Rotary Club of Bombay honours Dr. Rajendra Badwe with Citizen of Mumbai Award.
Rotary Club of Bombay honours Dr. Rajendra Badwe with Citizen of Mumbai Award.
Dr. Badwe is Professor Emeritus and former Director of Tata Memorial Centre.
Thank you very much, President Israni, Mr. Agarwal, and friends. I’m honoured to be conferred the citizen of Mumbai, and would say that the credit for whatever was enumerated as my achievements is essentially to the House of Tatas, who have relentlessly supported our efforts at Tata Memorial Centre, the Department of Atomic Energy, that courtesy Dr. Homi Bhabha has always been a major support all through these 80 years of existence of this hospital. And the unstinting support that I have got from the society at large, and I can’t forget the kind of faith that is reposed by the patients in offering themselves at the time when they’re all shields down for them to come back to normalcy. So all these individuals and the societies are important for anybody to get whatever one can achieve.
But talking of cancer, it wasn’t a very common disease a few decades ago. Today it is extremely common. But we are shade better off compared to what the West is. And that we can say with fair degree of confidence that in rural pockets, where we run cancer registries with house-to-house surveys in about 3 to 4 million people, we know that cancer there is less. It affects about 40 to 50 individuals per 1 lakh population per year. The same number as I move from a rural pocket to a mid-sized town. This number rises from 40 to 50 to 65 to 75. I come to Mumbai, which is the same as Bangalore, Kolkata, Chennai, and Delhi. And the number would be 100 per 100,000. And as I move from here to any European country or United States, the number would be 350 per 100,000 per year. So we are much better off. That should not push us into complacency.
So I must confess that I’m an eternal optimist. So let’s look at the positive points that we have here. And the best part is that these numbers of 45 in rural, 75 in mid-sized town, and 100 in cities have remained a straight line in these populations for the last 20 years. Whereas all other BRIC countries, excluding India, these numbers are rising everywhere. So there is something different about us. But the rate at which urbanisation is happening and urbanisation is inevitable, the numbers will rise. A simple example, Barshi, a town in the middle of Maharashtra, about 400 kilometres from here, has a rural pocket. And somewhere in 1996, 97, an urban pocket evolved in Barshi, a textile town. By 2005, the numbers rose from 45 in rural pockets to 65 in urban pockets. And they are apart by 10 kilometres. So there is something that we, a price that we pay for urbanisation, and that’s going to happen. These numbers in the West are constant everywhere, because there is no rural Europe.
And it is exactly the same even in Punjab. There is no rural Punjab. So there is no town or village in Punjab where the numbers are 45 and 50, everywhere it is 75. So like a mid-sized town. The whole of Punjab is like that. So we are in for a rise. Presently 70% of our population is rural. 25% is a mid-sized town and 5% is urban. We will have 5% rising to 25, rising to 50. So in another about 2 or 3 decades we will have 100 across. That about the same time we are okay as far as the West in comparison to the Western countries. The good part of these 100 is that two-thirds of the cancers of these 100 lend themselves very easily to early detection because two-thirds are constituted by oral cancer, breast cancer and cervical cancer. All three lend themselves very easily to early detection and if detected early the cure rates exceed 85-90%.
Here is the edited text with UK spellings and corrected grammar:
I can’t say this to somebody diagnosed with diabetes or hypertension at age 50 that you can have 25 years of life. That doesn’t happen. We don’t look at it with the respect that we should be giving for a life-threatening disease which we do for cancer and that’s only because somebody gets cancer and the deaths are maximum in the first three years, first four years. Somebody gets diabetes and blood pressure, the deaths are maximum between year 10 and year 16 after the diagnosis. So it doesn’t kind of hit you as much as it should but the death rates are similar whether it is diabetes, hypertension or it is cancer.
Two-thirds of cancers are also preventable. So 40% of cancers in India are related to tobacco and we need to do something about it. The industry needs to do something about it, which is very easily said to be extremely difficult to do because if you talk to the farmers they get their payment of the crop two years in advance. Now who is going to do that? It’s impossible but we need some incentive, some alternative cash crop and the money flowing to these farmers for them to stop. But the farmer is extremely comfortable only for one reason that this crop doesn’t require any support system. Insects don’t touch this crop. Insects know that it is bad. And when I spoke to this farmer we had gone for awareness in a district called Kheda in Gujarat which was the largest producer of tobacco some time ago. Now Karnataka has taken over.
