Railing
against cancer!
At
a time when the fight against cancer is enjoying a second wind with the advent of new
therapies, France is preparing to implement a massive anti-cancer scheme.
By Emmanuel
Thévenon, journalist
Imatinib was the
breakthrough ... For Professor François Guilhot, of the Jean-Bernard Hospital in
Poitiers, this drug is no less than "the equivalent of penicillin in the treatment of
infections". Indeed, a number of studies show that almost 90% of patients suffering
from chronic myeloid leukaemia or Gastro-Intestinal Stromal Tumour (GIST) have seen their
condition improve in a spectacular way. Of these, half have experienced full remission.
Unheard of.
Cancer arises from the
uncontrolled proliferation of abnormal cells that have become insensitive to messages from
the body ordering them to "kill themselves" (apoptosis). They then gradually
invade the surrounding tissues to form a tumour. They may also travel through the body to
form new tumours, or metastases. Unlike traditional chemotherapy treatments, which also
damage healthy cells, Imatinib only attacks cancerous cells. It has almost no side effects
and significantly reduces the risk of the occurrence of metastases. First available a year
ago, it is soon to be followed by a new family of drug treatments, just as
"targeted".
Less mutilating
surgery
Until now, the fight
against cancer, which affects 700,000 patients in France*, was advancing in slow steps -
it took twenty-five years of scientific progress in many fields to raise the cure rate
from 20% to 45%, for all cancers. Among the successes are breast and testicular cancers:
the five-year survival rate of these diseases is now 70% for the first and 85% for the
second.
This considerable
progress is the result, amongst other factors, of the spectacular development of medical
imaging: after radiography, ultra-sound, scanning, scintiphotography, and MNR (magnetic
nuclear resonance) come today’s PET scans. Positron Emission Tomography can pick up
tumours measuring only 4 or 5 millimetres.
Surgery is becoming
less and less mutilating and invasive. In the treatment of breast cancer, for example,
intervention is now usually limited to removing the tumour and not the whole breast.
Combining it with post-operative radiotherapy offers the same chances of tumour control as
a mastectomy (ablation of the breast). Radiotherapy is also benefiting from new
technologies, but it is chemotherapy above all, much used as a complementary treatment in
cancers of the breast, colon and ovary, that has made huge advances. A more effective
treatment, it also has fewer side effects (nausea, fatigue, etc.) than before.
But not all cancers
have benefited from these therapeutic advances. The five-year survival rate for cancer of
the pancreas remains desperately stuck at 4%, and 8% for lung cancer, even though it is
one of the most common. The figures: each year there are 270,000 new cancer cases
(compared to 170,000 in 1980) and almost 150,000 reported deaths.
Structural
weaknesses
The general ageing of
the population explains this large rise in the number of people affected, so the trend
will not be reversed for a long time. An aggravating factor is the recent dramatic
increase in women smoking which is also expected to lead to a sharp rise in the number of
lung cancer cases in the near future.
Yet, according to David
Khayat, head of the medical oncology department at the Pitié-Salpêtrière hospital in
Paris, "Almost 45,000 deaths caused by cancer each year could be avoided if optimum
use were made of all the resources available to us today, both in screening and treatment
of the condition."
Several reports and
national commissions have pointed the finger at the structural weaknesses of the fight
against cancer in France. Action is too often fragmented, there is a recruitment problem
with cancer specialists and radiotherapists, a shortage of medical imaging equipment
(especially PET scanners), a weakness in applied research and a lack of involvement by the
French pharmaceutical industry in the field of cancer, a serious shortage of psychologists
specialising in the treatment of cancer patients... Without a national register, we
don’t even know exactly how many cancer sufferers there are! The consequences are
that there is neither epidemiological monitoring nor an assessment of the financial cost
for a disease which is the second most common cause of death in France. This attitude is
all the more regrettable in that treatments, particularly the latest generation of drugs,
cost a great deal of money: treating one patient with Imatinib costs 30,000 euros a year,
and twice as much in the acute phase.
Psychological
support
Referring to a real
"national tragedy", the President of the Republic, Jacques Chirac, has made the
fight against cancer one of the "major projects" of his five-year term
(2002-2007). In March 2003, he presented an ambitious "cancer plan" which will
be implemented over "five years and cost half a billion euros."
Its first commitment is
to step up the "war" against tobacco, through massive prevention campaigns and
by increasing prices, which will help dissuade the youngest. The plan also makes provision
to strengthen the fight against cancers of occupational origin and to extend screening.
Every woman aged between forty-nine and sixty-nine is invited to undergo a mammography
every two years. According to recent data, these regular breast X-rays will reduce
mortality by 30%. Similar schemes are going to be run for cancer of the colon and of the
uterus.
The number of medical
imaging machines is also to be significantly increased. The aim is to provide at least one
PET scanner for every million people. More generally, research (epidemiological, genetic
and clinical) will be encouraged, under the aegis of the French national cancer institute.
This new body, which is expected to start work in 2004, will primarily be responsible for
coordinating the activities of the various bodies involved (public services, public and
private hospitals, cancer campaigning centres, scientific research institutes, health
insurers, etc.).
