Pragmatische Lösung eines komplexen Problems Schweizer ...

PRESSESPIEGEL
millions de citoyens à être ouvertement et pleinement
informés sur les décisions majeures
qui pourraient avoir un impact sur leur santé et
leur bien-être individuels».
Margaret Chan a nommé un groupe d’experts
chargé d’examiner la réponse à la pandémie
et la manière dont a été appliqué le Règlement
sanitaire international. Ce groupe a commencé
ses travaux. Mais ce dont l’OMS a besoin rapidement,
c’est d’un sérieux dépoussiérage de
ses procédures et de la mise en oeuvre d’une
véritable transparence et d’une sanctuarisation
de ses décisions à l’égard de toute influence,
notamment celle d’intérêts privés. Faute de
quoi, non seulement l’OMS aura dilapidé le
crédit qu’elle avait accumulé jusqu’ici face aux
grands défis sanitaires, mais elle aura laissé le
monde sans cabine de pilotage face à une future
pandémie, qui ne sera pas nécessairement
aussi clémente que l’a été, jusqu’ici, celle de
2009-2010.
Le Monde, 7 juin 2010
Moving cancer up the global
health agenda
40 years ago, cancer was a scourge mainly affecting
developed nations. But, as the latest
global cancer data from the International Agency
for Research on Cancer (IARC) confirm, most
new cases of cancer and deaths from cancer
now occur in developing countries.
Released on June 1, IARC’s GLOBOCAN 2008 -
an online resource that provides the most accurate
estimates of cancer incidence and mortality
in countries currently available - shows that
in 2008, 53% of the 12.7 million new cases
of cancer and 63% of the 7.6 million cancer
deaths worldwide occurred in developing countries.
Projections from GLOBOCAN 2008 also
suggest that this trend is likely to remain over
the next couple of decades.
The proportion of new cancer cases in developing
nations has increased in part because of
better control of infectious diseases in these
countries, population growth and ageing, and
changes in lifestyle. Meanwhile, in developed
nations, cancer prevention and early detection
have improved. Additionally, low survival rates
for cancer in developing countries and improved
survival in the developed world have led
to the biggest concentration of cancer deaths
falling on the poorest nations.
However, cancer control and care have remained
a low priority in developing countries
and on global health agendas. Data from GLO-
BOCAN 2008 should help to change this situation.
On a practical level, countries can use
the software to produce an important piece of
public health documentation showing the priority
cancers in their populations.
Acting on the data will, of course, prove more
difficult. Most low-income and middle-income
countries have health systems that are poorly
prepared to grapple with the double burden
of infectious and non-communicable diseases
such as cancer. Poor economies cannot currently
access curative therapies, state-of-theart
surgery, or expensive cancer drugs that are
the mainstay of cancer care in developed nations.
Therefore, scaling up prevention and early
diagnosis will be the most cost-effective ways
of dealing with cancer in developing countries
in the near future.
Tobacco control will be key. Overall, smoking
prevalence continues to increase in many lowincome
and middle-income countries: 82% of
smokers are in these nations. All countries, including
developing nations, need to sign and
ratify the Framework Convention on Tobacco
Control, which contains evidenced-based provisions
to reduce tobacco use through reduction
in demand and supply. Health ministries should
see tobacco control as a broad effort to tackle
not only cancer but also other non-communicable
diseases, such as cardiovascular diseases
and chronic respiratory diseases.
Additionally, synergies between efforts to
control cancer and existing health initiatives
should be sought. For example, GLOBOCAN
2008 shows that cervical and liver cancers
are much more common in developing regions
than in developed regions. Most liver cancers
can be prevented by simple childhood immunisation
against hepatitis B, and cervical cancer
can be prevented by vaccination of adolescent
girls against the human papillomavirus (HPV).
Such vaccines could be incorporated into established
vaccination programmes.
Cost, however, is an issue. The HPV vaccine
and most life-saving cancer drugs remain prohibitively
expensive for developing countries. To
this end, the work of the Global Task Force on
Expanded Cancer Care and Control in the Developing
World, launched in November last year,
will be crucial. The Task Force aims to design
and implement global and regional initiatives
for the financing and procurement of affordable
cancer drugs, vaccines, and services. Innovative
financing mechanisms, such as those created
to procure antiretroviral and antimalarial
drugs for developing nations, should be developed
for anticancer vaccines and treatments.
Furthermore, the staggering imbalance in the
distribution of resources needs to be rectified.
Only 5% of global cancer resources are currently
spent in developing countries, which account
for almost 80% of disability-adjusted life years
lost in the world to this disease.
There is hope for improved resources for noncommunicable
diseases, including cancer.
Thanks to a concerted effort by WHO and partners,
the huge burden of chronic diseases in
developing countries is starting to get the attention
it deserves on the global health stage.
This visibility was marked by the recent passing
of a UN resolution to tackle non-communicable
diseases. But much remains to be done. The
data from GLOBOCAN 2008 should provide the
first steps on what is likely to be a long road to
improving cancer control and care in developing
nations.
Am Lebensende
The Lancet, June 12, 2010
Es war ein komplizierter Fall, den der Bundesgerichtshof
als Revisionsinstanz in einem Fall
von Sterbehilfe zu entscheiden hatte. Letztlich
haben sich die Karlsruher Richter, obwohl die
zu beurteilenden Tatbestände davor lagen, bei
ihrem Freispruch auf das Patientenverfügungsgesetz
vom 1. September 2009 als Rechtsgrundlage
berufen. Das könnte man positivistisch
nennen, was in Deutschland oft kritisch
gemeint ist; im vorliegenden Fall erscheint es
aber weise.
In ihrer Begründung geben die Richter zu Protokoll,
dass die Rechtslage wegen «miteinander
nicht ohne weiteres vereinbarer Entscheidungen
des Bundesgerichtshofes» und «Divergenzen
in der Rechtsprechung» vor der Verabschiedung
des Gesetzes unklar gewesen sei - eine
für Ärzte kaum zumutbare und für Angehörige
schwer erträgliche Lage. Auf die ethischen und
rechtsphilosophischen Fragen, die mit dem Problem
der Sterbehilfe verbunden sind, gehen sie
insofern ein, als sie eine an Äusserlichkeiten
orientierte Unterscheidung von «Tun und Unterlassen»
verwerfen; fast salomonisch subsumieren
sie beides unter den Begriff «Behandlungsabbruch».
Ob der Unterschied zwischen einer
«auf Lebensbeendigung gerichteten Tötung»
und «Verhaltensweisen…, die dem krankheitsbedingten
Sterbenlassen mit Einwilligung des
Betroffenen seinen Lauf lassen», trennschärfer
und rechtlich praktikabler ist, wird sich allerdings
noch zeigen müssen.
Die letztlich nicht abschliessbare Debatte darüber,
ob eine Jahre zuvor abgegebene Patientenverfügung
über die Zeit gültig bleibe oder
ob es darüber hinaus nötig oder überhaupt
möglich sei, den mutmasslichen Willen einer
im Wachkoma liegenden, sterbenden Patientin
200 Schweizer Krebsbulletin • Nr. 3/2010