El médico neumonólogo argentino radicado en Canadá desde 1981, que dirigió el equipo de médicos que logró controlar la epidemia del SIDA mediante medicación.
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00:00At that time, it was discussed how to cure what was called at that time the AIDS, a little despectively.
00:07And at a given moment, a team of researchers appeared,
00:11who were arguing that it could be stopped,
00:15that AIDS could be turned into a chronic disease with a cocktail of drugs.
00:20And this seemed magical.
00:21Imagine that all the 90s and 2000s had gone through the fear of having sexual relations,
00:26being conservative.
00:28And in that team, there was an Argentine, and they argued it,
00:32they said, no, it's going to be possible, it's not going to be possible.
00:34And finally, it was possible.
00:36That man is sitting here at this table,
00:38he is Julio González Montaner, he is a neuromonologist,
00:40he is a researcher, registered in Canada,
00:45that's why you're going to see a rare registration.
00:47The media law does not force us to put a registration of when he is an Argentine doctor.
00:51He is Argentine, but he is registered in Canada.
00:55Good morning.
00:56Good morning, Orlando.
00:58What happens when you go around the world,
01:02and you are one of those who collaborated so that today,
01:06HIV is like hypertension, for example, that can be treated with drugs.
01:10Before, people were dying and there was nothing to do.
01:15Look, when I went to Canada in 1981,
01:17I went to train, actually,
01:20and right at that moment, an epidemic began,
01:24which, as you described, was devastating.
01:27What did you do? Was it private life?
01:29It changed everything, it changed society, it changed everything.
01:32And I, as I was doing,
01:34my specialty is pneumonia, like my father.
01:38And then I started treating patients who were dying
01:41with a very bad pneumonia, which was called pneumonia porneumocystis carinii.
01:45And we found a treatment for them,
01:47prevention, we changed their lives.
01:50But unfortunately, my patients died the same,
01:52because the virus continued to progress and the immunity...
01:55And it lowered the immune system.
01:57Exactly. And then, a little, how can I tell you,
02:00I felt the challenge that, having intimate knowledge
02:04of the difficulties that the disease created,
02:07that I had a strategy that could work.
02:11And using the teachings of my father,
02:13the treatment of tuberculosis,
02:15I began to do studies of combination of antivirals
02:19to counteract AIDS.
02:21And ten years passed, but in 1996,
02:24I had the privilege of being able to show the world,
02:28from Vancouver, where I work,
02:30that if we used triple therapy at that time,
02:33we could stop the viral replication,
02:36with which the individual recovers,
02:38from an immunological point of view,
02:40there is no progression in the disease.
02:42It negativizes.
02:43Yes, but much more important.
02:45First, you don't get sick. Second, you don't die.
02:48And third, as you say,
02:50in a negative way, the viral load,
02:52there are no more viruses circulating,
02:54and therefore that person no longer infects.
02:58And that gave us the guideline
03:00that we could use the treatment as prevention.
03:04And we started a new campaign from 2006,
03:07and in 2024,
03:10we announced that in the province of British Columbia,
03:13the HIV and AIDS epidemic is absolutely controlled.
03:18The problem we have
03:20is that we continue to diagnose more patients,
03:22because the rest of the world
03:24is not yet in the same control environment
03:27that we have in the province of British Columbia.
03:29And then our campaign is to try to show people
03:33the opportunity we have to practically eliminate
03:37this incredible challenge that was HIV and AIDS,
03:41but for that we don't have to put the batteries.
03:43Now, you worked so much with the great virus of the 90s and 2000s.
03:49Now you are working on diseases that are not transmitted by virus.
03:53Look, what happened was this.
03:55In 2015, I had the privilege
03:58of being able to bring the rest of the world to Vancouver
04:00to see what we were doing.
04:02We achieved that the United Nations,
04:04the World Health Organization,
04:06and all the countries of the world coordinated,
04:10agreed that our strategy of the 90s,
04:1390s, 90s, I don't care about the details,
04:15but in any case, the treatment for prevention
04:18would be the new global guideline
04:20to be able to basically control HIV and AIDS
04:24for the year 2030.
