I t was in mid-1973 that we published The Nature of Cancer - 23 chapters, 55 comprehensive and exhaustive tables, 132 illultrations, over 6000 references in 932 pages. Its scope is encyclopedic, covering the cancer scene from pre-Christian times to early 1973.
The leit motif of the book is cancerrealism - an unblinking survey of cancer that provides a two-fold revelation; First, that cancer is not a medical problem to be understood, managed and ultimately solved by some Nobel-prize winners but a biological phenomenon, a time- bound universal process impartially affecting plants, insects, animals and us humans. Secondly, the genuine comprehension of cancer is a democratic process, for, of, and by the people irrespective of their layness or learnedness. Cancer-experts, or rather doctors, have a role to play - of providing ease if and when cancer causes dis-ease.
The specific features of cancer are - causeless, cureless, unpreventable, silent for years in the body before it bothers the per- son or becomes detectable by the doctor, not bothered to be the cause of death, occurring every where, in excess nowhere, affecting on an average one out of five human beings, and like God, impartial to kings and cobblers, rich and poor, doctors and non-doctors, all ages, both sexes.
Each cancer occurs in the womb of the cosmos, conversing with all the cancers that were, are and will be, and hence managing to be invariably unique - unprecendented, unparalleled, unrepeatable. The autochthonous, programmed character of cancer makes it unresearchable. What is cancer, we cannot research upon; what we have been researching upon has never been, is not, will never be cancer.
At the suggestion of Ivan Illich, we compressed The Nature of Cancer into one-twentieth its size, without sacrificing its essence. The condensed version, Cancer: Myths and Realities of Cause and Cure , came out in English, German and Dutch in 1979, and in Gujarati in 1988. The German edition underwent a reprint in 1984. All told, start- ing from 1973, it is nearly twenty years since we enunciated the truth about cancer - cancerrealism. We owe to the reader a survey of the "advances" made by the powerful world of cancer specialists and researchers, and the change in our own thinking that we were compelled to make on account of those advances.
Despite the respectful reviews that The Nature of Cancer and its abridged version received the world over, the cancer establishment has remained blissfully unaware of the concept of cancerrealism. The absence of any qualitative change in its ethos has been expectedly compensated by a quantitative overkill in funding, research, papers, books, conferences, claims and promises.
At the Tata Memorial Centre (TMC), Parel, comprising the Tata Memorial Hospital (TMH) and the Cancer Research Institute (CRI), the annual budget was Rs. 0.5 crores in 1968, Rs. 18 crores in 1989 and Rs. 26.42 crores in 1991. The floor space jumped from 18610 square meters in 1968 to 36591 in 1989 and 53887 in 1991. The TMC completed its Golden Jubilee in 1991, being "in the forefront of research, treatment and education in cancer in India." At its very start, the souvenir declared - " We need funds. More funds. More help. "
The steep hike in the TMC's budget does not reflect the fact that its CRI wing has been more in the news for its work on an experimental leprosy vaccine than for any breakthrough in cancer. From its 1991 budget of Rs. 26.42 crores, the TMC will be raising it to Rs. 40 crores in 1993, and we predict that the then souvenir will again plead: " We need funds. More funds. More help." It is a yearly ritual with all cancer institutes, the world over.
The current bible in cancerology is Cancer: Principles and Practice of Oncology , edited by three top names in USA cancer establishment - DeVita, Hellman and Rosenberg; its fourth edition published in 1993, has 211 contributors, and 2747 large two-column pages, 108 pages of index, all in compact print. In its very "Preface" are assertions to- tally at variance with long-established and scientifically accepted facts on cancer. The claims are about (a) early diagnosis and treatment (b) dramatic changes in cancer research and (c) more and more cures and less and less morbidity.
These assertions by the most respected members of the American cancer establishment are best interpreted through a generalization on the issue by a double-Nobel-laureate American, Linus Pauling, in his comment about an investigative book by Ralph Moss, a former Assistant Director of Public Affairs at the Mecca of cancer research and treatment, namely, the Sloan-Kettering Institute (where Sanjiva Reddy, Nargis Dutt and the Shah of Iran were treated). Dr. Pauling makes it clear: "The revelations in this book about the ways in which the Amercian people have been betrayed by the cancer establish- ment, the medical profession, and the government are shocking. Everyone should know that the 'war on cancer' is largely a fraud, and that the National Cancer Institute and the American Cancer Society are derelict in their duties to the people who support them."
