*An Intellectual Tribute to Dr. Manu Kothari, Part II: The War on “The War on Cancer”

In 1973, Dr. Manu Kothari and his associate, Dr. Lopa Mehta, published their voluminous tome, The Nature of Cancer, which I am tempted to describe as a war on the “war on cancer”.  The military metaphor has, of course, long been regnant in the US:  for well over a decade the American public and people overseas have been hearing about the “war on terror”, but this war was preceded by the “war on drugs”.  Neither war has been concluded; neither war is likely to be brought to a close; indeed, neither war has a foreseeable end, and the prosecutors of such wars, and their allies and friends in and out of government, have too much to lose if either war was brought to a decisive end.  All this is certainly true of the “war on cancer”, which has consumed hundreds of billions of dollars, perhaps trillions of dollars, thus far.

However, the war on cancer differs from the war on drugs the war on terror in some fundamental respects.   The war on drugs is increasingly being recognized, except by the Republican Party – not, it should be noted, by some outlandish or extreme members of the party, since such a view presumes that there are sane or even intelligent members of the Republican Party, which is very much to be doubted—as an egregious error which has needlessly committed hundreds of thousands of Americans to prison terms, and similarly the war on terror has had more than its share of detractors.  But the “war on cancer” is construed, by every sector of the American public, as a holy mission:  to be sure, there are those who think that there might have been some scams, and a few people have doubted whether all forms of cancer research have been productive, but there is an overwhelming consensus that cancer is a deadly disease that must be exterminated and that no effort must be spared to stamp it out.

Cancer research draws in more funding than any other medical endeavor; the war on cancer has its foot-soldiers and generals; and donors and philanthropists, whose wealth is often ill-begotten, easily become heroes and celebrities in a culture where donations in the name of cancer research earn one goodwill and, if the gift is substantial enough, cultural capital in the form of a building or institute named after the donor.  It is a telling fact that in his highly celebrated “biography” of cancer, The Emperor of All Maladies, the talented writer and doctor, Dr. Siddhartha Mukherjee, entirely succumbs to this dominant narrative.  On reading him, one inescapably reaches the conclusion that if we soldier on, achieve “early detection”, and eliminate the scourge of smoking—but apparently not bother with the monstrous-sized polluting SUVs and pick-up trucks with which America has an undying love affair—victory will be at hand.

Dr. Manu Kothari had an entirely different view of cancer and what passes for “cancer research”.  His views would be distilled in two much shorter works, both co-authored with Dr. Lopa Mehta:  Cancer:  Myths and Realities of Cause and Cure (1979) and Living, Dying:  A New Perspective on the Phenomena of Disease and Dying (1992).   He unflinchingly put forward the view, which certainly did not win him any friends from among those in the cancer(ous) industry, and even gained him the opprobrium of establishment doctors alarmed at his broader views about the nature of disease, that the billions of dollars expended on finding  a cure for cancer had not advanced our knowledge of the “disease” an iota.  Writing on cancer for The Future of Knowledge of Culture:  A Dictionary for the Twenty-first Century (Viking Penguin 2005), co-edited by Ashis Nandy and myself, Manubhai put the matter quite succinctly in expressing his agreement with the view of some patients that the “treatment [was] worse than the disease.  Macfarlane Burnett, the Australian immunologist of wide renown, summed up in the 1970s the outcome of all cancer research in just two words:  precisely nil.”  As Manubhai was to add towards his conclusion, “On the medical claims about the early diagnosis and treatment of cancer, one could invoke Churchillian rhetoric:  Never in the history of science has so much untruth been told by so few to so many for so long.”

How, then, was Dr. Kothari inclined to think of cancer?  His views may, at first, seem wholly unpalatable:  “Cancer—far more benign than malignant mankind—is what it is, and does what it does, because of unalterable, unabrogable biorealities that attend this fascinating phenomenon.” Manubhai took it as an imperative that we must first understand death and look at it not something that is to be feared, delayed, managed, ostracized, and repelled but rather as a friend, even as something that is to be revered.  He was critical of medical science for representing one disease or the other as the cause of death:  as he put it in Living, Dying, “Disease and death, in fact, are inherent components of man’s development, are governed by time and regulated by the herd, behave independently of each other and, in essence, are causally unrelated, death by itself being a programmed normal function performed by a living being.”

