In 1979, Valerio Gennaro graduated in Medicine and Surgery at the University of Genoa and then qualified as a surgeon and specialized in Oncology, Hygiene and Preventive Medicine with orientation in Public Health.
The scenario is that of the 80s and there is plenty of space to do research on diseases that involve the community, to explore the field of cancer, to grow and develop epidemiological discipline.
Gennaro has trained and perfected himself in Italy and abroad. He studied at the Istituto Superiore di Sanità (ISS), at the International Agency for the Research on Cancer (IARC, Lyon, F) and at the School of Hygiene and Public Health of Johns Hopkins University (JHU, Baltimore, USA), where he also achieved the Post Doctoral Fellowship in Environmental Health Sciences (1988-90).
He was a cancer epidemiologist at the National Institute for Cancer Research in Genoa (IST), in the role of medical director in the Department of Epidemiology and Prevention (now IRCCS, Scientific Hospitalization and Treatment Institute, Policlinico San Martino in Genoa) . He followed the Sevesl Cancer Registry (80s), and then the Genoa and Liguria Registry.
It collaborates with public institutions and citizens for the defense of the environment, health and peace.
Since 1992 he has been a consultant to the Public Prosecutor's Office on occupational and environmental epidemiology and to the Labor Section of the Genoa Court; since 1994 he has been responsible for the Regional Operational Center (COR) of Liguria of the National Mesothelioma Register (RENAM, INAIL). He is the contact person for Genoa of the Association of Doctors for the Environment (ISDE). He is a member of the IARC Working Group, the Association of Epidemiologists and the Italian Association of Cancer Registries.
Dr. Gennaro and I talk to him on the phone several times: a conversation arises which will be difficult to summarize in one song but I will try.
The topic I want to understand better is the position of preventive medicine and epidemiology in the face of vivisection. Researchers call it 'animal experimentation', and it is a play on words to present it better, to give the matter an aseptic, scientifically irreproachable role, to silence the reality of useless violence. It irritates to hear the word vivisection. Researchers who advocate the inevitability of experiments on mice, cats, dogs, macaques and other mammals. they claim to use appropriate painkillers and anesthetics, but investigations often do not confirm these claims.
In the climate of now open conflict between pro tests and anti-visionists, associations of doctors, psychologists, biologists, and other professionals belonging to OSA (Beyond Animal Experimentation) and Limav (...) they find themselves attacked and disparaged - to the sound of "I the longest resume of yours ”- as if there could be absolutely no possibility of seeing beyond the known model. Yet there are already interesting examples of cutting-edge equipment in the world and recently, in the United States, the EPA has decided that there will be more and more room for alternatives in the near future.
What does the well-known Italian epidemiologist Valerio Gennaro think about it, fresh from retirement? What reflections can we anti-vivisection professionals give?
Let's start from the beginning. Let's take the discussion away.
Who is Valerio Gennaro? How did your business start? I ask him directly. He is kind, helpful, and above all passionate about the subject he has loved and studied for forty years.
Your experience in the epidemiological field: how the approach to the person in the epidemiological field has changed. What are you leaving to your young colleagues today?
Dear Valeria, epidemiology does not concern so much 'the person', but the population, the community. It is a very beautiful field because we try to examine the homogeneous group, as we said in the 60s and 70s. Through this discipline you can understand how a community is doing. It is a scientific discipline because it takes measurements, needs standards, criteria, formulas, parameters, evaluations and the results must be verifiable and repeatable. I fell in love with epidemiology right away, despite not being a fan of math. I had just graduated when I went to the hospital asking myself and the world "but where is cancer prevention done?", Because I was fascinated by the proposals of Veronesi, who had convinced us that a few years later, if we had worked in that direction, we would have defeated the tumors. See, it was the late 70s and we're still in a painful situation.
I was a graduate, therefore, and I consider myself a privileged. I studied these issues, I also did the thesis on workers' health, to understand if there were dysfunctional diseases, if some diseases were more present as a function of specific pollutants present in the refinery, such as hydrocarbons or other, and so I did the discovery of an occupational disease. I'm talking about mesothelioma, a reality that apparently had nothing to do with it, not associated with exposure to hydrocarbons, which instead produces leukemias, lymphomas, and other cancers such as brain tumors. I had found this excess of mesothelioma which I did not explain. It was only five cases but I didn't expect it. In this way we discovered that there was the 'asbestos' of asbestos and even there I spent a bad quarter of an hour because the petrochemical industry, when I published the article internationally, attacked me. A polite attack; I was told it was a strange thing, a type of tumor that I had only found, which was a coincidence, also trying to attribute the results to old exposures, to previous occupations of these workers. The beauty of the scientific world is that there is connection. A Canadian scientist, Professor Finkelstein, who was also studying the problem of asbestos and refineries, gave me support, so we were able to respond scientifically to those who denied these evidences (knowing well to do it). Epidemiology is therefore the discipline that helps to understand how a community is compared to a standard and what the possible causes are, and therefore the epidemiologist should be 'enrolled' in formulating hypotheses on how to bring communities back to health. Not so much those that the epidemiologist has studied but subsequent ones, to limit and not repeat the damage.