The use of the term fraud would appear harsh. This fraud is not one of the intention but of cultivated ignorance of cancerrealism. The April 2-8, 1989 issue of the The Illustrated Weekly of India ran a cover story: "How Indian doctors are now successfully beating back the Big C (= Cancer)." The story centred on TMH, but also referred to cancer centres and research all over India. One statement was: "Radiotherapy is very effective." In the October 1989 issue of Nature , it was reported that radiotherapy by itself precipitates lethal heart conditions and other cancers.
In January 1991, the Time magazine carried a cover story on breast cancer, describing it as a puzzling plague that had not spread such celebrities as Betty Ford and Nancy Reagan, the wives of two Presi- dents. The article talked of increased modalities of treatment includ- ing radiotherapy and chemotherapy. In the same month and year, an article and an annotative editorial in the Journal of Clinical Oncology bemoaned the fact that cancerologists are more scientific and ratio- nal when it comes to treating their own kith and kin, but quite erratic and irrational when they treat their patients with surgery, radiotherapy or chemotherapy. This medical schizophrenia of the Doctor/Doctor's near-ones being more precious than the patients is age-old, but the oceanic mass of verifiable data has not prevented the cancerologists from perpetrating a fraud on their unsuspecting patients.
The one silver lining in the whole dark cloud of confusion over cancer is a statement by UK's most prestigious organization, the Imperial Cancer Research Fund, in its appeal for funds in The Practitioner (London), of February, 1979: "It is good to remember that most people live their lives untouched by any form of cancer."
The very rationale of the foregoing could be perceived from a radical stand taken by Prof. Eysenck, a noted psychologist of UK. In December 1980, Professor Eysenck declared that there is no proof that smoking causes lung cancer and heart disease. "There are too many inconsistencies, downright errors, and unsupported conclusions in the research to make it possible to accept the suggestions as proven that cigarette smoking in a meaningful sense causes lung cancer or cardiovascular disease." It's time causalism in cancer was granted a decent burial.
Cancer in Our Near Ones
In mid-1975, Khushwant Singh allowed our views on cancer to be featured as a cover story for the The Illustrated Weekly of India . In August 1975, a leading Gujarati editor / writer met us and asked us point-blank if we would sustain our views if one of us or a near-one were diagnosed to have cancer. As luck would have it, MLK's father, aged 70, came to the KEM hospital for an eye check-up when a rou- tine X-ray chest revealed a large cancer of the lung on the right side. With the X-ray film still wet, the procession went to the Chest Special- ist where the following transpired:
Chest-Specialist: "What have you done to yourself? You have ruined yourself by smoking."
MLK: "Doctor, he has enjoyed smoking for the last 57 years. Neither he nor I have any grudge against what has happened."
Chest Specialist: "O.K.! Arrange for a biopsy and we will see what to do. But he must give up smoking."
It was a Thursday. The biopsy was scheduled on Saturday under gen- eral anaesthesia. On Friday morning, MLK's father sat with him over a cup of tea.
MLK"s father: " Manu, I have read your large book on cancer and I know it makes no difference whether you treat or do not treat lung cancer. Tomorrow we will go to Rajkot for a pleasure trip as planned. Don't cancel the tickets. And do not ask me to give up smoking."
So MLK and parents went to Saurashtra for an outing. There was no follow-up sought, no second opinion. No treatment. Thirteen years after the above episode, MLK's father died peacefully, and not due to cancer.
In August 1984, MLK's mother, aged 69, complained of the loss of appetite, otherwise, fully fit. She was feeling from within that some- thing was amiss.
MLK's mother: " Manu, this may be my last illness. I think I have to go."
MLK: " Yes, Ma. If you think that it is time for you to go, we will have no quarrel with it."
She was seen by a surgeon, another surgeon, a top physician. CT scan was done to understand why she had progressive loss of appetite, distension of abdomen, and collection of fluid in the right pleural cavity. A tentative diagnosis of TB was made and she was to be put on full regimen of anti-tuberculous drugs including injection streptomycin. But before launching on to that, on October 13, 1984, a part of the fluid was removed from the chest.
