When we were studying medicine we refereed to cancer as the big C. Recently the New Delhi- born Siddhartha Mukuherjee’s debut book “ The Emperor of All Maladies: A biography of cancer” ( Scribner) has galvanized attention on the big C. The good doctor/author practises oncology in New York and writes magnificently. Cancer’s history can be traced to time immemorial. The Egyptians knew about tumors 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, Nixon was feeling tired of the Vietnam war and realized 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 hopes that this would be a more popular move that could result in an unambiguous victory, compared to the other war he was faced with. No question, Nixon’s war on cancer in the US launched this dreaded disease into the limelight and provided more political and financial support for research, diagnosis, and treatment.

Basically treatment with 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 called chronic 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.

Amazingly Gleevec which costs annually about fifty  thousand US $ is available for free  ( thanks to the generosity of kind hearted groups abroad) in Nepal if you have chronic myeloid leukemia ( CML) and are enrolled in a programme, for example at Patan Hospital. And even though resistance to Gleevec has developed and a second line drug is available ( again, for free in Nepal), there is no doubt Gleevec has helped out thousands of people to continue to live.

Many oncologists 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. In fact, in medical statistics one common test is the total numbers needed to treat ( NNT) to see one useful result.  However, it is re assuring that Mukherjee in his book allows himself hope. He should know because as a cancer doctor, he has the inside track and writes very well.