But this farmer, a very old man, when we spoke about how bad tobacco is and he said, main jab chota tha tab tobacco hum compound mein lagate the. So that cattle don’t come in and they know that it is bad. Imagine what has happened over a period of time, we need to do something about it and there are many things that can be done. I will not go into the details but suffice to say 40% of cancers are related to tobacco, 90% of heart attacks and strokes are related to tobacco. Somewhere close to about 40-45% of other deaths are related to the next thing that I am going to talk about and that’s obesity.
Obesity induces diabetes, it induces micro vessel disease, heart attacks, you name the problems and it comes out of diabetes which is because of obesity and obesity also produces 19 different cancers. Usually after such talks I walk home. But in general we need to do something to reduce this.
The third preventable factor is infections and infections are reducing. Infection-related cancers. I will name three of them today. One is uterine cervical cancer in women. Reducing at breakneck speed. We don’t know why. If the vaccine was to be given, it would have an effect 25 years down the line because this is to be given at age 9 to 13 and women will have maximum risk when they cross 45 years of age. So its effect will be visible then. But today as we speak, the incidence of cervical cancer in the city of Mumbai which stood 25 years ago at 24 per 100,000 women, today it stands at 6 per 100,000. We haven’t done anything at all to prevent it. The almighty has done something.
When it goes below 6 by WHO definition, this becomes a rare disease. And you might want to ask, why don’t I take a yellow fever vaccine? Because yellow fever doesn’t exist here. It’s exactly the same for many others. I will not go into the political statement of whether we should be giving HPV vaccination for our grandchildren or not. Suffice to say, at 100, even if I take the largest number, two-thirds of cancers are preventable. Two-thirds also lend themselves to early detection and we can have a cure rate of more than 80%. These two-thirds are the ones that we should be greatly worried about. And in general, cancer in women behaves much better than in men. God has been kinder to women than men because death rates are on average for the same cancer. Fortunately, breast cancer doesn’t affect men too much. But for many other cancers, the death rate will be about 20-25% more in men compared to women. So there is something protecting all women further down that these cancers are preventable. And also I would touch upon one last component of the incidence of cervical cancer in rural Barshi, even today stands at 24, urban Barshi 10 km away, 12 per 100,000. Mumbai 6 per 100,000. The whole of the Middle East, 5 per 100,000. And when I look at our Muslim brethren in Barshi, rural, 5 per 100,000. Barshi urban, 5 per 100,000. Muslim brethren anywhere, 5 per 100,000. I am not advising circumcision for everybody.
But religion is supposed to give us a better quality of life. Who we pray to is not important. What is important is that there should be a better quality of life. And the same thing can be taught by teaching good hygiene to our children and grandchildren. Visiting one of the places in one of the camps like this and talking about cancer in Rajasthan, there was this gentleman who came up with a parchment on which something was written in a language which I don’t understand. Maybe a Marwadi or whatever. And he read it out to me. It said that the man in the house should be earning money, giving protection. The woman in the house should be doing food and providing care for everybody. As we went down, the grandmother in the house was supposed to teach the grandchild once he crossed his age of nine genital hygiene. Duties prescribed, this is some 100 years ago that the family was protecting these parchments. What are the duties of individuals? And I was so surprised that cleanliness of the penile region in men needs retraction of the prepuce, the covering of the penis. And that is impossible to do before the age of eight. Because it is physiologically not allowed to be done and if it is forced, it creates a surgical complication called paraphimosis which needs surgery. So it is said very clearly to be done at nine years of age. Imagine what kind of knowledge we already had but today the West is best, unfortunately.
