Prof. Dr. Dragan Primorac: I came to Bulgaria to find opportunities for collaboration in healthcare
Former Minister of Science, Education and Sports of the Republic of Croatia prof. Primorac, what is the purpose of your visit to Bulgaria?
The reason I came here is that I want to find all the possibilities for collaboration in health. I came to Bulgaria to meet my long-term friends and partners – New Life Clinic in Plovdiv. There are exceptional professionals in this clinic in the face of Professor. Neri Laufer, who is one of the first doctors in the world who did in-vitro fertilization in humans (fertilization outside the body), founder of IVF centers in the USA and Israel. I am very interested to find out how the model works in Bulgaria because New Life offers a very advanced technology to the Bulgarian market. If I have to be perfectly honest, the Balkans are suffering from a dwindling population and that is why I have been telling our ministers that we build great universities, great roads, but for whom? Who will be there if we lose our young people? Furthermore, I would like to see what the opportunities are, here in Bulgaria.
What is your relationship with the Israeli investors who have made the biggest health investment in the Balkans in the field of reproductive health?
I often go to Israel because they are among the leaders in the field of finance worldwide. When you take care to nurture and develop such great intellectual potential, you stimulate people to live and work in your country and you strengthen the economy. That is why together with them we created a project called “Foundation”, which provides 1,000 scholarships to 1,000 specially selected people, but in areas, which are in need of development in Croatia. If we have too many lawyers and economists, we start giving scholarships to people in the fields of medicine and engineering sciences to increase the students in those given fields. Thus the government is very well aware of what they have. Each country must know where its economy will be in 5, 10, 15 or even 20 years. This is a strategy that can change the entire system.
You, along with Mayo Clinic USA, organize one of the largest conferences on genetics in the world, with the participation of over 40 countries and Nobel-Prize-winning lecturers. Tell us more about it!
The conference in Dubrovnik is organized in collaboration with Mayo Clinic, which was ranked number 1 among hospitals in the US for 2016-2017 (for endocrinology and diabetes, gastroenterology, geriatrics, gynecology, nephrology, neurology and neurosurgery, pulmonology, urology. http: //www.mayoclinic.org/about-mayo-clinic/quality/top-ranked ). We want to send a message regarding the direction in which the medicine of the 22nd century is moving. Furthermore, I am proud to inform you that 5 Nobel Prize winners will deliver lectures at the conference: Avram Hershko, Robert Huber, Paul Modrich, Harald zur Hausen and Ada Yonath. If you look at a list of the other invited lecturers, you will notice that 80% of them are world leaders in the field of medicine. The conference will also be attended by Anthony Atala – the man who cultured the first human organ in the laboratory. This scientific event is also a unique opportunity for young students, an opportunity that could change their lives.
The conference will talk about how to treat diabetes type2, as well as new handling and treatment of genes and stem cells that will enable us to better understand cancer. At the conference the subject of biomarkers discovery and disease prognosis and development will also be discussed. The second major topic will epigenetics (science that studies the influence of the environment on genes) because a common mistake that people make is that everything is written in the genes – not everything, there are external factors. Another subject we will talk about is the human microbiome (the bioflora unique in each person), because we start to lose important bacteria in our intestines, destroying them with antibiotics and thus becoming vulnerable to so many diseases, including autoimmune diseases. Topics from the field of pharmacogenomics will follow (the science that studies how genes influence the intake and processing of medications) because each year 120,000 people in the USA and over 100,000 in Europe die, because the wrong medication is prescribed to them. That’s why we created the first-ever book to explain the composition and effects of drugs. It is very important to know how to properly treat a disease – with proper medication and the right dosage, at the right time.
Conferences like this one can make Europe stronger, as a stage for an important message that will reach many countries, because the conference will be attended by representatives from over 40 countries and about 540 scientists.
If you analyze the topics of the conference you will notice that the first part is dedicated to medicine and how important it is, and the second part to forensics. I personally work in the field of judicial genetics. My mission during the 90s was to develop the field of genetics in order for us to be able to identify the victims of war. Unfortunately, but at the same time thanks to war, with my colleagues from America we were able to develop this field. Now my role is to use DNA technology to fight terrorism and to investigate criminal offenses. Each country should have a database of offenders’DNA. In my new book, I go one step forward – if there is no data in the DNA database for the person of interest, with the help of a new technology, we can predict eye color, gender, age, ethnicity. This is a revolution in forensics because now many cases from the past can be revisited and solved.
Your new book came out recently. Would you tell us more about it? Will it be translated for Bulgarian readers?