On Tuesday, October 16, LAM was urgently summoned by Dr. Kinare, the chief pathologist, " How to inform Dr. Kothari that his mother has metastatic cancer?" LAM said: "Let us call him right away." So at 12.00 noon, on that day, MLK saw the cancer cells, and had a glimpse of the whole cosmos in those spherical balls. He thanked the cells for what they were doing for his mother.
By 1.00 p.m. the father was informed, and by 1.15, the mother. "What would you like to have done?" MLK asked.
Both parents said: "We will do as you decide."
A decision was taken not to do anything. On Thursday, the 18th morning mother went around in the wheel-chair to thank all the staff and returned home. At home, the atmosphere was one of relaxation.
On Friday, MLK's sister arrived from abroad with the latest I.V. infu- sions for parenteral administration, since mother could hardly take anything by mouth. MLK declined to poke mother anywhere. The sister argued that even for the sake of letting father feel that some- thing positive is being done, mother should be given I.V. protein and fat. "If mother looks so fit and peaceful, I do not want to make father feel better by making mother feel worse." Mother was prayerful all the time, sleepless though because of hacking cough. In the midst of all that, she was concerned about the well-being of the many guests who had come to be with her.
On Saturday, Oct 20th, around 11.00 p.m. she asked for Manu: "Call your father." He came, and for the first time she addressed him as Liladharbhai." She bowed to him and took leave of him. Then she asked all children to live in harmony with each other, and love each other. The breathlessness was increasing. But her prayers were on, with hands folded.
At 2.30 a.m. she was made to sit up, resting on the arms of MLK. Her skin was supple, moist and full of health and feelings. She asked for a bhajan to be sung: "Tere Mandir ka hoon Dipak Jal Raha." MLK's brother Dipak had died suddenly in 1977, and mother loved to hear this bhajan now and again. At 2.40 a.m., she asked for another song, "Ye Rate Ye Mausam" to be sung. At 2.50 a.m., MLK asked: "How are you feeling, Ma!" From the depth of her soul, came a definite whisper. "Very fine." At 2.55 a.m., she had peacefully, smilingly merged with the infinite.
In the condolence meeting, doctors expressed surprise that MLK did not capitulate into getting her treated. Mrs. Kalyani Mani felt that the mother expressed her profound love and respect for MLK by getting the dreaded disease and then by smilingly living with it till the end.
January 1989, MLK's aunt, aged 77, bilaterally blind because of glau- coma came to G.S. Medical College with just a lump above the right clavicle. MLK told her that it was cancer, but for which nothing was to be done excepting eating well, sleeping well and remaining cheerful. With this, she put on about three kilograms of weight. The supraclav- icular lump enlarged, ulcerated and bled. Additional lumps appeared in the right breast, left breast and both the axillae. No pain. No sleepless- ness. The neck lump had enlarged. The front of the neck and the left inframandibular region were plastered with cancer. There was no break of skin in that region. One day, on hugging her, MLK perceived foul smell. We were treating her with the conviction that cancer per se does not stink. It was only after it is irradiated or treated with chemotherapy that it is prone to foul smell. Shantaben's foul smell was a surprise.
On inquiry, it turned out that at someone's instance she had started applying her own urine. This explained the stink. Regardless of her ulcerated wound, she was given a generous bath and that was the end of the stink.
Shantaben developed massive edema of the right upper limb, and the right lower limb. The lump in the clavicular region had turned into a deep wound, red and fleshy, revealing through it some of the structures in the mediastinal region. After a few days the edematous limbs developed multiple lymphatic blisters that exuded substantial quantity of fluid. The edema subsequently reduced considerably. In our experience of 35 years with cancer, this was the first time that an edematous limb because of cancer had returned to near-normal size on its own.
It was in July end, on one of the weekly visits, that MLK perceived that Shantaben's body was refusing to ask for any nourishment. He spoke to her: "Shantaben, now you have to prepare to go. I will meet you upstairs wherever you are."
That was in the morning. The same evening, while talking to her son, she passed away suddenly because of a heart attack. Her cancer stayed with her. Her cancer per se did not kill her.
