Coming up soon at King’s! Conference celebrating the legacy of Joseph Lister: Antisepsis, Surgery, and Global Health.

This year marks the 100th anniversary of the death of Joseph Lister, who was Professor of Clinical Surgery at King’s College, London from 1877 to 1893. The appointment of Lister as William Fergusson’s successor was not uncontroversial, as Lister had antagonised many London surgeons by his remarks on the un-scientific character of surgery in the capital. Having developed his methods of antiseptic surgery at the Universities of Glasgow and Edinburgh, Lister brought ideas and techniques to King’s College Hospital which would prove foundational to subsequent conceptions and practice of surgery and medicine. Lister’s methods of promoting sterility of the surgical field before, during and after operation – his ‘system’ – evolved throughout his career and were grounded in antisepsis. Although Lister’s techniques evolved throughout his career, they remained true to the fundamental notion that infection is caused by germs, and that prevention of germs from entering the wound (asepsis) coupled with precautionary measures if they gained entry (antisepsis) is the surest method of avoiding infection. From March 22nd to March 24th 2012, King’s College London will be hosting a major conference to celebrate Lister’s legacy, and will be examining both the significance of his techniques in their historical context, and the enduring impact that Lister has had on twentieth- and twenty-first-century medical and surgical practice. The conference will be run in association with the Royal Society and the Hunterian Museum at the Royal College of Surgeons, and events will take place at both of these institutions and at the King’s College London Strand Campus. You can access the full program of the conference here The conference will be of interest to academic historians, clinical and healthcare scientists and practitioners , bioscience, health policy and management professionals, and those with an interest in Lister, Listerism and the development of antiseptic surgery. Only a few days are left to register for the conference! The last booking date is March 8th.
Follow this link for registration.

Getting rid of entrenched but erroneous perceptions: cancer burden in the next decade.

While cancer is still broadly perceived as disease of high-income countries (HICs), nowadays low-middle income countries (LMICs) bear a majority share of the burden of cancer, and this trend will only be increasing over the next decade. Some figures are telling: over 70 % of all global cancer deaths occur LMICs, where cancer claims over 5,3 M lives each year. The rising proportion of cases in these countries is caused by population growth and ageing, combined with reduced mortality from infectious disease.
For many types of cancers, future changes in incidence, survival, and mortality rates will greatly depend on whether key risk factors can be controlled in LMICs, as in these countries major risk factors continue to rise and awareness of the importance of screening and early detection is low. Besides, in LMICs stigma associated with cancer and the financial barriers of poverty prevent many people from seeking preventive services or care at early stages.

While a widespread assumption is that cancer control and care is not feasible or effective in LMICs, the following evidence challenges it, and supports a global policy change:
1) much can be done without the latest and most expensive technologies to treat cancer. Indeed, for several cancers, life can be substantially extended with fairly low cost system drug treatment, mostly through prevention (tobacco for lung cancer, HPV per cervical, head and neck, anal cancer, hepatitis infection for hepatocellular cancer). Other cancers, as cervical, breast, colorectal, are potentially curable with early detection and treatment, including surgery.
2) pain control is typically low cost and easily delivered, and the barriers to delivery are mostly caused by substance controls. Better regulation for pain control could have a substantial impact at improving quality of life of oncological patients.
3) lessons from the past: think of HIV! A decade ago, vehement critics were asserting that complex care as that needed for AIDS could not be scaled up within weak health systems, such as sub-saharian Africa. However these predictions proved wrong, and represent now a fundamental precedent that we cannot ignore. The increasing burden of cancer in LMICs represents a problem of unacceptable inequality in the distribution of resources worldwide, and requires a transition from a policy focus on public health to a policy focus on global health. According to the definition proposed by Lee & Collins (2005), the transition from public health to global health issue occurs where “The determinants of health or health outcomes circumvent, undermine or are oblivious to the territorial boundaries of states and this beyond the capacity of individual countries alone to address through domestic institutions”.

The perception that cancer is a disease only of HICs is deeply entrenched in our society, but it has been proven erroneous, and needs getting rid of. Such a perception leads to an underestimation of the costs associated with premature death and disability in LMICs: according to current estimates, only around 5 % of global resources for cancer are spent in LMIC countries, while these countries get around 80 % of the disability-adjusted life years lost worldwide to cancer. This is the so-called 5/80 cancer disequilibrium and is no longer acceptable.

Further reading:

Farmer P, Frenk J, Kanul FM, et al. Expansion of cancer care and control in countries of low and middle income: a call to action, Lancet 2010, doi:10.1016/S0140-6736(08)61345-8.

Global Task Force on Expanded Access to Cancer Care and Control in Developing Countries, 2010.

Lee K, Collin J, eds. Global change and health. Maidenhead, Berkshire UK; McgrawHill, Open University Press 2005.