Predicting and evaluating response to therapy may become one of the most important indications for FDG-PET in oncology. The FDG-PET result could serve as a surrogate for actual patient outcomes in clinical practice and in drug development. The FDG-PET end result can be qualitative or, increasingly often, quantitative.

In this context, three methodological aspects of a totally different nature are of crucial importance: getting the right numbers out of the scan (standardization, validation of simplified quantitative measures), validating the biological relevance of the tracer signal (changes), and developing and validating the response criteria. In this chapter, examples of each of these domains (physics, biology, and epidemiology) will be discussed. To some extent, the cases have been modified from actual practice for didactical reasons.

A 62-year-old female with locally advanced cancer of the left breast was treated with experimental neoadjuvant chemotherapy. No data have been published on FDG-PET and this new therapeutic agent. A secondary aim of the study is to explore the use of FDG-PET to evaluate the response to this therapy.

Acquisition and processing parameters and findings

Dynamic FDG-PET scans were obtained at baseline and after one cycle of therapy. The PET scanner (ECAT EXACT HR+; Siemens/CTI, Knoxville) used provides an axial field of view of 15.5 cmand produces 63 transaxial slices with a slice thickness of 2.5mm. The patient fasted for at least 6 hours prior to the imaging sessions. The patient was scanned in the supine position with arms at her sides. The patient was positioned in such a way that the dominant lesions were in the center of the field of view.

From moral order to individual right

Subsistence need carries the moral authority of the community. Because it carries this authority, subsistence need has power over the member, the power to determine what the member needs and how that need will be satisfied. The community's power over its members carries with it an obligation to assure, so far as possible, that the member's needs, which are also the community's needs, are satisfied. The member has his or her obligation to do work of a particular kind and, more generally, to perform his or her designated function. And the community has its obligation to assure, so far as possible, the livelihood of its members. In a world where the community no longer carries the moral authority to determine need and how need is satisfied, what replaces the community's moral authority and the system of mutual obligation that goes with it is the ideal of individual right. The growing hegemony of this ideal has the most far-reaching implications for the theory of need and the idea of poverty. To see where the ideal of right takes the theory of need, we will first consider that ideal more closely.

The language of right links conduct to volition. In a moral order, conduct is determined by external imperatives. In a system of individual rights, conduct originates in individual will.

The facilitating environment and the normative order

In this book, we treat poverty as the lack of something vital in living. We consider this something vital the capacity and opportunity to make doing the expression of being. The availability of the capacity depends on a number of factors, the most important of which fall into the category Winnicott refers to as a “facilitating environment.” In concluding, we would like to explore this dimension of the problem in a preliminary way to indicate what our concept of poverty might imply for policy and institutions.

The literature directly concerned with the facilitating environment tends to conceive it narrowly as the environment in the family, and especially the relationships that shape early emotional development. If we were to summarize the issue at this level, the main elements would be (1) the conception of the emerging person held in the mind of the parent, especially whether that conception is animated by the principle of the “freedom of opportunities yet undetermined” as Erikson terms it, and (2) the provision of a setting in which it is safe to make doing an expression of being so that it is possible for self-development to occur.

We can make our main point in the following way. The parent relates to the infant or young child in a specific way, shaping a relationship that has a specific meaning into which the infant or young child fits. We can divide the modes of relating into two groups.

In this chapter, we explore three examples of how thinking about poverty and unemployment shapes poverty policy. The link forged by the Puritans between personal character and fortune has been particularly influential in shaping poverty policy. Recent and contemporary accounts of poverty often revert to the formula that character is all, circumstances nothing, while other, opposed, accounts formulate the issue in the same framework, simply reversing the causality favored by the Puritans and insisting that circumstance is all and character has nothing to do with the problem. This view, in its more recent formulations, has required that we find ways to measure poverty so that we can gauge the effectiveness of poverty initiatives, the second topic of the chapter. We begin with the problem of unemployment and suggest that the way we understand the causes of unemployment affects who we judge to be responsible and what measures for alleviating poverty are seen as appropriate. We end by considering the idea of individual responsibility and its implications for thinking about poverty policy.

Self-correcting and crisis prone markets

England's New Poor Law of 1834 responded to the concern that poor relief leads to withdrawal from the labor market and encourages idleness. We see the same concern in the last quarter of the twentieth century in the idea that welfare payments would encourage people to remain outside of the workforce.

The problem of poverty is a central issue in thinking about underdevelopment. A way to organize this thinking is to ask what the different approaches to development see as missing in the lives of the poor. In broad terms, development thought has seen the poor as lacking income, the ability to satisfy basic needs, or the capabilities to lead a fully human life. In this chapter, we consider each of these possibilities in turn.

Growth and income

An emphasis on improving outcomes in developing countries by fostering economic growth can follow from neoclassical economics. The neoclassical approach takes as its building blocks information on preferences, endowments, and technology (Debreu 1959). In order for individual welfare to improve, given that preferences are held fixed by assumption, endowments need to increase or technology needs to develop. The emphasis on technological change is consistent with a focus on industrialization. And the idea of increasing endowments is also consistent with growth. Endowments, namely goods and services that individuals have access to for consumption and production purposes, would increase with growth and are themselves inputs for growth. Some of these services can be productive, such as those provided by labor or capital. From this point of view, we can also see why there might be a specific emphasis on increasing the productivity of labor. Hence, there is a neoclassical emphasis on human capital, the idea that through education and other means, workers will invest in their own productive capacity.

We speak about the poor as if we know who they are. We speak, for example, as if the arbitrary definitions used by government agencies to determine eligibility for their programs tell us who is poor and who is not. If we know who are the poor, the problem is what, if anything, to do about them. For some, knowing what to do about poverty means becoming an advocate for the poor, or for what their interests are imagined to be. Then, the problem becomes one of representation of interests, and possibly of the struggle on behalf of those interests against the interests of those who are not poor and whose interests might be opposed to the interests of the poor.

Sometimes we speak about poverty as if it were defined by wealth. The poor are those who do not have enough wealth. This is the approach taken by Adam Smith in the first paragraphs of The Wealth of Nations, where he defines the problem of political economy as the problem of wealth and poverty. When we speak this way, poverty often becomes a relative matter; the more wealth on average in our society, the more wealth we need to avoid being poor. This way of thinking about poverty makes it an implication of inequality, which, for some, makes poverty a problem of injustice. This follows if we convince ourselves that those who have less (and therefore are poor) do so because others have more.