MLK's brother-in-law Jaysukhbhai, aged 71, came six years ago with hoarseness of voice, and a diagnosis of vocal cord cancer, estab- lished by an ENT surgeon through scopy and biopsy.
The regimen planned included vegetable juices, chapaties made of flour of five cereals and pulses mixed together, salads, regular walk, eating well and sleeping well. Jaysukhbhai who had lost weight regained all his weight, gained some more, took to business and full life. He follows up once every three months. In between, examination shows the presence of cancer but no progress whatsoever. Jaysukhbhai is fit as any young man and has had no treatment whatsoever.
A lawyer, Mr. Shah, a shade older with the same disease took inspira- tion from Jaysukhbhai's case and lived well for three years, in the face of prognostication of doom by the specialists.
Principal Karia and Mr. Pittalwalla are not related to MLK, but became close to him.
Kariasaheb, aged 66, came with a table-tennis-ball sized mass in the left tonsillar region. Some nodes were palpable on that side. He could swallow liquefied food and hence no attempt was made to reduce the swelling in the mouth, which was extending backward into the throat. He was seen regularly for nine months, had a yatra of religious places, kept well and one day died of a heart attack: He died with his cancer.
Pittalwalla, a pious Bohri of 83, dreamt he had throat cancer and sent for MLK. Diagnosis was made. No treatment was given. Three months later, while serving his wife who had flu, he had sudden chest pain and died. Cancer is not the killer most people think it is.
Pragnya Buch, a lady relation in her forties, from Ahmedabad, urgently phoned up MLK about the proposed removal of her eye for a cancer of the retina diagnosed by a leading ophthalmologist of India. There and then MLK replied: "If it is cancer, you are too late; if not, you lose a normal eye." It's twelve years since and Pragnya as well as her eye are fine. Just following the above episode, the Ophthalmology Clinics of North America revealed that (a) if it is cancer, removal of the eye makes no difference to morbidity or mortality, and (b) one out of four eyes removed under the diagnosis of cancer turns out to be normal.
Not to be left out, LAM had two cases in her family.
Her aunt, mother of a pediatrician practicing in the USA, developed a breast lump, diagnosed as cancer. Being a doctor's mother and with two sons-in-law as doctors, she was shown once at Tata where they advised hormonal treatment to begin with and, at a subsequent stage, radiotherapy. She did not opt for either. Thereafter, she was busy with life, home and temple as usual. She could partake in a marriage of her granddaughter. After more than a year after the first diagnosis, she became bed-ridden because of weakness. She remained uncon- scious for about a day before peacefully breathing her last through brain involvement.
Another aunt of LAM, in her late eighties, was having some digestive disturbance. LAM could palpate a hard lump in her abdomen. She just gave her symptomatic relief but decided against finding out further about the lump. For nearly two and half years the aunt was in reasonably good condition, eating well and ambulatory. After that multiple subcuta- neous metastasis appeared on her back. But otherwise she remained active. Eight months later she became unconscious for a day and passed away peacefully. Her cancer remained kind to her till the end.
We have had some relatives and doctor-friends referred to us, and they too have been handled along similar lines. We are not against treatment which is imperative whenever there is dis-ease. But if there is no dis-ease or it is such that it is not amenable to any corrective measure, the safest course is not to trouble trouble unless unless trouble troubles you. The behaviour of cancer in the above cases, witnessed at close quarters and in the full eye of medical men around, testifies to its essential nature of being a part of one's growing, and in no way an invariable killer.
The occurrence of cancer in any individual follows the que sera sera principle. Therefore it is pointless to go seeking it thorough medical check-up. Not one member of our families has had a single check-up for cancer detection, despite the easy accessibility to all the sophistry around. Cancer truly need not be feared.
Beyond Anybody's Opinion Including Ours
Our summing up of cancer as an intrinsic, time-governed, senescent process that has no cause, no cure and therefore essentially no treatment has upset many people, medical and lay. How can such a complex process, as yet uncomprehended by all the researching scientists be so sweepingly summarized as an integral part of one's own self!
Our plea that, by and large, cancer can be left undisturbed has often invited the understandable but harshly worded criticism that we are against treatment and therefore against alleviating mankind's suffer- ing. Such criticism takes for granted that treatment always helps and not treating always worsens the cancer. Ask any average lay adult and you will hear enough stories to the contrary.