Over the years, unfortunately, this discipline has been scientifically weakened. It has been elegantly diverted towards mere statistics. We discovered the damage from pollution, from electromagnetic fields, from radiation, the devastation in the environment with pesticides, the damage in the work environment, yet today what is considered interesting is only clinical epidemiology, that is, the one that evaluates effectiveness and drug safety. Etiological, analytical, descriptive epidemiology has been eliminated, which is an equally important field. The one that tries to describe in a timely way what happens in a community. For example, evaluating the number of pre-term or underweight births, all things related to health, and which always have an inevitable share ... but there are avoidable shares. If you study this field well you can understand why some communities have excess mortality, abortions, hospitalizations etc.
Over the years, epidemiology has gradually been transformed into statistics only - which is also very useful, because without statistics there is no epidemiology. The problem is that we simply give numbers without treasuring them. Without interpreting them, analyzing them from a social, economic and political point of view.
Now the situation is bad. The etiological epidemiology that studies the causes of diseases is practically gone. There is a simulacrum. Partial. We only talk about tumors and we forget about other diseases, and above all about their avoidable causes, such as environmental ones, pollution and everything, making people believe that genetic causes prevail in importance. So if one has a tumor it almost becomes the 'fault' of heredity. In addition to the damage these people also suffer insult.
Why? This we must ask ourselves. As if somehow, the health system wanted to have sick people? This type of vision is connected to the vivisectionist approach… Alternatives?
As for animal experiments, certainly the contribution that epidemiologists can make is related to the knowledge of the causes of diseases.
Why don't people study more trying to understand why some get sick and others don't, trying to understand why some have certain diseases and not others?
The two tools that the epidemiologist uses are precisely cohort studies, studies of well-defined populations, homogeneous to see what happens in those groups over the years. And then there are the case-control studies, very interesting because they study the etiological differential that exists in the patient group compared to the control group. These studies help to understand the origin of the disease, whether it is distributed proportionately or randomly. Over the years we have seen whether a population exposed to a certain factor has suffered damage or not. It takes time for this type of approach. It takes rigor. Patience is needed ...
Of course, following the path you indicate would be a nice change of focus.
Yes, more can be done before experimenting with animals. Also because these, other species, non-human animals, are notoriously different from us. Taking into consideration the existing scientific literature by doing meta-analyzes would allow us to better understand the present. Read and interpret the scientific studies that are already there to reduce the number of patients first.
Today we talk about Alzheimer's, multiple sclerosis, ALS ... for these and other diseases we need to know in an updated and complete way if there has been an anticipation of the age of onset, if the number of new cases has increased and if these new ones cases are also in young people, in addition to having a natural increase in prevalence. But we have evidence that there is an increase in the incidence over the years and this seems to me to be a fundamental starting point.
If we want to fight a disease, we obviously have to reason and have an objective description. Verifiable. A description that convinces skeptics and starts from there, to see why, for example, over the years we have seen an increase in the number of new patients who may also be young? And then all this does not explain the fact of heredity, familiarity or randomness. If we have an increase year by year in the incidence, not in the prevalence (incidence or number of new cases), well there is something at a socio-environmental level and anything else that favors the increase in the sick. So isn't it just a problem of diagnosis? Is there an excess of 'fake' diagnoses? Is there overdiagnosis? Or is there a reality of socio-environmental causes?
Is it true that ten years ago the number of new cases was lower in age equality than what we can record today? If this is true this shows that there has been something in these years that has led to where we are today.
So to pull the strings on the theme of men and animals?
If the animals are the same as us, then trivially why use them without respect? If they are different, what is the use of really experimenting with them? Do not believe that the scientific world is free from corruption. It seems that current research is hardly credible. Sometimes it looks like a search for ... funding. As if the aim was not to reduce the number of patients, make them live better, and reduce the costs in personal and collective budgets as regards diagnosis, treatment and rehabilitation.
Today's research has problems because it favors disease screening rather than disease cause screening, as well as confusing prevention. Primary prevention, above all, is the most important because it means staying healthy without needing anything, avoiding only the causes of the diseases. This prevention is simply not done. It is not done systematically. Just think of the unsuccessful fight against smoking.
As for epidemiology, a discipline that does not require great costs, compared to the importance it assumes for men and women, for people, funding has not been and is not easy to find. For research involving animals to be used in the laboratory, on the other hand, there is talk of millions of euros and the great business behind this type of approach is evident. I believe that money could be invested much better to explore diseases in both descriptive and analytical, therefore punctual, ways.
Today epidemiological studies can be done with great accuracy, rigorously. Yet why, for example, on multiple sclerosis is it not possible to have data on the differences between levels, on new patients, taking into consideration populations over the years? With these data, we could already be halfway there.
Regions spend eighty percent of budgets on diagnosis and treatment and not on prevention. It seems, maliciously, that they want to have many patients but not to reduce the number of patients with prevention. Why is there this strong investment in disease screening and not to diagnose the causes of the diseases? Is it too scary or too comfortable to inform people about issues such as industrial pollution and the dangers of the substances we breathe, what we eat? Diagnosis is anticipated and prevention is not done, and it is certain that prevention does not need animal experimentation. Moreover, when we choose the type of animal, there is a fundamental vice. And it is not the only one.
Research as it is done today creates precariousness for public researchers. It is research that has reduced these researchers to poverty. He made them conditioned, blackmailed, scared. Furthermore, they are not operational in sufficient numbers to meet the needs of the population. In this context, the answer to the question "Why do we have to experiment with animals when we could study human populations more?"Is ... clear enough.
We need to invest in alternatives. We hope for the future.
It's like when someone makes a mistake ... or when he scores his own goal. A sad scenario, really. We really hope that the etiological epidemiology will rise stronger than before!
A big thanks.