"just a 20% chance that
what the CIM is doing

"is going... is real?

"This is going to fundamentally
impact human health.

"We need to be there.
We need to do this."

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- So they start there?
- Yes. Exact.

Dr. Elia Neninger is an oncologist

who's been treating patients with
the vaccine for about a decade.

Magaly Gomez was diagnosed

with advanced lung cancer one year ago.

Have you ever seen a
patient receive CimaVax?

No, this is the first. This is great.

CimaVax is administered once a month.

The patient receives four injections,

one in each arm and leg.

How successful has CimaVax been?

- For her? For her.
- For her.

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The tumors are smaller.

That's quite remarkable
that you go from this...

where she has, you know, a clearly...

you know, a discernible tumor,

and you can't see the...

- the vasculature.
- Uh-huh.

Uh, and then after the vaccine,

that...

that's gone, you can see a vasculature.

That's all cleared out! That's amazing!

So that was originally
advanced lung cancer.

Yeah, Three-B. Uh...

- Three-B is inoperable.
- Three-B.

But that's actually a pretty remarkable
response just on chest X-rays.

It's really... it's
really quite dramatic.

To hear some firsthand accounts,

Dr. Lee visited with a
group of CimaVax patients

who have responded
particularly well to treatment.

They all have high EGF levels,

and were given less than a year to live.

Magaly has been taking
CimaVax for six months.

Yolanda has survived
with it for four years,

and Marta, for eight years.

How has the treatment been?

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And yourself?

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A year ago, a promising
treatment like CimaVax

would never have been
sent here to the U.S.,

but last October,

due to the thawing
relationship between nations,

a historic decision was made to
allow the first clinical trial

of a Cuban drug on U.S. soil.

We followed Dr. Crombet
from Havana to Buffalo

as she joined Dr. Lee for
the start of the trial.

Hi! How are you?

- My friend.
- How have you been?

We're gonna start the trial today.

- First patient will get vaccinated today.
- Yes.

We have our expert from
Cuba who's vaccinated

- more patients than anybody, uh...
- Oh, no.

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And we are starting that team today.

The exciting thing about CimaVax

is whether or not you could
use it in other cancers,

that utilize EGF like colon cancer,

head and neck cancer, maybe
breast cancer, prostate cancer.

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Scientists here are looking

not only to replicate Cuba's results,

but to test CimaVax for use

as a traditional vaccine
in high-risk patients.

So, the idea there is to use CimaVax

to prevent lung cancer

in patients that have a high
risk of getting lung cancer.

So, high-risk smokers.

Uh, that's millions of people worldwide.

Lung cancer and diabetes
are only the beginning.

There's the potential for a whole
range of innovative Cuban drugs

for breast, neck, and even brain
cancer to make their way to the U.S.

With political differences between
the two countries pushed aside,

doctors can share in
medical breakthroughs,

and patients here may start to benefit

from Cuba's low-cost
and effective treatments.

We're hoping that those
novel vaccines and treatments

can actually come for clinical trials,

and development in the United
States using the same path.

So, we are on the first step

on a very big journey, hopefully,

that will be very exciting.

In season three of "Vice,"

correspondent Isobel Yeung

investigated how the
world's agricultural systems

are threatened by what
is known as monoculture,

the widespread cultivation
of a single type of crop.

The same gene is being
used almost worldwide.

If one of those families should develop

susceptibility to a new disease,

we'd be in real trouble.

Now, a similar practice
may be threatening

the existence of one of the
world's most popular fruits.

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Ouch.

Ow.

We've come here to the birthplace

of the Cavendish banana,

possibly the most important
fruit in the world,

eaten by billions of
us every single year.

We're here in the very depths
of the English countryside.

We're here in Chatsworth
House in England,

which is mostly known for its
stunning landscapes and gardens,

for over five centuries
of British aristocracy,

and, of course, for being the
birthplace of the Cavendish banana.

Every banana that's grown,
almost around the world today,

is a Cavendish banana,

and because they don't produce seed,

it's the same genetic
material in every plant,

and so, pretty much, every banana
that's eaten around the world

started their journey here in the
1830s as the Cavendish dwarf banana.

Hey!

Not having seeds means
you can munch your way

through Cavendish bananas
without chipping your teeth,

but it also means that they're sterile,

and can only be grown by replanting

identical offshoots.

They came in through China,
we think through Mauritius,

and they arrived in this country,

and the sixth Duke cultivated them,

got them to flower and fruit,

realized their potential as a food crop,

and from there they turned
it into a commercial crop

that they started to export,

and that's when we all started to
enjoy them on the supermarket shelf.