We have no personal views on cancer. What we have done is to study cancer patiently from various evolutionary, biological, clinical and thera- peutic aspects. The enormity of our study combined with an absence of any pre-fixed idea, has given to us a vision that we have offered, initially to the cancerologists, as The Nature of Cancer and then to the patients as Cancer: Myths and Realities of Cause and Cure . We must say that laypersons, particularly patients, have been far more open to having a revised perspective on cancer than are the doctors. Doctors tend to be too learned, too cocksure,too prejudiced.
Be that as it may, the fact remains that what we have perceived and expressed about cancer is consistent with all the known data on cancer. Neither in The Nature of Cancer nor in Cancer: Myths and Realities of Cause and Cure have we indulged in apologetic retrac- tions, ifs and buts, howevers or neverthelesses. And what we said but once did not have to change a wee bit over the last 20 years.
In 1981, Brian Inglis, a noted British journalist, wrote a book titled, The Diseases of Civilization, published from London. The only book on cancer that he chose to refer to in his tome is Cancer: Myths and Realities of Cause and Cure . Here is Inglis on the book:
The best-documented exposure of the weaknesses of conven- tional therapies that has recently appeared is Cancer: Myths and Realities of Cause and Cure, by two professors of anatomy, M.L. Kothari and L.A. Mehta. Orthodox medicine's assumptions about cancer, they argue, are based on a myth, 'including such "facts" as that cancer is caused by an agent (and hence can be pre- vented by ridding humanity of that agent) and that it can be diag- nosed at a stage when a pre-emptive strike at it would assure a cure.' Cancer cannot be prevented or treated, they claim; so di- agnosis cannot affect the ultimate issue. Although reviews of the book by cancer specialists were generally critical, they were also respectful. As the authors backed their contentions with over three hundred source references, most of them from medical books and journals of impeccable orthodoxy, it was not easy to dismiss them as cranks. The then deputy editor of World Medicine, though he found the book puzzling, conceded that 'an intellectually re- spectable case can be made for suggesting that the abandon- ment of all (well, nearly all) our surgery, radiotherapy and drugs would make precious little difference to our mortality rates.'
Cancer: Myths and Realities of Cause and Cure was introduced by Ivan Illich, and Dr. Scott-Samuel. Neither Inglis's summing up, nor what Illich or Scott-Samuel stated then has merited any change despite the passage of so many years and the ceaseless publication of papers or books on cancer (one every minute). Truth does not change with time.
After the publication of our books on cancer, we have preferred not to talk about the topic or our book anywhere. For the truth about cancer is such that it can be as easily comprehended by the lay as by the learned. Such a comprehension is beyond any -ism. It is a per- ception of reality that is amply borne out by anybody's and everybody's experience in any part of the world, and in relation to any cancer.
In 1908, Harvey Cushing, the famed US Brain surgeon wrote: "Aside from such simple measures as serve to palliate the severity of given symptoms - we have long stood helpless in the presence of a brain tumour." In the 35th volume of Clinical Neurosurgery , 1987, three lead- ing American neurosurgeons conclude that "His (Cushing's) observa- tion is as apt today as it was in the early twentieth century." What a group of Scottish physicians said about breast cancer in 1802 is as valid today, close to 2002. The biology of cancer, in man or dog, in an insect or an elephant is beyond anybody's effort or opinion. It is what it is. So it has been. So it will be, for ever. In our seeming pooh-poohing of the cancer establishment all that we have ventured to say, like a child, is that the king is naked under his clothes.
The Other Face of Cancer is almost a verbatim copy of Cancer: Myths and Realities of Cause and Cure as it was first published in 1979. So it would be if we were to reprint the 932 pages of The Nature of Cancer . Within the two books, there is a body of truth that democrati- cally belongs to everyone. Truth, Voltaire said, has no party. The truth about cancer is irrespective of MLK and LAM. The truth will outlive mankind.
