Thursday, March 20, 2014

Why Angie gets my BP up....

Why Angie gets my BP up....

 So this morning while signing the attendance register i ran into a friend of mine from another specialty- a surgical oncologist- which is the medical term for a surgeon who deals with cancer patients and we ended up walking together to the canteen to get our early morning booster shot of caffeine before heading to our respective departments to start the work day. Among all the medical specialties I have the greatest respect for cancer specialists as oncology is one of the toughest specialties to practice if you are a caring doctor. There is so much you wish you can do for your patients but you are unable to do much practically and you have to be satisfied with just small victories. I have known oncologists who celebrate their patients 5 year survival rates (still alive 5 years after surgery) as big celebrations. As i said i respect them very much but I wouldn't like to be one of them, for i feel too much for my patients to ever develop the detachment to watch a two year old child die slowly before my eyes in such pain. That’s just not me.

Anyway after exchanging personal updates on each other’s lives the talk slowly veered around to the latest stunt pulled by that stupid "celebrity"(this wasn’t the first or the tenth word i typed, but this is a family friendly blog hence all those other words describing her were censored) Angelina Jolie who is singlehandedly doing such a disservice to cancer care everywhere (read my earlier post here on her breast cancer stunt). The news is- for her next stunt Angie is going to get her uterus removed even though she doesn’t have uterine cancer. What does one say about a woman who goes on an organ removal spree just because a genetic test indicated a "possibility", I repeat "only a possibility" that she may develop cancer sometime in the future or far future?  And what does one say about doctors who pander to her depraved wishes? Well, let’s leave it at that.

As i was sipping a strong filter coffee and chatting with my oncologist friend the talk veered around to the newer tests being developed for cancer diagnosis- the BRCA gene test and stuff like that. As I had written in my earlier blogpost, the economics of such tests prices them out of the reach of the average Indian patients especially as they are just screening tests and offer no conclusive (strong) diagnosis. It’s quite a gamble to spend lakhs and lakhs of rupees just to screen yourself on the possibility of being diagnosed for cancer when there are other better tests available for economic (Indian) rates. And this enormous economic disparity also extends to the availability of therapeutic drugs (treatment). Right now as we speak, there are tests available which can suggest medicines perfectly suited for your individual body cells but unfortunately they are not yet available in India or even affordable to us for they cost a minimum of 25 lakhs a pop to tell us which medicine works faster for our body.

To explain this further I would like to give you a brief overview on the treatment for cancer. Feel free to skip this para and move on directly to the next if you are not interested. As you know cancer cells are just normal body cells gone wild due to a variety of causes, none of which we can state with certainty right now. And currently we have three options to treat cancer cells - we can surgically cut and remove the diseased cancer cells or sometimes the whole organ to prevent the caner from spreading to the nearby cells. Or we can give massive doses of radiation -designed to kill all living cells in the vicinity of the cancer cells hoping to kill the cancer cells along with the surrounding normal cells. Or we can give what’s called chemotherapy- drugs which kill the cancer cells - by targeting the growing cells and as cancer cells are the fastest growing cells in the body they are killed far faster than the other growing cells in the body like the hair, nail and tooth cells - which is why cancer patients often have a bald look.

What the Americans have done recently is they have manufactured a test whereby small bits of cancer cells taken from a patient’s body are treated with small drops of the different cancer drugs. Based on the test report which shows which drug kills the cancer cells of the patient's the fastest that drug alone can be given to the patient instead of giving the other drugs one by one on a trial and error basis as we do right now. This targeted delivery of drugs help in faster cure rates but unfortunately the cost is prohibitive - it costs upwards of 25-30 lakhs of rupees to just find out which drug works best and then you have to factor in the cost of the drug itself and the total treatment becomes very costly for the average cancer patient. So we muddle along as we always do and only hope that the newer tests become cheaper with time for us to use.

So after talking with my friend on cancer trends what do I advise the average patient? Simple. Cancer is easily deductible in its earlier stages. Any general health check up done at regular intervals can easily pick up the earliest signs of cancer before they metastasize (spread) throughout the body. At the earliest stage it is easy to kill the cancer cells and cure the patients fully. So just like the western countries do, we Indians should make a habit of having annual health checkups. In fact it’s even more necessary for us Indians because unlike the Americans we don’t have an affordable health care act (heard of Obamacare?) to take care of all our medical bills free. Here we pay our own bills and most medical care is un-affordable for the average Indian salaries. So be wise and get that check up done. End of advice session. As for Angelina Jolie, oh hell, I got nothing to say.

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