The plan also aims to
encourage the establishment of networks, such as Oncora (the Rhône-Alpes regional
oncology network), which brings together forty-two public and private establishments in
the Lyon area. Here the patient is at the centre of the system and his treatment is shared
by all the doctors involved: general practitioner, radiologist, oncologist, clinical
pathologist, etc. The clinicians pool their skills in order to give the patient, whatever
his or her social circumstances, the best chance of an optimum diagnostic and therapeutic
strategy.
If they so wish,
patients and their families will be more involved. They want to become "partners in
their own right" in the fight against their own disease, demanding to be informed,
consulted and involved in the conditions of their treatment. The disease should no longer
be a stigma that too often still condemns people to economic and social marginalisation.
"We no longer want," explains Régine Goinère, founder and president of the
cancer patient support organisation, Vivre Avec, "the term matériels de confort
[non-essential equipment] to be used against us in order to justify the low levels of
reimbursement for, for example, mammary prostheses or wigs."
Lastly, sufferers would
like to be offered appropriate psychological support to answer their questions and deal
with their worries, as shown by the success of the Espace de Rencontres et
d’Informations [patient support and information centre] devised by Anne Festa, at the
Gustave-Roussy institute in Villejuif, or the City of Paris Cancer Agency. Both these
places offer free welfare support, an attentive ear and psychological help for sufferers,
former patients and their family and friends, providing support as important, and as
miraculous, as new drug treatments.
Voluntary
organisations in the front line
Founded in 1918, the
Ligue contre le Cancer [League against Cancer] has more than 600,000 members. Each year,
it devotes about 23 million euros to research, 4.5 million euros to patient schemes and 5
million euros to education-prevention-screening. In particular, it trains volunteers to
listen to patients.
The ARC (Association
pour la Recherche sur le Cancer - Cancer Research) was founded in 1962 at Villejuif. Since
1996, when the former president left as a result of criminal activities, the organisation
has awarded more than 200 million euros (over 70% of its resources) to 5,200 cancer
research projects.
New weapons
against cancer
Herceptin is a very
promising drug. It blocks the anarchic development of tumour cells in some breast cancers.
Cetuximab, an antibody undergoing clinical trials, improves the efficacy of traditional
chemotherapy for tumours of the digestive system. It slows down the rate at which the
cancerous cells multiply and could also be used in the treatment of very common cancers
such as those of the lung, pancreas, head and neck.
Vaccines are also
arousing many hopes. Some are preventive, like the vaccine against cancer of the cervix
recently successfully tested in the United States. Others are curative. They work by
taking samples of the patient’s cancerous cells, then manipulating them so that they
stimulate the immune system. One vaccine still in the early stages of development, tested
on 300 patients, has proved to have an effect on cancers as varied as prostate, kidney,
skin (melanoma) and even lung cancer.
Another therapeutic
strategy is "asphyxiating" tumours by cutting off their food supply - blood.
Victims of colon cancer and leukaemia have already seen their tumours reduce in size with
this type of treatment which impedes the development of new blood vessels, which form
around the edges of the tumour and help it to grow by irrigating it.
The commonest cancers
Number of sufferers:
700 000.
Number of new cases
each year: 270 000.
Annual number of deaths
attributable to cancer: 150,000 (lung: 24,500; intestinal: 16,500; URT*: 11,500; breast:
11,000; prostate: 9,400).
More common in men are
lung, upper respiratory tract*, prostate and intestinal cancers. Women suffer most
commonly from breast cancer, followed by cancer of the colon and then lung cancer.
(Courtesy: Label
France Magazine, No:51, Embassy of France in Nepal)
Puzzles
in frames
Becoming
a superstar: Neo Rauch’s paintings are figurative, yet mysterious, and much sought
after by collectors
By Louise
Carstens
Neo Rauch doesn’t
like it when the conversation turns to money. It makes him feel uncomfortable. He gets
embarrassed and wonders: "What will my colleagues think?" In artist circles in
Leipzig people don’t talk about money. On the other hand, the topic of money can
scarcely be avoided when talking about the artist Neo Rauch. Rumour on the art scene has
it that all his paintings are sold almost immediately. That to get a work by him clients
have their names put down on waiting lists. And that until recently huge profits were to
be made, if you had bought early enough. Of course, there is some truth in these rumours.
Anyone who bought a Neo Rauch painting in pre-euro times for say 10,000 marks, can now
delight in a return that not even shares could yield, even in the best days of the stock
exchange: about 500%. At the latest by 2001, during the large exhibition at the Berlin
Guggenheim, the attention of the world was drawn to Neo Rauch. Now he’s a star. Even
if that gives him an eerie feeling, because it all happened much too quickly.
He came to Leipzig in
1981 from the small town of Aschersleben. The famous GDR artists he admired so much at the
time taught in Leipzig: Bernhard Heisig, Wolfgang Mattheuer, Werner Tübke. A few years
later, Rauch had made it; he was in Heisig’s masterclass. But Neo Rauch – his
real name, by the way – didn’t hit it off very well with the great model.