How long shall we hide the sun of the truth of cancerrealism by inge- nious explanations, instruments, techniques or the glint and gloss of the printed or projected media? Mankind got the Nobel-prize winning CT scan, and that soon got superseded by the MRI. Given these magic eyes, it is now easy for the experts to know and record the minutest anatomic detail in a living body, without even touching it. A push of the button and you locate tiny bits of cancer hidden in the body's depths. A catheter can be pushed up an artery feeding a cancer so that the artery can be blocked by selective embolization thus starving the can- cer to death. Through costly but hi-fi-endoscopes tumours can be biopsied, or even totally excised.
Yet all these attainments fail to alter the nature of cancer, its behaviour in the patient's body, its decision to run away from your probe to else- where in the body. Expectedly the cost of diagnosis and treatment of cancer has reached back-breaking limits, but the funeral-rate has remained unchanged. And it will never change.
The truth about cancer is not a by-product of money. Many a well- wisher suggested that before we ventured to say or write anything, we ought to have had a nod of assent of the authorities at the Tata Memorial. We are not even Pune-returned. But a Yale-returned doc- tor-friend put it down quite clearly that unless the Americans say 'yes' we should not publish our major work. Refusing to accept the creed that white skin is God's skin, we wrote and said what we perceived as reality. The rest is history. From 1973 onwards, every year has served to vindicate whatever we have stated.
Neither we killed a fly
Nor broke a test tube
Nor sought a farthing
Nor needed to confer.
The truth that we perceived is available to the common reader in En- glish, Dutch, German, and now in Gujarati. It may seem unbelievable but it is India that is telling the world what cancer is, and what can be done about it, and what cannot be and should not be. The knowledge about cancer has been democratized, globalized.
A cancer cell is derived from your own pre-existing normal cell. The two share the same genetic material, the same metabolic machinery, the same duplicating apparatus. Hundreds and hundreds of the most so- phisticated laboratory tests have failed to show a single feature that allows you to distinguish a cancer cell from a normal cell. Nobel- Laureate Szent-Gyorgyi is more humble on the issue: 'How can I differ- entiate between a normal cell and a cancer cell when I don't know what a cell is?' - that is how he concluded, as the Chairman of the 1979 Ciba Foundation Symposium, NO. 67 titled - Submolecular Biology and Cancer. The final conclusion about the cancerous change in a body cell is that it is a form of normal cell differentiation. Cancer cell is a normal cell, behaving cancerously as a part of its newly assigned func- tion. No chemical agent, or vaccine has been located that differentiates between the so-called cancer cells and the so-called normal cells.
Cancer therefore is derived from you. It's you. It is your own flesh and blood. It is not your enemy. It stays in your body quietly and peacefully for years together as a part and parcel of you. That a cancer can stay with you for so long itself proves the fact that it is an intrinsic, insepa- rable part of you.
In a hundred cases of stomach cancer two American surgeons cut through a cancerous mass and then sutured cancerous tissue with normal non-cancerous tissue and yet the suture-line healed as well as anywhere else in the healthy tissues of the body. If the cancerous mass was not an integral part of the body it would not have healed like normal tissues. Cancer is really you. To know cancer is to know your own self a little better. So to accept cancer, as integral to you is to accept yourself a little better.
Man sitting atop the evolutionary pyramid is an integral part of it and is governed by the pyramid, base onwards. We do not know how much can the naked ape (man) escape the characters of the phylum, class, order, genus, species or the herd he belongs to. Cancer is, to say the least, a species character. Being merely human is sufficient for the genesis of cancer.
If cancer is a mere cellular feature, and if you, like all other animals, are made up of cells, then you ought to be ready to accept that your cells too can undergo a cancerous change. Medical students start their study of anatomy by dissecting an earthworm, a cockroach, a lobster, and a frog to appreciate all the principles of anatomic organi- zation as govern human anatomy. Much of knowledge of human em- bryology is derived from the study of embryos of the so-called lower animals. And extensive cancer experiments on animals have shown that cancer in animals does not differ from cancer in humans. If you are given a thyroid cancer from a dog or a liver cancer from a pig without being told its source, the best pathologist would diagnose it as human cancer. To be human is to be cancerous.
Immunologists around 1945 floated the idea that cancer is an alien tissue that the immune system is eliminating all the time and it is only its failure that results in cancer. The recent realization is that, if at all, immunity pampers cancer cells by feeding them with nutrition and by coating the cancer cells with protective antibodies; the corollary is that cancer is not alien. It's very much you.
