When the train goes to hell, do all the cars go? Russia will leave the founder of the Higher School of Oncology, Ilya Fomintsev?

Ilya Fomintsev at the rally.

Ilya Fomintsev, a Russian oncologist and founder of the Higher School of Oncology, the “Not in Vain” Foundation, and the “Luch” Oncological Clinic, decided to leave the country after law enforcement officers came to his house. Previously, Fomintsev was detained for 20 days for taking part in protests against the war in Ukraine.

What will be the future of the Higher School of Oncology in Russia, and what awaits Russian oncology?

In late April in St. Petersburg, Polina Fomintseva, wife of Ilya Fomintsev, an oncologist and well-known educator, was walking her large dog, Thor, when she noticed two suspicious men in civilian clothes near her house. At seven o’clock in the evening the men appeared again, this time from the elevator on Fomintseva’s floor. The dog heard them and barked as a warning, Fomintseva recognized the strangers through the peephole and managed to lock the door. The men knocked and shouted at the door for about ten minutes, the dog barked, and Fomin’s wife and three small children became frightened. Through the door, the men identified themselves as policemen and asked to “comment on Ilya’s outing on the streets of Moscow” (at the end of February, Fomin spent eight days under arrest). On February 24, the day Russia launched its war against Ukraine, he left a Moscow cafe near Pushkin Square after reading the news and headed toward the people who were gathering for anti-war protests. On his way, he was stopped by police and detained for eight days. Polina Fomintseva did not open the door for the men, they left, but this incident became decisive. Ilya Fomintsev began to look for ways to emigrate from Russia.

Ilya Fomintsev initially worked as an oncology surgeon at the Leningrad Oncology Clinic, but in the late 2000s, after failing to save the life of his mother, who was diagnosed late with a malignant tumor in her breast, he began to engage in educational activities. Fomintsev organized free mammograms for women who wanted to be screened for breast cancer, and held charity concerts at his home with artists from the Mikhailovsky Theatre and the St. Petersburg Academic Philharmonic, named after Shostakovich, to raise awareness of oncology issues. Then, as now, the problem of the lack of early detection and prevention of cancer was acute. The projects developed, Fomintsev finally gave up his job as a doctor and in 2010 became an educator. The Cancer Prevention Fund was created, later renamed the Medical Solutions Fund “Not in Vain”. Soon, the doctor and his foundation began to engage in the education of the entire country in the field of oncology – Fomintsev gave free lectures, conducted educational forums, launched charitable campaigns and an online service with free consultations with oncologists, educational media on evidence-based medicine and an oncology encyclopedia. In addition, Fomintsev decided not only to educate people, but also to train doctors in the field.

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Together with the N.N. Petrov Research Institute of Oncology, he opened the Higher School of Oncology (HSO), a free residency program for young Russian doctors, who are trained according to the regular residency program of the Petrov Institute and take online classes with doctors from different countries. Residents are trained in critical analysis, communication skills with patients, searching for solutions in diagnosis and treatment using scientific publications, and discussing academic articles with patients. Free education and scholarships were provided by donors – both ordinary people with small regular donations and large corporate partners provided funds for the program. In 2021 there were 60 residents studying at the school simultaneously. The work of the “Not in vain” Foundation costs about 5 million rubles a month. Two years of education for one resident costs about 2 million rubles. The program has been running for seven years, during which 98 people have graduated from the school. The only condition for the graduates was to stay and work in Russia after graduation. This year, the HSO (Higher School of Organization) recruited a new group of 15 people, but there were not enough donations for the scholarship.