So essentially the hundreds of
billions of bananas that we consume

are all direct clones
of these bananas here?

- Yes.
- Yes.

Cool!

♪ I'm Chiquita Banana ♪

♪ And I've come to say ♪

♪ Bananas have to
ripen in a certain way ♪

This quirky-looking yellow fruit

was once unknown to the west,

but after a massive marketing campaign,

and an even bigger production plan,

it's now one of America's
most consumed fresh fruits.

The banana business model is the
cheapest fruit in the supermarket.

Author Dan Koeppel,

or Dan, the Banana Man,

explained how that all became possible.

Consider that a banana gets
shipped thousands of miles,

goes bad really fast.

How is it possible that
a banana can be so cheap?

Well, you gotta control
the things you can control,

which are labor and land,

and so when the banana industry started,

an essential part of
their business model

was to make sure that they
didn't pay anything, basically,

for workers, and they
didn't pay anything for land.

How did they do that? Military force.

So, over and over again,

the banana companies
took over countries...

Guatemala, Honduras,

Nicaragua, Colombia,
all over Latin America...

in order to make sure
their business model

of cheap bananas was preserved,

and this led to insane,

horrible amounts of bloodshed, genocide,

and the birth of the
term "Banana Republic,"

which meant a country that

wasn't controlled by its native people,

but by American banana companies.

I mean, it's kind of
shaped a lot of countries,

and even whole continents.

Oh, yeah, the very
makeup of Latin America

would not be the same
if not for bananas.

Now countries like Costa Rica

are dominated not just by a single crop,

but by a single clone,

creating one of the world's
biggest monocultures.

We're in a massive banana
plantation in Costa Rica.

Here in Latin America
is where the majority

of our bananas in the
U.S. actually come from.

If we have brown bananas, the
consumer just rejects them right out,

so every single stage of this
process has to be calculated to a "T."

Ugh!

So, on every single
one of these bunches,

you have about 150 bananas.

That's a lot of bananas they've
got to harvest every day,

and an operation this big needs
an equally large work force.

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Thousands and thousands
of Cavendish bananas

have been harvested just down here,

and now we're making our
way to the packing station

where they're gonna be shipped
all the way across the world.

The size of this plant is enormous.

You've got 8,000 boxes being
filled every single day,

full to the brim with bananas,

that's happening 365 days of the year,

so they're pretty busy.

The scale and speed at which
these bananas are cultivated,

packed, and shipped is only
possible because of the use

of this one clone of banana.

How did we get to rely so
heavily on just this one crop?

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Agricultural expert Dr.
Luis Pocasangre explained

that this is the problem
with monocultures.

They're all susceptible
to the same diseases,

which can spread like wildfire.

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This cancer is known as TR4,

a strain of Panama Disease,

and it's devastating banana
crops around the world.

Panama Disease is a fungus,
it's called fusarium wilt,

and it spreads very quickly.

It can destroy an entire
country's crop in four years.

It doesn't just kill the bananas.

It makes it impossible to grow
bananas in that place again.

Ground zero for the spread of
this disease is the Philippines,

the second largest banana
supplier in the world.

Bananas are central to
the Filipino economy,

accounting for nearly
90% of all exported fruit.

- So, this all used to be bananas here?
- Yes.

You know here on the edge,

you see quite a number of
plants that are yellowing.

So, essentially these are all
infected with the Panama Disease.

Gert Kema is a plant pathologist,

who works with banana corporations
as well as small farmers

to monitor and contain
the spread of TR4.

That's infected.

Over there, you see?

Right.

I can assure you that many of
the plants that are here around

that still look pretty good,

most likely, they're infected too.

- Really?
- Yes.

How long has this been
infected for, do you think?

Few months.

Once you see it, since
this takes months,

you're really very, very late,

and the farmer does everything
he can to kill those plants,

but it's not stopping the disease.

That's essentially what's going on.

Farmers here are frantically
trying to stop the spread

by chopping down the plants,

covering them with flammable
rice hull, and burning the pile.

This entire landscape is
dotted with rice hull fires.

You can see they're
spraying disinfectant

and trying to quarantine the plant,

but, I mean, these people have
been walking all over this area.

I've been walking all over this area.

There's no disinfectant around the farm,

only at the very entrance,

so, it's so hard to
contain this disease.

With containment nearly impossible,

small-time farmers are left
with the difficult choice

of how much land they're
willing to sacrifice

in order to contain the spread.

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In total, how many workers
have you had to lay off?