Epistemology is the science of the scope and limitations of a given piece of knowledge. Not all that you know helps you to alter what you know. Even after Newton drew our attention to the force of gravity, and even after we studied it and measured it in such great details, that has never meant that we can alter the principles of gravity. Apples must fall down. No apple can fall up. As Ardrey put it, even the makers of the space rockets bear in mind the falling down of the apple.
Our knowledge about cancer, however detailed, is like our knowledge of gravity. We can enjoy knowing cancer, without having the rights or the power to alter its essential suchness or character. To give you some samples of such limitations of our knowledge on cancer, here are some statements from reviews of books on cancer in the April 1990 issue of the world-famous Mayo Clinic Proceedings: (i) "In gen- eral, the text (on breast cancer) presents an accurate sense of limita- tions in various areas," and (ii) "Current methods of management of cancer of the bile ducts and pancreas are frustratingly limited." The May 1991 issue of The Practitioner , the highly-respected journal from London, has in its 235th year of publication, the following candour by Dr. Lewith, a mammologist: "In many instances, I feel that conven- tional, surgical and chemotherapeutic approaches to breast cancer are actively destructive, and may decrease life-expectancy."
From such specific examples, we could move on to a Nobelist gener- alization on all aspects of cancer. "If there could be such a thing as a comprehensive and unbiased survey of the results of cancer research, I fancy that the surveyor would finish his task with a devastating impression of futility. We have to face the reality that the practical outcome of the hundreds of thousands of man-years of work on the mechanism of chemical carcinogenesis, the significance of oncogenic viruses, the control of morphogenesis and immunological aspects of cancer has been precisely nil." (Sir Macfarlane Burnet.)
One vision becomes clear: We can continue to know limitlessly about cancer, may be for the next 1000 years. But all that we may know will not allow us to gain any ground against cancer in humans. Cancer has had, has, and will have the last laugh.
Why so? Because the forces which govern its genesis and its behaviour are truly cosmic, spanning infinite time and space, and hence well beyond the necessarily localized nature of any therapeutic approach. Cancer as an arm of Lord Shiva is denied no less majesty than the generative genius of Brahma and the fostering power of Vishnu. In the philosophic analysis, cancer is an integral part of the benevolent domain of Lord Shiva. Its undaunted character should teach us, man- kind, two lessons: In the kingdoms of the Lords of the Holy Trinity, all humans and animals are alike. And the dissolving / destructive Shiva in you is accorded no less importance than Brahma or Vishnu. Let cancer be.
Who really knows more about a cancer? A doctor or a patient? It has been taken for granted that the doctor is Mr. Know-All of the cancer and patient is Mr. Know-Nothing. But epistemologically it is the pa- tient who knows more about his / her cancer, because the patient experiences the cancer, the doctor thinks that he knows about it. What is to be trusted more? Experience or mere knowledge?
While interacting with a cancer-patient, we make it a point to drive home to the patient our conviction that it is the patient who is the greatest authority on his/her own cancer. It was Salisbury, thrice Prime Minister of UK, who generalized that " A gram of experience is worth a ton of theory." All cancer patients have experience of cancer by many grams, sometimes kilos. All cancer experts know tons and tons of theory which like the shifting sands keep on changing every hour de- pending on which way the Western scientific wind blows. This episte- mological essence may hurt many an expert, but the truth can no longer be denied.
A question may be asked: "If the understanding of cancer can be so simple, would not mankind come around to accepting its real - cause- less, cureless, self-regulating - nature by 2093 or 4093?" Chances are it will not. Drunk with its own exaggerated sense of human capa- bilities backed by the might of money and machines, it will continue to search for the curability and controllability of cancer. This ethos was summed up in August 1980 by America's leading magazine Science . "The desire to believe in progress in cancer treatments is so profound that people don't want to hear the disbelievers."
The brashness with which we have decided to forecast the shape of things to come, in cancerology, in the next 100 years may appear to most as unpardonable arrogance. "Given the scientific might of USA alone, don't you think that the cancer problem will be solved before 2094 arrives?" Right away we like to submit that there is not available to science, a single feature of cancer cell or cancer that will lend itself to research towards preventing or curing cancer or towards altering its behaviour in a given patient. The foregoing would stand true in 2094, and if humanity survives atom bombs, then in 4094 as well.
