The Big C- Nepali Times

When we were studying medicine we refereed to cancer as the "Big C". Recently the New Delhi-born Siddhartha Mukherjee's debut book 'The Emperor of All Maladies: A Biography of Cancer' (Scribner) has galvanised international attention on the Big C. The good doctor author practises oncology in New York, and writes magnificently.

Egyptians knew about tumours and the Greeks even differentiated benign tumors (oncos) from malignant ones (carcinos). Similar to Vedic thinking, Galen in the second century AD, proposed that poor diet (probably non-vegetarian) and environmental factors triggered malignancy.

In the past we only suspected people had cancer, but now with imaging techniques (x-rays, ultrasound, CT, MRI scans) we can see the actual, sinister growth. In 1970 in America, President Nixon was feeling tired of the Vietnam War and realised how much the war drained away the mental and physical resources of the country, not unlike the present effect of the Afghan War in the US.

However "Tricky Dick" as Nixon was known, had a plan: he declared war on cancer in the hope that this would be a more popular move that could result in an unambiguous victory, compared to the other war he was faced with. Nixon's war against the dreaded disease pushed it into the limelight and provided more political and financial support for research, diagnosis, and treatment with a universal impact.

Treatment of cancer boils down to burn (radiation), slash (surgery), or poison (chemotherapy). But over the years, research has made it possible to deploy highly targeted relatively non toxic-chemotherapy guided by genetics. Gleevec (imatinib is the pharmacological name) used against a special kind of leukaemia calledchronic myeloid leukaemia (CML) is the poster boy for cancer medicine. Gleevec's working mechanism is genetic based, so that unlike other cancer drugs which indiscriminately kill off all dividing cells (hence people on chemotherapy may go bald), gleevec targets a particular cancer cell. Gleevec is free for patients in Nepal.

Many doctors are pessimistic about the war on cancer partly because thousands of symptom-free people have to be screened with attendant anxieties, costs, and risks to prevent even one death. However, it is reassuring that Mukherjee allows himself hope. He should know because as a cancer doctor, and has the inside track.

His book is a biography of cancer itself, tracing its history that is almost as old as human history. He narrates the stories of cancer patients, how they deal with the diagnosis and treatment. He was inspired by a patient with stomach cancer who asked him to give it to her straight: whether it was worth the trouble and pain of treatment.

Mukherjee also delves into the new treatments that are in the pipeline, and how fast research is moving parallel at many levels. The book is a doctor's eye view of the disease, with both the sadness and triumphs of treating the afflicted.

1. sukha

" A good article is the one which mentions about the American towns ( Yuma), American events( Patiala meet) or American politicians( Nixon)." This should be the working principle of the Nepali times.

If anyone thinks otherwise, please go through the series of essay published at davbantari

I hope author does not have conflict of interest while writing such articles and serving at the nursing home which primarily caters the foreigners. It makes sense of his curious fondness of rare but fancy diseases, while turning the blind eyes towards Nepal and Nepali health issues.

Can you provide me the address where gleevec is provided free. Actually, it is marketed as Glivec in Indian subcontinent and the company (Novartis) is having legal battle with patent rights so that the price of this magic bullet remains high and unaffordable for the people of third world. the "free GLIVEC" claim is possibly a hoax.

But, who cares? I am writing an article to impress my possible foreign clients. My pretentious article will show that I am up to the date with medical developments and engrain my patients. Forget about the Nepali problems. Nepali patients are going to die anyway.

Ke kasso, dear writer and editor?

Posted on: 19 AUG 2011 | 5:36 PM NST

2. Sukha ko baje
Sukha or rather "Dukha",
I TOTALLY disagree with you on this one buddy.
First of all from what I know this column is not about writing just medical facts and figures....I can read that in a textbook or the daily news, thank you. This column is more about informing the reader about health related issues and while doing so keeping him/her entertained....which Dr. Basnyat never fails to do. I always believe that the purpose of one's writing is first to entertain while at the same sharing information --I wish I could do so the way the good doctor has done.
The way you express yourself, Sukha, seems like you have deep rooted desire NOT to like the author for one reason or the other --NOT fair. Oh how you must be wishing that it were you writing those articles. Guess what, then the Nepali Times would have to shut down because of NO readers. Ha-Ha!
Again, I think Dr. Basnyat has covered now and again about burning local health issues but honestly if he just wrote about them most of the time I would have been bored to death ....after all we need flavor in our life and in what we read.
And buddy do your homework right, GLEEVEC is given FOR FREE at the Patan Hospital to patients in need....doesn't cost them a paisa....never has for the past 4 years. Other organizations I hear are giving away this magic bullet as well for free or at a reduced price. Check it out.
Time to rethink about the whole matter ke kasso Sukha?
And as for Dr. Basnyat, keep up with this fine job you are doing....you might not know but you not only give us something to look forward to in every issue of the NT but also inspire us with your way of writing. Well done!

Posted on: 25 AUG 2011 | 11:23 AM NST