Let us look at the issues that are of concern to all of us. I had essentially made four points in my article.

One, to my friends in the media that the real story about the former power minister’s unfortunate death is not the way Apollo or AIIMS have handled Kumaramangalam’s disease but the fact that cancer is becoming a growing problem. And that Delhi is today a hotbed for blood cancers and still the government is not taking any cognizance of the problem.

*Two, the government must take cancer seriously. Its first task is to take preventive action, especially health education and environmental pollution control. But the government is doing nothing in this area that can be described as worthwhile. Even the data collection is very poor. *Three, India has a lot of poor people who cannot afford the high cost of cancer treatment. Therefore, there is a need for an insurance scheme.

*Four, cancer is a deadly disease. If you are an unfortunate person to get an unexplained problem like Mr P R Kumaramangalam, then persist till you get a pucca diagnosis which satisfies you. You don’t want to get a deadly surprise.

Dr Rajkumar has not touched upon any of these issues – each of which I consider critical for those who make health policy. He himself emphasizes the following points, one of which I did not make at all. He quotes me as saying that cancer treatment is extremely poor in this country and then goes on to say that the Cancer Institute at Adyar "are on par with any other major international cancer centre". It is quite possible that this is so. I have never visited the institute. But I am doubtful if any institute in India can make such a claim. I will share my experience with what is regarded as probably the best medical institution in India: the All India Institute of Medical Sciences based in Delhi.

Since I had a rare Central Nervous System (CNS) Non-Hodgkin’s Lymphoma, doctors in the US had put an Omayya Reservoir in my brain. This is a needle that goes through the skull and into the centre of the brain where it picks up the cerebrospinal fluid (CSF) and stores it in a plastic cup placed just under the scalp. Instead of going through the painful and laborious lumbar punctures on a regular basis, doctors can now, with a simple injection, inject anti-cancer drugs straight into my brain and collect CSF samples for analysis. After my return from the US I went to AIIMS to see if they could take out the CSF sample every three months to test for any recurrence of cancer.

As the doctors knew me well and were very fond of me, they refused to do it because of the fear of introducing an infection into my brain. They strongly advised me to get this extremely simple test done only in the US. It is not that the AIIMS could not do the test but they feared for my safety. And I remain deeply grateful to them for their honesty.

Late last year, I was shocked to find that my next door neighbour also had a CNS Non-Hodgkin’s Lymphoma – a disease which in the US has an annual incidence of about one out of ten million. Not only my doctors in the US were surprised to hear this statistical near-impossibility, when I told this to Dr V Ramalingaswami, the former director-general of the Indian Council of Medical Research, he too could only say, "we are  surely missing something here." I tried my best to send my neighbour to the US for treatment but the National Cancer Institute had completed its research project and was, therefore, no longer providing the free treatment which is legally mandated in the US for research patients. There is no way that a middle class Indian can afford US$100,000 for medical treatment. My neighbour took an off-the-cuff treatment at AIIMS, which everybody there told him may not prove effective. But nobody told him about the side-effects of the treatment, an important aspect of cancer treatment, especially periods of low immunity when he could catch any infection which could prove fatal. About one month into the treatment, he picked up a cough and died within a few days because of acute respiratory infection,  not cancer. As my neighbour was a journalist, the matter was  reported in the press in Delhi. But no action was ever taken. In the US, after every round of treatment, the doctors there would give me a long lecture about what symptoms to watch out for and come running to the hospital if I had them. But nothing like this was told to my neighbour by the doctors at AIIMS.

This year when I was diagnosed with gastric lymphoma I took my treatment at Apollo, an extremely expensive hospital by Indian standards, largely because of the confidence that the young oncologist there was able to inspire in me. Having seen literally the best cancer hospital in the world, the Clinical Centre of the National Institutes of Health, the US government’s medical powerhouse, I found even Apollo to be very poorly equipped. I, therefore, find it hard to believe Dr Rajkumar’s claim that the Cancer Institute has facilities as good as any other international institution. All of us who work in India do our best to work with what we have. There is nothing wrong with that. And, therefore, I have no ill-will against Apollo or AIIMS. But there is no need to delude ourselves that we are the best in the  world because then we will not aspire to be better.

My point that cancer is a disease that is best prevented, especially in a country like India where there are many poor people, is sadly dismissed by Dr Rajkumar saying that the   Cancer Institute in Adyar treats poor patients free of charge. Is  he trying to say that the few beds that exist in this institute or a handful of others like it is enough to meet the cancer treatment needs of all our one billion people? Surely not. I had presented the figure of Rs. 2-3 lakh as the average cost of treatment for all types of cancers after talking to several leading oncologists. It is quite possible that my figure is on the higher side but my purpose was to see if an insurance scheme is feasible even with this high cost of treatment. I think it is possible and the government should seriously promote one.

 The Chennai Cancer Institute claims to be getting, in some cases, as much as 80-100 per cent cure, for costs that are as low as Rs. 20,000-40,000 (that US$500-1,000). If this be true then the institute should publicise its capabilities in the US and a multi-billion dollar cancer treatment industry will immediately move over to India. A cancer cure is claimed only if a cancer patient remains in remission (free of the disease) for five years from the end of the treatment. This is a long follow-up period. And I wonder how many Indian hospitals are able to do this.

Indeed, there are certain cancers like cervical cancer in which the cure rates are quite high worldwide. But when all cancers are taken into account, even the US has achieved a cure rate of only about 50 per cent. Brain and lung tumours, for example, have low cure rates. Indian authorities should publish a good audit of  our cancer hospitals to show what cure rates are being achieved in India. Indeed, cancer incidence data is available from 1982, as Dr Rajkumar puts it, but then why is it that the last year for which the data is available is only 1991?

All that I can say is that I am neither trying to "send wrong signals to the general population" nor am I trying to damage "the morals of patients suffering from cancer." The piece was indeed written with anger because I want Indians to get angry at the incompetence of our governments in dealing with the serious challenges facing this country and push them to take up purposeful policies. In the case of cancer, I want a powerful preventive policy and an insurance system which helps those who are unfortunate to get the disease. Unless we stand up and fight, our politicians will do precious little.

Before closing I would like to inform the readers of the Hindu about a path-breaking study on the cause of cancer just completed by the prestigious Karolinska Institute in Sweden, which selects the Nobel prize winner for medicine every year, and published in the most prestigious medical journal of the world, the New England Journal of Medicine, only a few weeks ago. The study analyses the environmental risk and the genetic risk in the causation of cancer and is bound to shake up the cancer establishment worldwide. It concludes that the overriding cause of cancer is environment and not the genes.

CONTINUE>>

BACK>>