“At a time of universal deceit - telling the truth is a revolutionary act"
- George Orwell
"They were never defeated; they were only killed", was written about the famous French Foreign Legion. The same is true of cancer today. Both the French Legion and cancer are very powerful! Thank God, we do not have today as many deaths as we used to have, when I was a medical student, due to small pox, syphilis, cholera, typhoid and many other bacterial infectious diseases killing young people in thousands. That has, to a certain extent, pushed up the age of death today. Of course, we have more viral diseases coming up now, but on an average, the population in India and other developing countries lives a lot longer, thanks to better food and civic amenities and fall in infant mortality in many parts of the third world.
Life expectancy, not to be mistaken for life span, has gone up considerably mainly because of the fall in infant mortality. As I had written earlier on many occasions, cancer is not a disease in the conventional sense but a sort of an ageing problem with things going wrong with the normal physiological death of the body cells of which there are as many as 10 14. Cell death occurs even in children. It is not surprising, there fore, that if one lives longer the chance of coming up with a clinical cancer in some organ or the other is greater, although most of us have inside us every day some biological rogue cells, a potential future clinical cancer. Providentially most, if not all, of those cells die a natural death long before they could become clinical cancers. To assist that process we need to follow a healthy life style and fill our minds with universal love.
Consequently, cancer incidence has hardly gone down despite all that we claim to have done in that area. The present cancer management in modern medicine reminds one of the ways our ancestors in medicine used to brand every single disease with a red-hot iron. To cap it, the present cancer management, most of it not authenticated by scientific audits, is very expensive for an ordinary patient in the third world to afford. The vested interests do not let the indigenous drugs to have proper authentication either. To help cancer incidence go up in the third world the common person has changed his life style, aping the western life style, by smoking, drinking alcohol, and eating junk food with lots of salt, fat and sugar. Acculturation into cities leads people to be obese due to sedentary life styles. All these add to the burden of cancer growth and incidence.
Even in the US the incidence of cancer since 1930 has not shown any remarkable decline although there seems to be a dip in the graph around 2003 or so. That might not be an absolute fall, anyway. However, the third world is in for a big surprise with incidence going up very fast. Around 40% of cancer incidence worldwide could be brought down by regular exercise, eating healthy foods and not using tobacco. More and more people in Asia are moving to the cities, have started replacing their usual cereal, fruits and vegetable based fibre diet with fatty meals, full of meat and salt. Preserved foods that were popular in the west are making a foray into Asia in a big way. Most preserved foods have very high salt content. Heavy meat and salt diet would push up cancers of the stomach and colon. The results are for all to see.
Asia-Pacific now makes up half the world's cancer deaths with nearly 4.9 million new cases a year, roughly 45% of the global total in 2002. The number might rise to 7.8 million by 2020 if nothing changes. Mainland China alone, with 1.3 billion population, accounts for one fifth of the world cancer load with India not falling far behind. In the US, the apparent fall around 2003 is said to be due to the remarkable fall in smoking rates there. Smoking is rising in Asia with China leading the way. India would probably take over from China with our lethargy to contain smoking, both cigarette and beedi, while we are the leaders in the world for chewing tobacco with the highest incidence of oral and throat cancers. More than 300 million in China smoke tobacco and the estimates put at least a third of the Chinese population below 30 years at risk of dying in the near future due to lung cancer. While smoking has gone down considerably in the West, it is going up in Asia-Pacific!
“In England they had a Sanatorium for breast cancer patients in 19th century before any treatment was invented. (It was only later that William Halstead at the Johns Hopkins developed his radical mastectomy which led to many other mutilating radical surgeries for cancer) I remember going through their statistics and remember noticing a surprising finding because all these patients had no real medical treatment except tender loving care. One third of the patients, irrespective of the care, lived a long life and died of natural causes. I do not remember the average number of years. But definitely more than 15 to 20 years. One third of the patients did not make it for more than 2 years. The other third lived and died of fungating cancer after various number of years. So their average survival in the Sanatorium of 5 years was close to 50%.Important deduction that which stands good even today is - no matter what the treatment is - in the second group Cancer is so virulent that we have not made any change. First group automatically boosts the percentage number of any treatment given and boosts the ten year survival. It is only in the last group that everybody is trying to make the difference without knowing the natural history of breast cancer. For the sake of them the other two groups are also treated similarly. No body has looked into this because it is not an attractive paper to read and also it must be during the later part of 19th century before surgery was introduced for breast cancer patients. No body tried to develop a test to differentiate these three groups because I do not think many of those actively involved in the breast cancer are aware of this paper. We could have treated patients’ selectively with better results,” writes an American vascular surgeon who wanted to be a cancer surgeon during his early years of training there.