My book “Judicial application of DNA: interdisciplinary perspective” is extremely popular in the United States. This is the first book of its kind that covers everything from analysis of crime scenes through DNA analysis, statistics, the DNA of animals, the DNA of plants and court phenotypes to ethical issues, basically covering everything from the crime scene to the courtroom. The information in it is very important for everyone in the law enforcement profession – from constable to judges and lawyers and even students. The book has just been translated into Croatian and Chinese, and I would certainly like to see it translated into Bulgarian. I think it is very critical for the way police operates.
What’s new in personalized medicine on the genetic level?
A year ago, we began implementing a revolutionary procedure – taking fat from the abdomen and from this fatty tissue, we extract the stem cells, clean them and put them on the knee – a year after treatment, we have patients who no longer feel pain in their knee, who begin to move and even play tennis. Half of the patients subjected to this treatment returned to sport activities.
What is the cost of this intervention?
The procedure is expensive, but the government should ask itself the question – which is better – to pay for this procedure or to pay for a number of other things – such as conventional treatment, medication, painkillers, sick leave, eventually a knee prosthesis surgery and the subsequent rehabilitation. So, what is better? To spend a small portion of the money at the right time and in the right way or in time to spend tons of money?
We know that you are the first person to explore the origin of the Croatian people on the genetic level? Tell us more? Are there similarities between our two nations – Bulgarians and Croatians?
The third part of the conference is unique. As part of it, world leaders in anthropological genetics will tell the story of migrations, the history of DNA and genetics. We will publish data on the origin of the Croatian man, uncovered through analysis of the Y chromosome. This chromosome is very specific, because 95% of it does not undergo genetic recombination. When we analyze this chromosome, we discovered that 75% of it belongs to old Europeans, as we call the people who immigrated to this area 22,000 years ago, which means that these people have lived in this part of the Balkans for over 20,000 years! Last 25 percent of the genes were traced back to people who came in the Neolithic period and introduced agriculture and with it new types of food and the possibility of rapid expansion of the population. I have not worked on the genetics of the Bulgarian people, but what I know from a document published in 2013, the majority of Bulgarian men belong to the western Eurasian haplogroup from the post-glacial period. These are the Paleolithic collection groups. According to this document, the second wave, comes during the Mesolithic period, just before the Neolithic and introduces agriculture. The third wave is exactly during the Neolithic period.
The most important highlight is that we, in the Balkans, are lucky because we have had different migrations, which resulted in the mixing of many different genes. That is advantageous, because when people mix, their offspring is healthy. That’s why Bulgarians and Croats are such good athletes.
Prof. Primorac is a former Minister of Science, Education and Sports of the Republic of Croatia.
My first day as minister, I went to the Prime Minister and told him: “Are you sure you want me to be the Minister of Science, Education and Sports?” He said yes, but I replied that it might be a mistake. He asked why. I said to him: “I come from the USA, I am not a typical politician, I do not listen very much and I have my own personal ideas and want to use politics to help science and education.
The day I came in office, the budget of the ministry 1 billion euro. When I left, it was 2 billion, which is the largest increase in the budget of any minister of science and education in Europe. When I came into office only 7.8% of people had higher education, today that number is over 20%. The most important thing was that I introduced the study of two foreign languages in high schools. Now each student studies Croatian and 2 other languages! My team and I modernized the system and now every child in Croatia has an email address as well as access to the Internet. We built over 350 sports halls to make it possible for all Croatian students to play sports. We started with 150 000 children in high school who practice sport and finished with more than 350 000 over a period of six years.
I was able to realize a project which resulted in the return of 140 of the top Croatian doctorate degree holders from the USA. How did I do it? I went to these people and told them that they need to take advantage of the opportunity to make a difference because they are superb at what they do and as minister, I offered each of them a budget of € 150,000 and 1-2 young assistants. I promised them that if they return, Croatia will subsidize the interest on their apartments, leaving them to pay only 1.3%. I made a wonderful package for them and when they returned, all 140 of them brought fresh thinking and revolutionized the system.
I have a recipe for ministers because the biggest mistake that politicians make is that during elections, they all talk about education and science, and the first day after the election, they kill these fields. During my term as minister, I introduced state exams – every student who finishes high school sits for the same test in the same room at the same time with the same questions in order to understand who is who in Croatia. So university entry is dependent only on two things – the student’s high school diploma and his/her test results. This completely smashed corruption in the educational system. Everything was happening electronically and there was no way to have interference. Poor people who have no money but smart, managed to climb to the top and I did not care who is the son or daughter of the president, if they were not good enough, they did not get in. That made me so proud and happy.
Furthermore, through this matriculation system, we could better evaluate teachers. The day after the exam, you know who is who. Let me illustrate my point. For example, if a school has 500 students who applied to do medicine, but only 5 were successful, I go back and check why 495 of those students failed. In this way, we can evaluate who is not a good teacher in these schools and can improve the level of teaching as well as reward teachers who are excellent in their work. Only during communism “all are equal”, the best should be rewarded. Among the people I was the most popular minister in Croatia but I do not think I was the most popular with politicians. If you want to survive in politics, you have to listen, to be quiet and not make changes but I was none of those things. For me the most important were the people!
