I was bored…

I sat there as a senior Canadian professor gave a detailed lecture on the latest and advanced treatments for lung cancer. It was the twelfth class of the day. He spoke with such excitement and awe about the ground-breaking advances in targeted therapy, highlighting the remarkable promise shown in the clinical trials, conducted in the US. He casually mentioned the cost of the drug, and I did a mental conversion to Indian rupees. Yeah! So the newest trial proved that taking a drug which costs around ₹1 lakh per month, if taken along the current standard chemotherapy for a year, improved the survival chance by around one month more, in a stage-4 lung cancer. “Yeah… right!” - I mused. Who would be willing to spend that kind of money here..!?

But that is how science progresses, one step at a time. Trials like these have gradually improved the beneficial outcomes of the cancer treatment to an extent that, even in advanced cancers, accessible treatment options are there to cure or prolong life to a meaningful extent. We have to remember that these treatments were initially neither accessible to us nor were able to prolong life or cure cancer, when they were first introduced.

These drugs are developed by multinational companies who have to spend billions of dollars and 15 to 20 years to make a single drug or effective treatment. Till the patent gets over (around 15 years or so), they market the drugs at high prices, usually to international markets where price is not an issue because almost everyone has universal and unlimited insurance. After the patents get over, other companies can make the same drug and the prices come down. India is the leading producer of generic drugs in the world - so much so that some traditional cancer treatment drugs are produced in India and cancer patients all over the world are dependent on Indian factories for their cure. (Tariff that- we dare you !!!)

The professor went on about how Indian-made drugs are the cornerstone of cancer treatment in many countries including Canada. But my mind wandered off, thinking about a little boy in the cancer ward in medical college, to whom I had talked recently.

Kannan (name changed) was a cheerful 12-year-old who told his parents that the pain in his shoulder, which started after he fell down a few days ago while playing, was not going away. After a few rounds of scolding, for being careless while playing (as is usual in any middle-class Indian family), he was taken to a GP who noticed a swelling in the tip of his shoulder bone and was prudent enough to remember the few oncology classes he had attended during his MBBS days (which is an exception as Oncology is still not taught as a subject in MBBS). He was promptly referred to a higher centre and then to RCC at his parents' request.

Kannan underwent the usual battery of investigations - biopsies, scans etc. He was diagnosed with an aggressive bone cancer called Osteosarcoma. Luckily, it had not spread to any other organs - the disease was still curable, even though he had to undergo strong chemotherapy and surgery with a prosthesis (implant in place of a removed bone). The doctors sat down with his parents and explained the entire treatment in detail. As he came from a poor socioeconomic status, he would be included in the government’s Thalolam scheme and all treatments would be free.

Obviously, the parents were heartbroken. The total duration of treatment would be about 6 months. The chances of cure were about 70%. The father shared the news with his cousin who had a house near RCC - to arrange a stay for the period of treatment. He promised not to share the news with anyone else.

So obviously the child’s 2nd uncle’s, 1st cousin’s (thrice removed) nephew, called the very next day to offer his condolences and free advice.

“Did you start treatment?” he asked with concern.

“No,” the father said. “We are getting done the fitness tests and blood tests required to start chemo.”

“You are lucky that I called just in time. I know this guy, who knows this other guy, whose uncle’s great nephew was cured by this Naattu-vaidyar (traditional healer) in Ottappalam, Kerala. Why don’t you just see him before going through all these difficult treatments? Getting his appointment might be difficult but a cure is guaranteed if you see him just once.”

The child’s father also remembered reading about the miracle cancer cure from Ottappalam, as a news article. He thought “What’s the harm in seeing him just once?”

So, they got on the next train. The relative delivered on his promise to book an appointment and even though the travel was difficult, with the unwell child, and they had to wait a day to meet the Vaidyar, they finally got to the place.

The place had a divine feel - unlike the sterile, medical-smelling wards of RCC, they were greeted with an ancient and grand-looking house. The Vaidyar’s junior came first and explained the rules.