Having said all this, a few things about the last 15 years: Tata Hospital has been able to create good evidence, new evidence which has changed the practice of treating cancer across the globe in at least 15 different studies and a lot of it is because of support from DAE, support from Tata House, support from society and using some natural thoughts borrowing from other parallel sciences. We borrowed something from Dr. Adi Dastur’s science of gynaecology. I will give you in short what is doable and where the ideas are coming from. If you allow me, a cell in every woman moves from ovary to get into the uterus in every menstrual cycle. What is that? Movement of cells from one organ to the other, a cancer specialist calls it metastasis. It happens naturally and the second observation is that if I were to look at twins, identical twins need only one ovum, correct me if I am wrong Dr. Dastur, but non-identical twins require two ova. Second ova, how often do we see non-identical twins? Twins are uncommon, they are not uncommon now with IVF but prior to that twins are uncommon, non-identical twins are even rarer. So what does it mean? That once a cell is extruded, there must be a switch that doesn’t allow the second cell to go. We use the same principle that the moment a cell is extruded from the ovary, the lining starts secreting progesterone, a hormone which is there only in women.
I always say God has been kinder to women, which keeps everything under balance and it is this progesterone that we gave in an injectable form 3 days prior to breast cancer surgery to half the women, 800 women in a study, another 800 did not get it, 30% reduction in deaths related to breast cancer. The cost of that injection was 100 rupees. Proleutone, the depo preparation that we use, which presently indicates a threatened abortion. So it essentially keeps everything held together.
Holding the same kind of activity, we have now thought that if I am walking on the streets right in front of Taj, there is no reason why my survival instinct should be up. Is there any reason? No. But suddenly if 5 goons come in front of me, I will have all. Fright, fight and flight. I might want to run away. It is exactly the same thing happening when I am performing surgery. That the tumour which is alive is threatened and we did a very nice study of putting up something between 3 tissues collected at a distance of 5 minutes distance and the middle sample had about 900 genes that had gone up, exactly similar to the whole human being reacting to its surroundings. We changed that and we are now running a study that reduces the reaction of the tumour, that reaction is reduced exactly the same way as the host reaction is pushed. We use it to study with cannabis. If the host can be put into a state of bliss, can the tumour be put into a state of bliss and save lives?
That is the kind of research activity that is happening. But again I would say that as far as patient care is concerned, we give our best and try to rediscover ourselves on an everyday basis so that something new comes up and at the same time something that is cheapest to be used. 30% reduction by the 2 interventions that I mentioned in deaths. While these trials happened for 10 years, the West was doing some other trials that had a 20% reduction in, relative reduction in recurrence. No reduction in deaths. The cost of that medicine is about 25 lakhs. We are now running a study comparing that 25 lakhs with 500 rupees injection to see which one is better. And we would love to have your support, because there are 25 lakhs which all patients can’t afford. But those who can afford, let’s have them supported so that we have adequate numbers, 1,600 patients trial. 800 will receive this. 800 will receive 400 rupees worth of medication. And I’m sure we will show the West that we are better. And the West is not the best.
But before I conclude, no institution, no programme runs without the society feeling that they have a stake in it. And that is exactly what has happened for Tata Hospital. The Rotary Club has been supporting us in multiple ways. Those were enumerated. The Terry Fox Foundation with Mr. Gul Kripalani also supports a lot of research work in Tata Hospital. And we have lots and lots of people who come and donate money for research purposes. So I look forward to support in all forms. And it will be utilised and put to use the best way possible for poor patients, as well as I hate to say that systems are created for poor people, and systems are created for rich people, because that’s a very lopsided view that the treating doctor gets. One of the best determinants over and above completeness of treatment of the outcome is social class. And if I’m treating only the poor, my whole understanding of disease is very lopsided. If I’m treating only the rich, the same. But Tata Hospital is one place where we get all of them. And that’s why the solutions thought of are more generalisable and likely to be successful as they have been for the last 15 years.
Thank you very much again.
ROTARIANS ASK
I wanted to ask you, the government of India recently has tied up with Serum Institute for QHPC, CeraVax and for recombinant BCG for treating cervical and other cancers which they are buying at much reduced cost compared to what is available in the market. Given what you said about the low incidence and the improving numbers with cervical cancer, do you think this is essential and also having your background, I am sure you are advising the government of India in some way as to what they should be doing.
The very first question is extremely controversial. The government has already taken a stand that a vaccination is required. I would just say that I will not give it to my grandchildren.
One, is there any nexus between your diet, what you eat, veg or non-veg and cancer? And the next question, and I’m hoping you say no, is there any connection between alcohol and cancer?