How much time does it take to see results in this system?
You know, I started 9 years ago and the first results came after the sixth year, but the real changes in the economy and everything else you will only see after 10-15 years. The problem with politicians is that they want immediate change. However, that is also why people do not like politicians, they like leaders, there are many politicians, but few leaders.
The important thing to do when choosing ministers is that they have to be people who are successful in life, before they become ministers. You cannot have ministers who never made money in the private sector and have no experience in real life.
Do young people come back from abroad?
One of the things I do not understand is why people think it is bad for young people to study abroad. It is important to educate young people in different countries, because it is important for people to have an open mindset and exchange information. There is a lot of talk on the subject, I developed a strategy for Croatia and at the same time I was also mentor to 9 PhD students along with many other students. I am currently chairman of the International Committee of the American Academy of Forensic Sciences, a global ambassador for the University of Penn State (http://www.psu.edu), professor at many universities in medicine and forensic science. My mission is to help students to achieve their dreams, because if they achieve their dreams, I will be happy and the world will be happy.
Prof. Primorac, what made you start working in the field of genetics?
Sport has always been my dream since childhood. Ever since I was a young man, I saw so many athletes who struggle because of injuries. As a young doctor, I got involved in the field of bone diseases. And later, when we opened the clinic (St. Katherina Zagreb – http://en.svkatarina.hr) I decided that our priority is physical rehabilitation – orthopedic medicine, medicine of the spine, sports medicine. So I managed to attract the best orthopedic surgeon and the best neurosurgeon to the clinic and we realized that we could change the careers of athletes. It made us very happy.
However, everything we did was not just for athletes. Ordinary people also have access to it and should have access to it. The main concept of personalized genetic medicine is that we diagnose the cause of the problem much more accurately, which allows us to prescribe the most suitable treatment for each individual person.
Her excellency Mrs. Lyerka Alaybeg – the ambassador of the Republic of Croatia in Bulgaria: “Prof. Dr. Primorac is an outstanding scientist and a very interesting person.”
What is your attitude towards the work of Prof. Dr. Primorac?
First, I am very proud, as an individual and as a representative of the Croatian embassy, and I think that Bulgaria should also be proud that Prof. Dr. Primorac is here. He is an outstanding scientist and a very interesting person. I hope that in the future, through the work of prof. Primorac our two countries will develop deeper relations in the fields of biomedical sciences, health insurance and health care. In the past, we have had cooperation in these areas, especially in health care. We have been trying to start a project in the field of IT technology, but sadly governments in both countries are changed too often and when we start a project, we can never quite finish it. Bulgaria and Croatia are one of the rare examples of deep cooperation from the distant past. I think that tradition should continue and we should work very much in that direction.
Prof. Primorac will probably explain more about his work in science, health and sports. As you know, Croatia underwent a terrible war. There were many casualties, many went missing. Specialist able to identify the bodies were needed. Prof. Primorats and his team took on this task. Thus, he became one of the leading scientists in the field of identification and Croatia is now world famous as an expert in this field.
Thanks to this experience prof. Primorats started working in the field of genetics. Croatians, just like Bulgarians, are very interested in the Western Balkans – in the anthropological and genetic aspect. The professor has assembled teams in Zagreb and Split, which are centers of these sciences in Croatia. We already have enough experience and the necessary teams to help the development of other countries in these fields.
How do you think the visit of prof. Primorac will contribute to the development of Bulgarian-Croatian collaboration in the field of medicine?
Prof. Primorac will give details about the conference, which will take place in Dubrovnik. This is one of the leading conferences in its field worldwide. This year it will be attended by five Nobel laureates and more than 500 participants in total. Such attendants is almost a miracle in Europe. Many scientists from around the world were interested in the conference, but unfortunately now have to work on our relations with Bulgaria as Bulgarian officials have not expressed their desire to attend. During the visit of Prof. Primorac our task is to attract Bulgarian scientists, hospitals, doctors and especially the Minister in the relevant field. We will wait, because your government cannot make important decisions like this at the moment, although I think it is a necessity – a move which Bulgaria needs.
We, as an embassy, are interested in any cooperation with Bulgaria. Maybe something you do not know in relation to the field of health is that the pioneer of this field in Bulgaria is a Croat who was a great friend of your famous writer Ivan Vazov. Another interesting fact is that in the early 40s at the Medical University of Zagreb there were more Bulgarian than Croatian students.
In the past there was a very close relationship between Bulgaria and Croatia but during the reign in former Yugoslavia, that relationship was not encouraged and it was lost. In the present day, we trust that we will lay the foundations of these ties again.