BBC: Will your decision affect the work of the fund? Ilya Fomintsev: It will have an impact, but I hope not too much. I will continue to work remotely and hold meetings via video calls. And then I think I will create an organization outside the country. Right now I am trying to create an organization that will be international and not just tied to Russia. BBC: You talk a lot about how the most important thing in medicine is the patient. When you started, did you think that your work would be related to Russia and Russian patients? So it must have been a very painful decision to leave? Ilya Fomintsev: Very much. It took me a very long time to make a decision. It was very difficult to realize my internationality. In fact, there are exactly the same problems in medicine all over the former USSR. Everything we have done in Russia will be suitable for Poland, the Czech Republic, Slovakia, Slovenia and the Baltic countries. I will create a “krestrazh” (Fomintsev uses a term from the Harry Potter books, “krestrazh” is a magical artifact that allows a wizard to remain immortal as long as this object is intact – BBC), in a safe place in terms of systemic economic and political risks for business. First, we are talking about opening educational services for patients, including refugees in such former USSR republics as Kazakhstan, Uzbekistan, Tajikistan, and so on. I have tried everything to reconcile myself with the idea of having to leave somewhere, considering that I have worked like a slave here for 12 years. It’s difficult, understand, I’m a very social person, I don’t want to leave a bunch of friends here who don’t want to leave. But I have to do it for the sake of my family. The last straw was the police visit. That’s why. I’m finished. I’m everything. BBC: How have you been living since the war began? If I understand correctly, at some point you “got drunk”? Ilya Fomintsev: “Drinking – is too beautiful a concept. Not that I fell face down in the dirt, that never happened. But I really drank almost every day, it was the only thing that relaxed me at the end of the day. Now that the decision to emigrate has been made, it has become much easier. BBC: And what about the family, are they ready to move? Ilya Fomintsev: The family is the most important and the most desired. Well, except for the children, of course, they are still young. Right now I’m thinking about Latvia, but a lot depends on the possibilities of legalization, like getting a work permit, which I don’t have yet. I need to find someone who can help me with that. Before there were COVID restrictions, now there are war-related sanctions – everything changes every day. I have never dealt with residence permits or anything like that. To call someone and say, “Vasya, what do I have to do, where do I have to go?” I really don’t know. BBC: Did you not think about this before the war started? Ilya Fomintsev: Of course not, and I haven’t even thought about it. Why should I? Everything was going very well for me here, despite all the problems. BBC: And what kind of problems were there? Ilya Fomintsev: There was a pandemic. We would close, then not close, then open, then close again, then not really close. Then there was a decree excluding all private clinics from the compulsory health insurance (OMS), and I had a private clinic called “Luch”. Then something happened to Luch – Gazprom built an apartment building five meters from the clinic, and the stones cracked. Surveyors came and said: “Guys, thank you, you are free. I found a way to reformat the work of “Luch” and at the same time move the clinic to a new place. We have seen all the black swans (“black swan” – a concept introduced by writer Nassim Taleb, referring to rare and unexpected events with unforeseen consequences – BBC): a pandemic, war, regulatory guillotine, destruction of buildings. What is left – a fire and an alien invasion? I was ready to fight, but then the darkness comes and swallows the city hated by the prosecutor. BBC: Have you had any offers to work abroad? Ilya Fomintsev: Not yet. I won’t be able to work for anyone, I haven’t worked with a boss for 14 years. I can only work with partners or in my own organization. It will only end in a physical confrontation after a month of work, because it’s impossible for me, I don’t know how to work as a subordinate anymore. DEAR BBC: I saw the comments under your post by Ukrainian oncologist Alexander Stakhovsky, who writes that “the [VShO graduates] did not express their position on the war in Ukraine… They were either afraid or, worse, supported the ‘operation'”. Ilya Fomintsev: Yes, the Ukrainians accuse the Russians of passivity. BBC: Why are oncologists unwilling to express their views on the war? Ilya Fomintsev: There are very few people who support the government. This suggests that people are probably against it because they can support the war. They try not to be ostracized by those who are against it. I think that doctors in Russia are very dependent on the state. The overwhelming majority work in state institutions. Those who work in private clinics are also dependent on the state in many ways. Medicine is a highly regulated industry. It is not difficult to destroy a private clinic, so private clinics also sit quietly to avoid any problems.

Young residents of VSHO. In the center is Ilya Fomintsev.