“His greatness will see the child and diagnose the disease in an instant. He will tell you the treatment method. Follow his instructions to the letter - DO NOT ASK ANY QUESTIONS!”

The father thought, “Of course, divine knowledge permits no questioning, unlike scientific knowledge, which promotes questioning and which you can challenge with Google knowledge and second opinions.”

Kannan was taken to the presence of His Holiness. With just one look he was diagnosed with pittham of the shoulders - Silly! Modern medicine with all their scans and painful biopsies. The treatment would include one Ottamooli (mix of herbs), two Dhaaraas (oil bath), Uzhichil (massage) and exercise. There would also be two poojas included as the child’s Shukran (star alignment) was in the wrong position. But considering this as a special case, the Vaidyar agreed to do the pooja himself. The total cost of treatment? ₹3 lakhs. No Thalolam scheme for this because one has to pay for ‘real treatment’, for it to ‘take effect’.

After the initial set of treatments, which took about a month, the swelling increased in size. The worried parents asked the Vaidyar’s junior. He replied, “Don't you know the principles of Nattuvaidyam? Unlike modern medicine (‘allopathy’ in their terms) which suppresses pittham, traditional medicine will draw it out and then remove it. The swelling will increase in size, at first, and later decrease. Trust in his greatness and continue the treatment.”

Two days later, there was pus coming out of his shoulder. The parents were called to his room and told by the Vaidyar that the treatment was complete and was successful. “We have successfully drawn out the disease, it will drain out eventually, the remaining part of the treatment can be continued at my disciple’s ashram, which is nearer to your house. Just dressing with herbs is all that's needed.” The referral system, which is much better than our public health referral system, convinced them to go to another Ashram and continue treatment. After a few days of continued treatment, they escaped the place and were admitted in the cancer ward at the medical college, where I was working, and that's where I had seen them.

The child was miserable by then. There was a football-sized swelling on his shoulder. He was unable to move his hands and had severe pain. Both the parents and the child had tear-filled eyes when they asked us to somehow save them. But by then it was too late. The three months he lost with alternative treatment was too valuable and the cancer had spread to his lungs. All that could be done was to control his pain till his end.

Science cannot give false hopes. We cannot promise 100% cure like the Vaidyar. We cannot say if the child would come under the 70%, who would be cured, or the 30%, who would not be cured, but we can give you the right treatment. Whether it was discovered in plants or in animals or by Vaidyans, it doesn't matter to science. If it can be used to treat a disease better, it will be integrated into modern medicine. We have done that before and will continue to do it. In fact, some of the most important drugs in traditional chemotherapy are originally derived from plants. But they are not just powdered and in patients. They are scientifically studied and active ingredients are isolated and enriched and used in patients after years of research.

There might be mistakes in our science, but we accept and change them and become better by sharing and exploring knowledge. A medical oncologist in India, who has undergone a minimum of 12 years of training, will always know that their knowledge about this emperor of maladies is very much incomplete, while the Vaidyar whose history of training is most probably untraceable, will tell you that they know everything about cancer and that the knowledge suddenly dawned on them when they have been living in a cave in Himalayas.

I sat there lost in thought - What would have been going through the parents’ minds when taking such a young child to such frauds? Was it really the father’s fault or the relatives? Or did the news of the miracle cure in the paper that the father had read, change his decision? Is it a failure of our education or our health system? Why do people chase after self-fashioned Gods in any branch of healing? Is it basic human nature to do so? These may be some questions even the scientific method cannot answer.

The professor was finishing his lecture. “The average cost of developing an anticancer drug is 700 million dollars (about 6,000 crore INR)“ - Damn the medicine mafia! I clapped my hands with the crowd after the lecture was completed. But I still had to sit through the CME (continuing medical education) programme for 3 more lectures that day. Because unlike the Vaidyar, my education must continue till the day I stop treating patients.