facebook and the world

I am presenting a fascinating and visually stunning map which was created by a facebook intern named Paul Butler. He explains how this piece was generated: “I defined weights for each pair of cities as a function of the Euclidean distance between them and the number of friends between them. Then I plotted lines between the pairs by weight, so that pairs of cities with the most friendships between them were drawn on top of the others. “ You can read more on the topic here. The map shows that Russia and China are completely out of FB’s world, so it is most of Africa. In fact, Russia and China use some facebook clones, namely vkontakte.ru and renren, which are character friendly and provide, at least for China, government-friendly censorship of several key terms. Moreover, most of Africa and some parts of the southern American continent are not covered by the internet.

It is impressive that, at least in subsaharan Africa, the map does also illustrate the only countries where an efficient prevention of tumors is available. In fact, the prevention of cancer of the uterine cervix, breast and liver has been started only in South Africa, in Kenya -Tanzania, in Ghana - Nigeria, exactly where facebook lines are present in the map.  It seems fairly obvious that the pattern of diffusion of the internet in Africa (and facebook, as a consequence) reflects a higher level of civilization and a deeper consciousness of social health problems in those countries.

Sign now for a cancer free world

The Union for International Cancer Control (UICC) is the leading international non-governmental organisation dedicated to the global prevention and control of cancer. It is set in Geneva, Switzerland, and was founded in 1933. UICC is the “custodian” of the World Cancer Declaration which is a call to action to substantially reduce the global cancer burden by 2020.The declaration was unanimously adopted at the World Leader’s Summit of policymakers, leaders & health experts during the 2008 World Cancer Congress in Geneva. The Declaration calls on the world to take immediate steps to reduce the global cancer burden and outlines 11 targets to be achieved by 2020. These include: 1) development of sustainable delivery systems to ensure that effective cancer control programmes are available in all countries; 2) improved measurement of the global cancer burden and the impact of cancer control interventions; 3) reduction of global tobacco consumption, obesity and alcohol intake levels; 4) effective widespread vaccination of populations in the areas affected by human papilloma virus (HPV) and hepatitis B virus (HBV); 5) improved public attitudes towards cancer by dispelling damaging myths and misconceptions about the disease; 6) improved diagnosis of many cancers when still localized through the provision of screening and early detection programmes; 7) increased access to accurate cancer diagnosis, 8) appropriate cancer treatments, supportive care, rehabilitation and palliative services for all patients worldwide; 9) increased access to effective pain control measures for all cancer patients in pain; 10) increased number of training opportunities available for health professionals in different aspects of cancer control; 11) achievement of major improvements in cancer survival rates in all countries. The declaration can be downloaded from the UICC website in different languages. Currently about 128000 people and 1035 organizations from all over the world have signed it. The reasons why everybody should do so are that cancer kills more people than AIDS, Malaria, and Tuberculosis combined, and the death toll is set to rise dramatically in the coming decades; two-thirds of cancer-related deaths occur in countries where resources available for cancer control are limited or nonexistent; without significant improvement, over 17 million people are projected to succumb from this disease by 2030; many cancers can be prevented, and several cancers can be cured if detected early and treated appropriately. This blog has been provided by a link to allow people to sign the Declaration (see the column on the right) . Let’s support such a call to action!

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.

Cancer of the cervix uteri, a preventable tumor

Cancer of the cervix uteri is the second most common cancer among women worldwide. About 86% of the cases occur in developing countries. Every 10 minutes, a woman in Africa dies from cervical cancer, despite the fact that almost every case is preventable through a programme of screening, treatment and vaccination against the Human Papilloma Virus (HPV). In Madagascar it is the most commonly detected malignancy in females with an incidence >45 cases / 100000 inhabitants per year. According to the African Oxford Foundation "Globally there are over 500,000 new cases of cervical cancer annually and in excess of 270,000 deaths, accounting for 9% of female cancer deaths. 85% of cases occur in developing countries and in Africa Mortality rates vary seventeen fold between the different regions of the world. Cervical cancer contributes over 2.7 million years of life lost among women between the ages of 25 and 64 worldwide, some 2.4 million of which occur in developing areas and only 0.3 million in developed countries. Africa has 9 times the incidence of cervical cancer compared to the USA and 24 times the mortality. Cervical cancer incidence and mortality rates have declined substantially in Western countries following the introduction of screening programmes. Screening programmes in Africa, are however, often rudimentary or non-existent. The vast majority of women who suffer cervical cancer in Sub-Saharan Africa present with disease advanced far beyond the capacity of surgery or other treatment modalities to offer cure. Palliative care services are very poorly developed and therefore these unfortunate women are sentenced to a miserable end of life.