BBC: Where do VHO graduates work after their residency? Ilya Fomintsev: Mainly in Moscow and St. Petersburg. Until we solve this problem, and to be honest, I don’t want to solve it anymore. BBC: Why are you staying in Moscow and St. Petersburg? Ilya Fomintsev: In the regions, the healthcare system is very outdated, it is almost impossible to break through with new ideas or concepts in pharmacies. It is a very aggressive environment. It is easier for graduates to gain experience in central clinics, where there are more medical opportunities. In the federal clinics there were whole islands of outdated medical training. But now they will cease to function. BBC: Tell me about the money. You wrote that donations have decreased. I saw that there are several foreign companies among the donors. What is happening to them? Ilya Fomintsev: Before the war, we were in the negotiation stage, when companies committed to participate in a particular project. We had already exchanged documents and were about to sign contracts. About 50-60 million rubles were lost by these companies. BBC: On the Foundation’s website, among its partners, there is the logo of the Potanin Fund. Have the sanctions imposed on it affected the work of your foundation? Ilya Fomintsev: We worked with him a long time ago, but it was a long time ago and in small things. BBC: Accessible environment for oncology patients – this program is planned until 2024. Ilya Fomintsev: The answers to your questions will harm the fund. Do you understand what’s going on? I cannot answer your questions, because any answer can cause damage. Well, it’s impossible to live and work in such conditions! BBC: You wrote that it will be difficult to buy medicine. Is this already happening? Ilya Fomintsev: I don’t know at what prices they will be bought when the pre-war stocks are exhausted. I strongly doubt that they will be sold at the official exchange rate of the ruble. Most likely, it will not be the case, because the official exchange rate is unlikely to cover the risks of pharmaceutical companies. In the first three weeks of the war in Russia, panic set in, original anticancer drugs began to be rapidly bought up, at some point they disappeared, but then reappeared with a 30-50% markup, according to employees of oncology companies. In Moscow and St. Petersburg, original drugs still remain in treatment regimens, some of which can be obtained through the OMS (mandatory health insurance system). In the regions, it is more difficult, say the BBC interviewees, doctors from state and private clinics. Even before the war, in the Russian regions, original drugs were being replaced in the treatment protocol by Indian or Russian analogues. During the war, the economic sanctions imposed on Russia created logistical difficulties for medical suppliers. However, as long as civilian aircraft can fly, medicines can be delivered to Russia by courier from Israel or Germany. This is expensive and can only be used for individual patients, not for all clinics. BBC: Is there anything to worry about for people with money who can afford private treatment? Ilya Fomintsev: Yes, because the cost of treatment will increase. Oncology is a very expensive business, and it can make anyone sad. It’s a lot of money, millions of rubles. And oncology insurance is a pretty good solution for many. These are relatively small contributions and good coverage – for 5000 rubles a year you get 6.5 million rubles of coverage. You can do a lot with 6.5 million rubles. Oncology insurance is unpopular in Russia, according to the service “Oncology Insurance”. According to their estimates, only 300-700 thousand people in the country have cancer insurance. Even human resources managers of large companies do not consider oncology insurance a necessity, although it is cheap and the number of people diagnosed with cancer is increasing worldwide. Insured persons continue to receive treatment abroad during the war, and it is not necessary to be in Russia for this. BBC: Do you have insurance? Ilya Fominzev: No, I have not been insured yet, because in Russia I can find cancer treatment for myself with just a text message. But now I have to get insurance because I am leaving. BBC: How will the war affect oncology in Russia in the future? Ilya Fomintsev: If you think that war can have any positive effect… Do you really have such thoughts? I’m not going to give any details yet, and no one is going to name them yet. Well, it’s like asking: When a train goes to hell, do all the cars go? Does the 7th car go? Yes, it does. And the 8th? Yes, it goes to hell, too. And all the cars go. Oncology too.

None of the interviewees from state and private clinics and medical organizations who spoke to the BBC was able to determine the future of oncology more precisely than “it wasn’t very good before, and it’s going to get worse”. Due to the unpredictability of the war, no one dares to make predictions about it before the end of the summer.

As long as the treatment of patients depends on existing pre-war contracts with clinics, pharmaceutical companies and doctors, and new contracts are in the process of being signed, the greatest concern is the sanctions on the supply of medical equipment. Clinics are equipped with Philips, Siemens, and Canon equipment, and it will be difficult to replace their spare parts with Chinese or Russian ones. New technologies, in particular, sequencing, decoding the genomic content of cancer cells, are performed with foreign equipment and with the help of foreign drugs, and it is difficult to talk about their future availability in Russia at the moment.

In addition, all new clinical trials (CT) and some types of experimental oncology treatments conducted by European and American companies are suspended in Russia. In the case of CT, this means that Russian patients may be left without new drugs.

In mid-May, after a week-long vacation in Armenia, Fomintsev posted on social media – an announcement about the search for a new owner for the dog named Tora. “It will be very painful for me, but I have to write this. Renting different apartments, moving across borders with all this and a huge 40 kg dog is almost impossible,” Fomintsev wrote on Facebook.

The Fomintsev family claims to have no savings, living “paycheck to paycheck, like about three-quarters of the country. They will most likely move with their three children to Israel, where cancer treatment is a hallmark of the country.

According to the latest estimates by the leading researcher at the Institute of Social Analysis and Forecasting of the Russian Presidential Academy of National Economy and Public Administration, Julia Florinskaya, 150,000 people have left Russia since the beginning of the war in Ukraine.

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