04:26At that moment, I realized
04:29that the experience we had
04:31was an extremely important experience
04:33and that it opened the door
04:35for the rest of the world to do what we did
04:38and we started to make a path
04:41to control other infectious diseases.
04:44For example, other diseases of sexual transmission,
04:47syphilis, gonorrhea, chlamydia, monkeypox,
04:50for example, hepatitis C, and many others.
04:54And we started those campaigns with great success.
04:57And therefore, we started to think
04:59if this works for infectious diseases,
05:02in an infectious way,
05:04why don't we try to adapt the strategy
05:07for social contagion diseases?
05:09And that's where I'm amazed,
05:11because what you're talking about,
05:13social contagion diseases,
05:15you're talking about tobacco,
05:17I also deduce alcohol, obesity,
05:19and I suppose drugs.
05:20Exactly.
05:21And then we have a...
05:23But what happens is that there is also
05:26the human condition, right?
05:28Of course.
05:29How to work, how to do,
05:31that is, the prevention that comes in rationally
05:34that the man, in his impulses,
05:36stops doing the things
05:38that end up screwing up his life.
05:40Look, what happens is this.
05:44In a way, the AIDS challenge
05:47changed our mentality.
05:49Why?
05:50Because, you know,
05:51and you said it in the introduction,
05:53in the first decades of AIDS treatment
05:55was the ABC,
05:57abstinence, be faithful, and condom.
05:59Abstinence, monogamy,
06:01be monogamous,
06:02and use a condom.
06:06And that is difficult.
06:07And it came from the sexual revolution
06:09of the sexual changes in the 70s.
06:11We had to turn it around.
06:13What we realized is that
06:15we have to be more inclusive
06:17in our way of thinking,
06:19that behavioral changes are important,
06:21but not only behavioral changes,
06:23but we have to support people
06:24who need behavioral changes
06:26with information, with education,
06:28and as long as there are treatments
06:30that can help facilitate,
06:32for example, the abandonment of the use of tobacco,
06:34the replacement of toxic drugs
06:36with less toxic drugs,
06:38and the cessation of the use of drugs.
06:40Well, a good part of contemporary diseases
06:42have to do with habits.
06:43Exactly.
06:44I mean, everything from the heart,
06:46diabetes, lungs,
06:48have to do with...
06:49Neurovascular accidents.
06:51Hypertension.
06:52It has to do with bad habits.
06:53And at that point,
06:54how important is the State
06:55or public health
06:57for prevention
06:58and also for the research work
07:00that you do?
07:02Well, I tell you,
07:04my relationship since 1996
07:07with public health
07:09and with politicians
07:10is precisely what changed everything.
07:12Because now, let's say,
07:13I'm no longer a typical doctor
07:15who sits in the consultation
07:17and waits for you to come.
07:18No, no.
07:19Now, my program,
07:21what it does is
07:22we hook up with the government,
07:23we hook up with public health,
07:25and all together
07:26we are going to look for you.
07:27Of course, of course.
07:28You can be a privileged person
07:30that tomorrow your head hurts
07:32and you say,
07:33I have to go see Dr. Montaner.
07:34Or that tomorrow you have
07:35any problem
07:36and you know where you have to be,
07:38what you have to do
07:39to be able to find the solution.
07:41The problem is that
07:42most of the patients
07:44have priorities
07:48that compete
07:49from the economic point of view,
07:51from the point of view of family,
07:52from the point of view
07:53of what they want to do, etc.
07:55And HIV and AIDS, for example,
07:57have a ten-year incubation phase.
07:59If I tell you
08:01that you have to stop working
08:03because you have to come see me,
08:05it doesn't work.
08:06So what we have done
08:08is transfer the responsibility
08:10that you have access
08:12to our services
08:14to the program.
08:16And therefore,
08:17what is needed to help you
08:18so that you can do it,
08:20we will do it,
08:21including bringing the medication to your house.
08:23Sure, because that meeting
08:24was a benefit for society too, right?
08:26Exactly.
