By Anil Agarwal

I am not just angry but livid with the political system and the media. Our ‘capable’ politicians did some public breast beating on young Kumaramangalam’s untimely death and the media reported this ritual without any thought.

The minister had a form of blood cancer called leukaemia. Having suffered from another form of blood cancer called lymphoma – three times in just six years and thanks to God I am still alive, having achieved some kind of record, I guess – I have some idea of what it takes to deal with cancer and, as an environmentalist, I have a deep interest in the role of pollution, lifestyles and diet in its causation. But there was not one substantive political statement or media report on how to deal with this horrifying disease on which there is nothing but a conspiracy of silence from the government. Unable to deal with traditional diseases like diarrhoeas and malaria, the ministry of health has been acting like an ostrich, refusing even to acknowledge the seriousness of the problem. But when a young minister dies, for the media, he provides an excellent peg for substantive reports on a major public health problem, which today affects more than a million new people every year. How could the media have missed such an opportunity!

Kumaramangalam died of leukaemia not because the private sector Apollo Hospital misdiagnosed him and the ‘prestigious’ All India Institute of Medical Sciences (AIIMS) failed to deal with him but because cancer treatment is extremely poor in this country even as pollution in cities like Delhi are making people more susceptible to the disease. What is great is that cancer is a great leveller and even important people don’t escape it except, of course, ordinary people don’t get a bevy of doctors flitting around them. For a poor person, the very diagnosis of cancer is equal to death. According to Dr Vinod Raina of AIIMS, only about 30 per cent of the patients diagnosed with cancer undergo treatment because of cost and many drop out halfway having run out of money. The average cost of treatment of cancer can be some Rs. 2-3 lakh and that is when there are no major complications. The parliament was told recently that the government has spent Rs. 6 crore on the treatment of former prime minister, V P Singh.

Cancer treatment is becoming better – in the US survival rates for many cancers is now higher than 50 per cent – but, unfortunately, the cost of treatment is also going up. For example, an infusion of monoclonal antibodies or a bone marrow transplant is now recommended for various cancers which greatly increases the chances of success. Monoclonal antibodies, for instance, can specifically target cancer cells but one infusion can cost as much as one lakh rupees and a patient may have to take several.

So what do we do in India? Firstly, we have to take the preventive route, especially because we have far too many poor people who cannot afford treatment. Unless, of course, our politicians don’t mind poor people dying despite all their pro-poor rhetoric. This means controlling pollution – a gigantic task for the government – and educating the people to have better diets and improve their lifestyles. For instance, awareness of the risks of smoking has cut lung cancer rates dramatically in the US. But, in India, there is very little health education; fruits, vegetables and dairy products are full of pesticides; and, pollution of air, water and soil is growing by leaps and bounds. The government does not even collect cancer data properly or regularly and make them known to the public. They are considered a secret by the government. We had to ferret out the data with the help of a doctor.

The latest data on cancer incidence is available for 1991 only and that too only from hospitals in five metros and one rural area. But even the data that is available is very worrying. The best way to understand the impact of cancer is not to look at the annual incidence rate (which is about 150 per 100,000 people) but at the lifetime incidence rate because cancer is more or less a fatal disease. You normally are not lucky enough to get it more than once. The rural data shows a lifetime incidence of one out of 34-36 men and one out of 18-20 women get cancer. But the urban data for the worst city – Delhi – is one out of 13-14 men and one out of 9-10 women followed closely by Chennai. In other words, cities are more cancer-prone than rural areas and that, in the early 1990s, we could have expected one out of 10-15 urban Indians to get cancer in their lifetime – that is, every second or third family would have to face a health emergency at some time or the other. When compared to Western countries which have a lifetime incidence of one out of 4-6 persons, the Indian data looks good but,don’t worry, we are catching up with them. The government’s data relies only on hospital data which makes it inadequate and probably an underestimate..

My personal experience shows that a city like Delhi is probably already matching the Western world. The Centre for Science and Environment (CSE), an environmental NGO which I head, has had 35 members on its board of directors coming from Delhi in the last 20 years of its existence. Of these 35, six have had cancer and three are already dead, which gives a lifetime incidence rate as high as one out of six: the prevailing situation in the West.

The situation with respect to blood cancers like lymphomas and leukaemias is even worse in Delhi. Though the overall cancer incidence is higher in women, it is higher in men in the case of blood cancers. The average incidence of blood cancers in men of Delhi is about four times more than in the rural area for which data is available, twice that in Bhopal, and nearly 50 per cent more than in Chennai, Mumbai and Bangalore. Even in the case of women, Delhi tops the list leaving the other cities way behind. Of the six directors of CSE who have had cancer, exactly half have had blood cancers of which two were diagnosed in their 40s. ‘Young’ Kumaramangalam getting leukaemia in his 40s will only surprise our politicians. And like Kumaramangalan, of the three CSE directors who had the misfortune to suffer from blood cancers, two have already passed away.

I am the only one alive even though I had such a rare lymphoma – in my eyes, brain and the spinal cord -- that there were in the early 1990s not even 200 medically recorded cases of this specific version of the disease. Not one doctor in India – and I sought help from the best of the best – could even diagnose the disease. I survived only because I was able to find medical researchers in the US who was trying to develop a treatment for such a rare disease. Isn’t it amazing that there are scientists in this world who are trying to find answers to medical problems that have not even affected 200 people even while our own boffins are still struggling with diseases that affect millions! But tell that to our science braggarts who want to send a man to the moon to ‘prove’ India’s third-rate prowess in science?