"Those were my apprenticeship years, and I realized that the strange patterns
didn’t appeal to me," is how he puts it today. He rebelled. At a time when
things were brewing in Leipzig anyway, when the first demonstrations were taking place
from the Nikolai Church, he staged his revolt on canvas. Successfully. Luck would have it
that he met the conscientious gallery owner Gerd Harry Lybke, who took his paintings as
far as America and secured him a handful of US collectors.
Neo Rauch remained in
Leipzig. Around him, everything that could change was changing. New houses, fancy shops,
elegant arcades, expensive inner city restaurants. Yet just a few steps away from the
glittering city are disused factories, unemployed people (currently almost 20% in
Leipzig). Neo Rauch’s studio in the Plagwitz quarter was once part of a cotton mill.
The machines have since been sold off to China. The marvellous redbrick buildings have
been vacated and are being gradually occupied by artists. This is where he paints, away
from the hustle and bustle of the art business. The artist Rosa Loy, with whom he has a
twelve-year-old son, paints next door, as it were. And beside that again, another artist
friend of his is busy in his workshop with his paintbrush. At midday, Neo cooks for all of
them. Here he preserves a little Saxon idyll for himself, without which he possibly might
not be able to bear the success. The visitor is first served a meal. You can have a nice
chat cutting and preparing fennel.
The room is filled with
the sounds of Frank Sinatra and Elvis Presley. And half an hour later, when the pot of
pasta with a tasty sauce made of tomatoes, anchovies and fennel is on the table, the
artist too is ready to talk. About old times. About his grandparents, who brought up the
young orphan. About clinker buildings and Saxon landscapes, which repeatedly crop up in
his works. And about the figures that stand around in his paintings, large, rigid and
mysterious.
For example, the backwoodsman or "Hinterwäldler" with his fur waistcoat and
cudgel, Rauch’s "alter Ego" who "is allowed to stomp through the
paintings" in his rough boots. At the moment that uncouth fellow is taking up quite a
lot of space in all the artist’s new works. On some canvases he appears three times:
either with a paintbrush in his hand, or an axe, or a cudgel. When he gets fed up with
him, Rauch will simply let him die: "He has to disappear sometime."
An agreeable
proximity to Georg Baselitz
In the past, Rauch was
very keen on the artists Francis Bacon and Gérard Garouste, whom he discovered on his
first trips to the West. Today he says, "I have no models anymore. That phase is
over. If you still have models at the age of 40 something is wrong." The only thing
he is prepared to concede is "an agreeable proximity to the artist Georg
Baselitz." In the 1960s Baselitz painted a "Heimkehrer" who bears a
remarkable resemblance to Rauch’s "Hinterwäldler." "He is also
someone from the East who has been wounded by the sleek art business in the West.
Baselitz’ figure has clearly visible open wounds. In my work, these are to be
anticipated!" In Neo Rauch’s pale, almost faded-looking paintings, danger always
seems to be lurking somewhere. Two children with heavy bricks in their hands standing in
front of a glass house. A man selling matches to a woman with a petrol can. Blobs of tar
floating through the air. A motorway leading nowhere. Men attached to tubes that seem to
be growing out of the seat of their trousers. UFOs hovering. And repeatedly,
forbidding-looking factories, airplane hangars, high-rise apartments. "No touching
up" has been done here, according to Rauch, everything is cool, sometimes cynical,
and always a bit uncanny.
Why are art connoisseurs so avid for these paintings? Probably because his work fulfils
two collector’s longings at one and the same time: the longing for good figurative
painting, and the longing for paintings from the East which are far removed from Socialist
Realism. Neo Rauch’s figures are workers and housewives, pilots and soldiers, who
appear to be pursuing simple activities. On closer inspection, however, their actions
becomes more and more puzzling. Ultimately they remain inexplicable. "It
shouldn’t be possible to interpret my paintings fully," says Rauch.
Neo Rauch never had any
doubts about painting, although in his lifetime "there has been no shortage of loud
mouths declaring it to be dead." "When such pamphlets rain down upon you, then
you just have to pull in your head for a moment and let them fly past," he says. Then
it’s back to work again. For "painting is a natural phenomenon, an unalterable
fact. It will always exist."
Art Telegram
Art Scene: almost 8000
free lance fine artists work in Germany, while more than 33,000 fine artists such as
sculptors, designers, lay-outers, textile designers or restorers are employed under
contract.
Art market: a total of
585 art museums, 490 exhibition venues and 326 galleries either show or sell art.
Art academies: 24 state
and private art schools and academies train artists.
Art associations: 226
art associations promote art.
Art city: Cologne is
regarded as Germany’s art city par excellence. The Museum Ludwig there exhibits 20th
and 21st century art, while the Federal Association of German Galleries and Art Book
Publishers (BVDG) has its headquarters in Cologne, which is also home to the sculpture
park of the collectors Eleonore and Michael Stoffels, and artists such as Gerhard Richter
and H.A. Schult.
(Courtesy:
Deutschland Magazine, Embassy of Germany, Kathmandu) |