08:27And at the end of the road,
08:28I suppose also in the savings
08:29of public health funds.
08:30Of course, of course.
08:31Because the sick patient
08:32costs more than the healthy patient.
08:33Exactly.
08:34Exactly.
08:35There has to be someone who understands it.
08:36That was the key
08:38that opened the door
08:39for me to the government house.
08:41When we did
08:43the first paper,
08:45let's say,
08:46that we had to change
08:47the schedule of the program,
08:49what we did was calculate
08:50the return on investment.
08:51And that's when they started listening to you.
08:52And they said,
08:53ah, look,
08:54we save money.
08:55We did the return on investment.
08:57You calculate it.
08:58I'll give you a very simple example.
09:00Suppose that this treatment
09:01solves the problem of HIV and AIDS.
09:03It's expensive, yes, of course.
09:05We understand that.
09:07What you have to do
09:08is look for
09:09what is the benefit it brings.
09:11From the point of view
09:12of morbidity and mortality,
09:14HIV and death prevention,
09:16this will give you
09:17a return on benefit
09:18that forms,
09:19it's something like this,
09:22determined.
09:23Doctor,
09:24I face all the time
09:25on the subject of prevention
09:26something that hurts me
09:27and bothers me.
09:28There are people
09:29who come to tell me,
09:30who come to consult me
09:31if they are in a condition
09:32to retire,
09:33maybe not.
09:34And he tells me like this,
09:35a short guy,
09:36I have HIV
09:37and in my job
09:38they don't know.
09:39So,
09:40it would be good
09:41to talk to all those people
09:42from the medical field
09:43and ask you,
09:44today,
09:45HIV is still
09:46a topic of marginality,
09:48it is still
09:49a medical limitation,
09:51medically.
09:52Absolutely not.
09:53HIV today
09:54is no different
09:55than hypertension
09:56or diabetes.
09:57Well treated,
09:58you will have
09:59a normal longevity,
10:00you will have
10:01a normal reproductive life
10:02and you will die
10:03the same way
10:04we all die
10:05when we are old.
10:06But,
10:07I tell you more,
10:08if you allow me
10:09to finish.
10:10The return on investment
10:11for a medicine
10:12that works
10:13to ten points
10:14is excellent,
10:15but if that intervention
10:16prevents
10:17the death
10:18of a person
10:19or two,
10:20the return on investment
10:21will be exponentially
10:22greater.
10:23Why?
10:24Because
10:25if you don't
10:26transmit it
10:27to one,
10:28two,
10:29three,
10:30four,
10:31five,
10:32whatever you want,
10:33they will not
10:34transmit it either.
10:35But,
10:36on the other hand,
10:37the teams
10:38also play.
10:39So,
10:40the food industry,
10:41the tobacco industry,
10:42there are a number
10:43of guys
10:44who also play.
10:45There are
10:46a lot of
10:47guys
10:48who play.
10:49Let's remember
10:50what happened
10:51in the Clinton era
10:52when they were
10:53about to
10:54ban tobacco,
10:55when the food
10:56industry,
10:57which is also
10:58responsible
10:59for much
11:00of what
11:01happens
11:02in the long
11:03term
11:04in health,
11:05they also
11:06say,
11:07well,
11:08they also
11:09play.
11:10And that's why
11:11the regulatory
11:12field
11:13plays a very
11:14important role
11:15in this.
11:16And what
11:17we are advocating
11:18is that,
11:19yes,
11:20it's not like
11:21the shrink inflation,
11:22that we change
11:23that to make
11:24more money.
11:25No,
11:26what we have
11:27to do
11:28is that the
11:29portions are
11:30smaller
11:31to be able
11:32to improve
11:33health
11:34and that the
11:35price is
11:36measured
11:37with the
11:38volume
11:39that I am
11:40selling you
11:41and not
11:42that they
11:43sell you
11:44half a bottle
11:45of
11:46this
11:47and
11:48that
11:49they
11:50sell
11:51you
11:52not
11:53half a
11:54bottle
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11:56this
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11:58that
11:59they
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