The American Congress, in 1969, urged an "all-out war on cancer," to conquer it by 1976. At the same time, American Cancer Society in- spired a group of citizens to form a Citizens' Committee for the Con- quest of Cancer which began a public-relations campaign aimed at the passage, in the American senate, of the aforestated all-out effort. In full page ads, the Citizens' Committee cried out:
MR. NIXON: YOU CAN CURE CANCER
If prayers are heard in Heaven, this prayer is heard the most:
"Dear God, please, not cancer." Still, more than 318,000 Americans died of cancer last year.
This year, Mr. President, you have in your power to begin to end this curse.
- New York Times , December 9, 1969
Dr. Randolph Lee Clark, a famed cancerologist and editor of the Year Book of Cancer for years, declared emphatically: "With a billion dol- lars a year for ten years we could lick cancer." It seemed that God had refused to hear prayers, but the President of America did. On Decem- ber 23, 1971, President Nixon signed into law the National Cancer Act - "a national crusade to be accomplished" by what Nixon called for, "the same kind of concentrated effort that split the atom and took men to the moon." What is cancer, after all, before the might and the genius of America.
The bicentenary, 1976, arrived and passed away without a scratch on the C of Cancer.
LIFE magazine published a special bicentennial issue on the 100 out- standing events in American history, but conquest of cancer, or even a mention of the war on cancer found no place. The August 26, 1991 issue of Time , featuring the crisis in American science, listed all its major achievements, but could not write one word against cancer.
Cancer had licked America and has had the last laugh. The story is no different from England, or from France where at Lyon is located the International Agency for Research on Cancer (IARC) or from Swit- zerland housing the Union Internationale Contre Le Cancer (UICC). Cancer can never have a solution, because it is not a problem.
As a closing argument against the researchability of cancer, we will put before the reader something very commonplace: Until recently it was taken for granted and taught - still taught - that in a cell the nucleus dominates the cytoplasm. The cancer researchers looked at the nu- clei of cancer cells describing this feature and that as pathognomonic of cancer.
Suddenly, the world of cytology has realized that the nucleus is not the boss; it takes orders from the cytoplasm. Further, that the cancerness of a cancer cell resides not in its nucleus, but in its cyto- plasm. The most elaborate and advanced microscopy of cancer cells, that had all along depended on its ability to help see and describe the nuclei of cancer cells, has bitten the dust. The microscopes can help you see cytoplasm, but the very nebulousness of it rules out any localization of cancer in it. For the purpose of identifying a cancer cell, the science of microscopes is dead.
Structurally, a cancer cell refuses to be distinguished from a normal cell. Functionally, a normal cell shows all the features that a cancer cell shows, and vice versa . Cancer cell is a normal cell. This normality will remain forever unresearchable. Like a beautiful sunset, sunrise, moonlit night, or the star-studded night of a new moon, cancer will lend itself to viewing and admiration, but will refuse to alter its mood and course at the behest of mankind.
As we go to the press, a fresh-from-the-frying pan gimmick is the researchers' declaration that they have located a gene - BRCA 1 on Chromosome 17 - that foretells if the bearer will or will not develop breast cancer in the distant future. Despite the unabashed, typical scientific ambivalence that surrounds this discovery, it has unleashed a flood-tide of scare-mongering, breast/s-chopping, dollar-making. As the prestigious New England Journal of Medicine editorialized recently, a glut of medical men is, now, begetting a glut of money- making medical mythology. The female breast has, once again, be- come a research and fiscal bonanza. The discovery earlier, of the genes that dictate the occurrence of bowel / bladder / lung cancer, has meant many conferences, papers and books, without any help to the patients.
Modern medicine's bankruptcy vis-a-vis heart attack, high blood pres- sure, stroke or arthritis - all age-related, intrinsic biologic phenomena - is no different. Nor is its penchant for frightening the lay public by demonizing these natural processes, and hiding from the public view, their essential benignity. The Other Face of Cancer is a story that could be retold by just substituting for cancer any of the above dis- ease, without compromising the flavour or the essence of the whole text. Physician, heal thyself!
|February, 1994||Manu Kothari|