Poverty and ignorance are the leading causes of cervical cancer in the third world. Breast cancer does not lag behind lung cancer either. The western hype about pap smear screening and mammography tests have been shown to be of not much use in reducing cancer deaths by the authentic audits like the one designed by David Eddy, a former professor of cardiac surgery at Stanford, who now is their professor of health management. Alcohol, especially the country made liquor, available freely in India and other poor countries, with all kinds of added chemicals to boost the strength, (methyl alcohol included) is killing people by the thousands of cirrhosis and liver cancer. Malaysia has the highest incidence of breast cancers.
The Pharma lobby is selling the idea that new vaccines against Hepatitis B and Papilloma viruses would bring down death rates significantly of both liver and cervical cancers respectively. This has to be taken with a pinch of salt, as most statistics about vaccine efficacy seems to be flawed. "The statistic that is often quoted is that there are 25,000 kids infected with Hepatitis B in the US. After repeatedly asking the question as to how the CDC arrived at this number, Harold S. Margolis, MD, Chief of the Hepatitis Branch of the CDC finally admitted that 25,000 kids is simply an estimate. They have no hard proof that there are definitely 25,000 kids with Hepatitis B.," wrote Lisa F. Reiss. If that were the state of affairs in the US imagine what would it be in India or Asia?
"The efficacy of common vaccines may be greatly exaggerated. In a 1998 study, it was stated "investigator bias probably has overestimated the efficacy of most vaccines." "Clinicians' compliance levels in monitoring illness in vaccine recipients varied widely in trial protocols." "Less compliant investigators were far more likely to report data making vaccines appear more effective against mild or moderate disease. Our data suggest that observer compliance (observer bias) can significantly inflate calculated vaccine efficacy…it is likely that all recently completed efficacy trials have been affected by this type of observer bias and all vaccines have considerably less efficacy against mild disease than published data suggest" (Pediatrics, 1998; 102: 909-912) Now to believe that cancer incidence will be brought down by vaccination seems far fetched, at least for now.
There were researchers who found that breast cancer mortality declines with increasing sunlight intensity at 87 locations across the USA. After considering possible causal factors including diet, they conclude that "lack of exposure to UV sunlight can increase the prevalence of vitamin D deficiency [which] may place some populations at higher risk for breast cancer". (Preventive Medicine 19: 614-622, 1990). The same authors also did a study of Sunlight and breast cancer incidence in the USSR (Int. J Epidemiol 1990 Dec; 19(4): 820-4) with similar results. Garland and Garland did an earlier study Do sunlight and vitamin D reduce the risk of colon cancer? (Int. J Epidemiol 1980; 9: 227-231) which concluded that they do. They point out in their 1990 paper that "populations at high risk for breast cancer are also at high risk for colon cancer, and those at low risk for breast cancer are typically at low risk for colon cancer".
“The history of medical attitudes to ultraviolet is interesting. In 1877 scientists discovered that sunlight had the effect of killing bacteria; research over the next thirty years showed that the UV component was responsible, and could kill off the bacteria of tuberculosis, cholera, anthrax and other diseases. In 1903 the Nobel prize was given to Niels Finsen for his demonstration that sunlight therapy was effective against tuberculosis, then "the captain of the armies of death". Sanatoria to treat tubercular patients by sunlight were set up, and UV therapy.” Earlier studies in the US had clearly shown that breast and colon cancers were lowest in those areas with plenty of sunlight compared to others where sunlight was not as abundant.
We are back to the square one. Cancer still is an enigma. For the developing third world countries, the agenda seems to be clear from the above data. We have to concentrate on economic empowerment of our less fortunate, give them primary education, clean drinking water and decent clean food-their own native foods, proper sexual education to avoid cancer provoking infections and wage a full-scale war on alcohol, tobacco and cooking smoke with deadly carbon monoxide in it. In addition, there are many methods of treating cancer in the ancient Indian systems like Ayurveda, Siddha etc, which need to be authenticated for use without much expenditure for research. The hi-tech western cancer treatments may be reserved for those that could afford them.
The present cancer management reminds one of the way Sir Arbathnot Lane used to perform total colectomy as the cure for chronic fatigue syndromes in London for years up until the time Sir George Bernard Shaw ridiculed it in his famous Doctors' Dilemma. Screening for cancer is certainly not cost effective as of now for universal use, neither is it inexpensive as it is made out to be. Regular screening for cancer could be the privilege of the rich and the famous. Let us motivate our poor people to change their mode of living to avoid cancer in the end. The war on cancer reminds one of the infamous Iraq war at the moment. Whereas cancer cells could be killed by our three-pronged attack-surgery, chemotherapy and radiation, the three also destroying a sizeable chunk of normal body cells in the bargain, cancer remains to be defeated!
“If liberty means anything at all, it means the right to tell people what they do not want to hear"
- George Orwell