The answer to the second question will be either yes or no, depending upon if we are meeting on a single malt in the evening. So when I said 350 cancers per 100,000 population in the West, one of the major differences is because of colorectal cancer, the large intestinal cancer. That affects somewhere close to about nine individuals per 100,000 in India, and that number in the US or in Europe is 60 per 100,000. So we are already in a very protected mode. As far as our diet is concerned, at least there we shouldn’t be saying the West is best. And when somebody says that he is non-vegetarian here, he would probably have five other things on his plate, and one of those would be non-vegetarian, and that would have a lot of spices. If you are from the interior of Maharashtra, you will be served that non-vegetarian with a nice green chilli, and the fellow will merrily bite into it. Please understand, all these condiments, including chilli, increase the speed at which the movement happens in our intestine. If the speed is adequate, that means neither do we have a constipated face, nor do we have constipation. If both those conditions are satisfied, then the amount of time that a foreign DNA comes in contact with our lining epithelium is much shorter, which is not the case in the West. If you ask for non-vegetarian, the fellow is having cold cuts in the morning, steak in the afternoon and something else in the evening, all of it non-vegetarian, and that steak will have a miserable potato in the corner in the form of vegetables, which will be left untouched. And there are no spices. It’s raw flesh. So constipation is the norm, because we need some irritant for movement to occur.
We were working on a drug for breast cancer, and this was an international study. So there were 250 centres across the globe contributing to this study. And it is a norm in any pharmaceutical industry-supported study, that if there is any side effect reported in any centre, it is shared with all the centres. Every week, I would get at least about five or six such letters that people were complaining of, the patients were complaining of frequency of motions and loose motions. We contributed 73 patients to this study, not a single patient complained of loose motions or frequency of motions. And we didn’t ask. When the trial got over and we stopped the drug, there were multitudes of women who came and asked that we have constipation now. So we are happy having more than one motion. The world is not. And that’s why colon cancer is low here.
Second question, Everything in moderation is fine, including sin.
I was wondering, on the urbanisation issue, have you determined is it pollution or is it chemical foods? What is it that’s creating the higher incidence?
So two major components, one is obesity. A lot of our obesity is because of excess food. We eat because it is time to eat food. Even our children, I wonder whether they understand what hunger is. It’s a word in books. There is so much food around, and when I go to talk in schools, I find that they’re all roly-poly children. And in these talks, usually parents are also there, and there is not a single mother who doesn’t say that the child doesn’t eat. And I wonder what is happening exactly. So obesity is one cause, preventable.
The second cause is pollution, and pollution is of various kinds. One is auto exhaust. Also the pollution, if you look at the pollution as it is reported in the press today, it is a certain size of particle, and the number of those sizes of particles. So beyond this size, who decided this? Who decided that it should be this size onwards that we should be looking at? It’s the West that has decided, because it was convenient for them to sell vehicles. And vehicles produce pollution which is smaller than that size. Lung cancer in Mumbai affects 10 individuals per 100,000. This number in the West, even after correction for smoking and non-smoking, affects approximately 65 individuals. So it doesn’t matter what the size of the particle is. It’s the chemical content of that particle that is important. And let me tell you that right from your nostril up to the place where, through the voice box, the air enters, there are enough protections for particulate matter to be trapped. Right from wetness of your throat, and the inside of your nose, and the hair there, all of it are excellent filters for particulate matter. But we define pollution by the size of the particle, not by the contents of the particle.
I’m Rahul Shah from NM Medical, so I’m going to ask your question on diagnostics, which is, given the sheer overflow of patients that go out from TMH for investigations, has the time come now to formalise the arrangement with private centres of repute so that patients can get their tests done in time and at good centres?
We have attempted this. This was attempted about eight years ago once that we sought at what rate will this be done and we can send patients across. We were not very successful in the kind of rates that we got but we don’t mind doing it again so that there is need. There is a need for diagnostics to be done at various places because we are overburdened. Tata Hospital was made to look after 10,000 new patients and 25,000 follow-ups per annum. Today we see 85,000 new cancer patients per year and 600,000 follow-ups. It is impossible that we will be able to satisfy and give services to all of us.