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This is just one plantation
of hundreds in the region.

Thousands more acres of banana
crops have been affected,

and the disease is spreading quickly.

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monoculture is a bad thing.

It's not just a bad thing because
it means we only get one banana,

and there are many more that taste good.

monoculture's a bad thing because
it's an environmental disaster.

It's a cultural and social disaster.

It requires the transformation

of forests into factories.

I'd say the chances of
the Cavendish banana crop

being devastated by Panama Disease

are 100%.

The question is: will
there be a replacement?

And will it be a replacement
that repeats the monoculture

and repeats the mistake?

Or will it be part of a sort
of arsenal of varietal bananas?

The reason he's so confident
that this will happen,

is because it's
actually happened before.

Over 50 years ago,

the entire banana industry
was almost wiped out

by the original strain of this fungus.

The original banana that gave
birth to the banana industry

was a different breed.

- This banana was called the Gros Michel.
- Mm-hmm.

It was a bigger banana
than the one we have now.

It tasted better, in every
way, it was a better banana,

except it was susceptible
to this disease.

And by 1960,

it was what we call commercially,
or functionally, extinct.

To replace it, they needed a banana

that looked like the Gros Michel,

which they'd been marketing
for about half a century.

There was only one option:

the somewhat inferior-tasting,

but aesthetically
similar, Cavendish banana.

They invent bagging and boxing.

They invent ripening rooms.

They come up with all these
ways to make the Cavendish work,

and they gamble that people aren't
gonna care that it tastes bad,

and that's what happened,

and the Cavendish becomes our banana,

and the Gros Michel, and
the lesson of the Gros Michel

is totally forgotten.

An entire global monoculture
has been built around

exporting this one inferior banana,

which could suffer the same
fate as the Gros Michel.

Even though worldwide,

there are around 1,000
different types of bananas.

This is a Cavendish that when it ripens,

it doesn't turn yellow.

Mmm, cheers.

It's better than the... the Cavendish,

but this is not the
one that is exported.

The market is used to...

- a yellow banana.
- Mmm!

It does feel weird
eating a green banana.

Mmm.

- What's this?
- Fhia 17.

It's the product of hybridization.

- Mm-hmm.
- Moderately resistant to TR4.

So why is this one not used?

- Because the taste is no good.
- Shame.

What about this one?
This one looks funny.

That doesn't affect the pulp, see?

But nobody will buy them because
they judge it by the skin.

Yeah, it's not very appealing, is it?

Because with consumers,
like America, for instance,

you buy with your eyes.

As the industry continues to rely

on the one most marketable banana,

the risk of this massive monoculture

being wiped out by
disease is ramping up.

TR4 has now spread all across Asia,

to the Middle East and then to Africa.

Back in Latin America, one botanist,

Dr. Juan Aguilar,

is the banana's best hope at survival.

We went to Honduras where he,
and his team of scientists,

are inventing new breeds
in the hopes of finding

a marketable, disease-resistant banana.

The pollinator is the person
who make sex with banana.

- Why do you need to do that?
- For example:

I am resistant to cancer,

and you is not resistant to cancer.

We need to make love.

Make sex to get the son who maybe

will be resistant to cancer.

This is the sperm.

Huh?

This is the... the male flower.

If you put your finger, you feel...

that the female is sticky.

This female is ready to make sex...

- ... today. Only today.
- Okay.

So, these little guys are
completely resistant to TR4.

What they've got to do now is
isolate this one resistant trait,

and put it into the
Cavendish, so crossbreed it.

The problem is that could be a
really, really long, laborious process.

These bananas are incapable

of sexually reproducing on their own.

So, Aguilar's doing it for them.

Three months after pollination,

these bananas are harvested,
peeled and squashed.

By Aguilar's own estimates,

it takes about 12,000 bananas

to find a single seed.

Once they find a seed, it's grown
to see what traits it carries,

before being crossbred multiple times

to create the hybrid they're after.

It's kind of worrisome if this is
one of the most viable solutions

for our TR4 problem worldwide.

They've been going for decades,

and they still haven't found
a TR4 resistant Cavendish,

and who knows how many more decades

they're gonna be going for
before they do find one.

While Aguilar continues his search

for that ultimate, golden,
disease-resistant banana,

its future as a monoculture crop

poses a bigger question about
our agricultural systems.

By demanding the cheapest, most
uniform products in our lunch boxes,

we don't just run the risk
of losing the almighty banana,

but also the biodiversity
of life on Earth.

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I'll save the bananas for you.

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Synced and corrected by Aaronnmb
www.addic7ed.com