Salgado's afro-pessimism

Sebastiao Salgado is one of the most famous photojournalist in the world. Educated as an economist, he began his photography career in 1973 while traveling for work for the International coffee organization. Working entirely in a black and white format he has been able to construct penetrating images of the dispossessed peoples all over the world. He has a great respect for his subjects and always testifies to the fundamental dignity of all humanity while simultaneously protesting its violation by war, poverty and other injustices. He has published several books. One of them, Africa is an homage to the continent’s people and wildlife. The most impressive photos depict returning refugees, child soldiers, child portraits, rural workers, breathtaking pictures of Rwanda, hospitals, villages, etc. The majority of the pictures focus on what the text describes as “afro-pessimism”.  In fact, most of his pictures make you weep but this is done  with dignity and respect to the subjects in the photographs. Looking at Salgado’s work especially in this book is like being transported to another world, one that in many respects, and unfortunately, still exists. He has the ability to describe so many bad things making something beautiful out of it while, at the same time, not diminishing the suffering or the value of the subjects. Afro-pessimism is probably a feeling one cannot avoid when faced to the poverty, injustices, and human misery which are still so great and prominent sometimes in the life of African people. This blog is probably a little afro-pessimistic too but such a feeling, or attitude, is a positive one; in fact, talking about the problems serves as a stimulus to solve them. As many people as possible in the developed world should be invited to participate, to be part of the discussion, to get to know the real problems, to be truly concerned about what is going on in the underdeveloped world. Even a blog can help.

targeted therapies for advanced cancer or primary prevention of tumors: ethical and economical issues.

Targeted terapies have significantly changed the treatment of cancer over the past 10 years. These drugs are now a component of therapy for many common malignancies, including breast, colorectal, lung, and pancreatic cancers, as well as lymphoma, leukemia, and multiple myeloma. They are a sort of smart bombs designed to target the cancer cells and block or slow the growth of certain types of cancer minimising damage to healthy cells . Most of them, however, improve survival by only a few weeks or months but they don’t cure cancer.

Targeted therapies are incredibly expensive. For example multidrug colorectal cancer treatment regimens containing bevacizumab or cetuximab cost up to $30,790 for eight weeks. In the United States, sales of erlotinib, a drug which is able to prolong survival by few months in a selected fraction (no more than 20%) of lung cancer, totalled $457 million in 2008 (Annual report to shareholders, 2008. Genentech). This is the reason why their use is an opportunity and a threat to every system that simultaneously seeks to improve the health of its members or citizens and to work within ever-tightening budget constraints.

These considerations open additional ethical issues. It is better to invest on a minimal increase in time survival for a patient with highly advanced gastrointestinal or pulmonary cancer or, instead, on the primary prevention of some preventable tumors when this is feasible?. Carcinoma of the cervix uteri represents a good example of preventable tumor. There is, in fact, compelling evidence that vaccination against human papilloma virus (HPV) in young girls allows total prevention of the tumor. Gardasil, the HPV vaccine, is currently being offered for approximately $120 per single dose. Three doses are required over a 6-month period, making the total cost for the HPV vaccine about $360. With the same amount of money which is required to treat a patient with advanced colon cancer administering the above multidrug treatment regimen ($30,790) we could pay for a vaccination campaign against HPV for 87,500 girls (!). While the patient with colon cancer will eventually die, the above population of future women will be be totally protected from carcinoma of the cervix uteri. I am well aware that biotechnological research in pharmacogenomics should not be stopped because it will eventually provide, in the future, the magic drug to stop cancer. At the same time, however, money should be used also for people of the third world to cope the emerging epidemic of preventable tumors at least because this will impact beneficially the life of the whole planet.