The emperor of maladies

IN PERSPECTIVE

I read Siddhartha Mukherjee’s cathartic book The emperor of all maladies while caring for a cancer patient. It was liberating to an extent. This Pulitzer Prize-winner makes you see things differently, especially when you are watching someone dying in bits and pieces.

Studies don’t tell you the real truth about this dreaded disease. They merely address issues like success/failure rates, policies and programs. They cannot fathom that sinking feeling you experience when the radiologist holds up a wet X-Ray to show you a dark patch. Or, when the pathologist hands you a slide with an apologetic smile. Or, when the specialist in nuclear medicine points to a screen that lights up like a Christmas tree to tell you that the end is approaching.

We have made great strides in the diagnosis and treatment of this disease. But very little has been done to prevent it. According to the Indian Council of Medical Research (ICMR) cancer, which has doubled over the last 25 years, is the second most common cause of death in India today, with oral cancer leading this grim statistic.Again, of the 100 types of cancer that can afflict people, the commonest and deadliest type in this country is related to tobacco. Ironically, it is also the single most preventable cause of death. It has been officially established that more than 2,500 persons die in India every day due to tobacco-related illnesses alone. Last year, tobacco use is said to have accounted for more than 300,000 deaths in this country.

These shameful statistics need to wake up governments, doctors and the general public to fight this enemy lurking on our doorstep. Yet, this killer weed is legally sold and made freely available to the public despite governments knowing that it has no health benefits.

On the other hand, it slowly destroys its victim whether it is smoked, chewed, or inhaled. Other than triggering cancer, it can also damage the heart, lungs and liver. The addictive nicotine in tobacco is merciless. Doctors know it. Oncologists have seen its devastating effects. Medical associations are certainly not ignorant of the colossal damage it can cause. Governments, both at the Centre and in the states, are fully aware of its drain on the Exchequer, leave alone its capacity to wreck families.

Yet, why have they not taken steps to ban the sale of cigarettes and other related products? The tobacco lobby must be fearfully strong and powerful to continue to flourish. Its products remain easily accessible to the public because they are highly profitable to its manufacturers. If leading business houses like ITC use facile arguments like “if you ban cigarettes in India, you make way for the illicit invasion of foreign brands,” the only answer has to be a strong citizens’ movement to fight this scourge.

Tobacco’s saddest victims are teen-aged children. You have to see it to understand its gravity. A visit to a hospice in Bengaluru where the victims of cancer come to die is an eye-opener. That is where I met 16-year-old Raji from Marathahalli dying of oral cancer — the deadliest of cancers. Her face was completely disfigured and only her luminous eyes described her pain. It was the result of chewing tobacco.

Youth need to wake up

If only educational institutions can arrange tours for young people to these places, where they can see the horrors of tobacco addiction. It would be far more effective than the warning “tobacco is injurious to health,” which makes no dent on its consumers.

Young boys and girls who think smoking is chic need to be made aware of its dangers. The same is true for the parents who smoke and expose their children to the risks of second-hand smoke.

At the end of the day, it is the government’s responsibility to ensure that the merchants of death do not thrive. Cigarette manufacturers, their advertisers and promoters are all partners in this crime. Schools, colleges, clubs, theatres and other public places that permit smoking in designated areas are equally guilty. Doctors and oncologists who prefer to treat its victims rather than fight the tobacco lobby have failed their patients. Citizen groups that seek better roads, parks and playgrounds should wage a war against the sale of tobacco, too. It needs a concerted effort by all the players to win this battle.

Especially so when there are other players who profit by the spread of tobacco-related diseases like pharmaceutical companies. Cancer is a rich man’s disease, and these business houses, their distributors and chemists make a killing out of it.

If a pack of ten tablets cost Rs 75,000 five years ago, a single immunotherapy session costs Rs 1 lakh today. How many families can afford this luxury?