He argued that cancer occurs throughout the human lifespan; moreover, it is very democratic, and cancer’s “benevolence” could be inferred from the fact that it occurs everywhere “but in excess nowhere.”  He described cancer’s distribution as one in five:  one person bears the cancerous cross so that the other four might live.  Manubhai does not ask of us that we love cancer; but he does ask of us that we not hate it.  Once one understands that cancer is always with us, the very fibre of our being, we are no longer inclined to seek treatment:  he entirely rejected the idea of early screening, and deplored chemotherapy and radiotherapy as “despicable overkill by medicine.”  The fact that as a doctor, one remembered by his students as a very good one who did his profession proud, he was able to advance such views is a remarkable testament to his courage.  What is not less striking is that he had been articulating such a position for over four decades:  not surprisingly, one of his most ardent admirers was Ivan Illich, whose own Medical Nemesis, published one year after Manubhai’s The Nature of Cancer (1973), still remains the most trenchant critique of institutionalized forms of modern medicine.  Illich would go on to write the foreword to Manubhai’s smaller book on cancer.  Interestingly enough, the most recent exhaustive study on “early detection” all but confirms Dr. Kothari’s claims:  as reported by the New York Times on 20 August 2015, in an article headlined “Doubt Is Raised Over Value of Surgery for Breast Lesion at Earliest Stage”, “As many as 60,000 American women each year are told they have a very early stage of breast cancer — Stage 0, as it is commonly known — a possible precursor to what could be a deadly tumor. And almost every one of the women has either a lumpectomy or a mastectomy, and often a double mastectomy, removing a healthy breast as well.  Yet it now appears that treatment may make no difference in their outcomes. Patients with this condition had close to the same likelihood of dying of breast cancer as women in the general population, and the few who died did so despite treatment, not for lack of it, researchers reported Thursday in JAMA [Journal of the American Medical Association] Oncology.”

(to be continued)

See also Part I on this blog

*The Provocations of Ashis Nandy

 

For close to four decades, Ashis Nandy has occupied a liminal presence on the Indian intellectual scene.  In nearly every respect, whether from the standpoint of the intellectual positions he has adopted, the trajectory of his professional life, his stance towards religious faith, or the politics that he embraces, Nandy has carved out a worldview that is distinct even singular.  Though he is viewed in the public domain as an academic, he has always kept a distance from university life as such and has spent his entire career as a Fellow at the Centre for the Study of Developing Societies.  There are few scholars who have subjected the very idea of ‘development’, and the certitude with which experts speak of ‘developing societies’, to such rigorous scrutiny as has Nandy.  For all his immense learning, he has little use for the pedantry that often passes for scholarship –– one reason, among others, why some people characterize him as a maverick, gadfly, or contrarian.

 

Trained as a clinical psychologist, Nandy has disavowed the profession of psychology.  Some of his readers grumble at his propensity for psychoanalytical readings of personalities, but his use of Freud is, so to speak, homegrown.  There was a time, though this is much less so the case now, when left intellectuals routinely branded Nandy, born into a Christian family, as a Hindu fundamentalist.  I doubt very much that he can at all be described as a man of faith, but he has kept faith with the idea that non-believers have no higher duty than to defend the right of each person to his or her faith.  One could continue in this vein, almost ad infinitum:  thus, to take one last illustration, though one can hardly describe Nandy as a biographer, it is striking that much of his work pivots around individual lives, whether it be Gandhi, Tagore, Rammohan Roy, Jagdish Chandra Bose, the mathematician Ramanujan, the ‘first modern Indian environmentalist’ Kapilprasad Bhattacharjee, the ‘first non-western psychoanalyst’ Girindrasekhar Bose, the jurist Radha Binod Pal, and many others.  These lives provide the frame around which Nandy has spun complex narratives, though some will call them yarns, about the culture of politics, the politics of culture, and the manner in which knowledge systems insinuate themselves into the praxis of everyday life.

 

The highly anomalous mold within which his thoughts are wrought lead Nandy to some extraordinary insights but also make him unusually vulnerable to attack. His writings on communalism and secularism provide a case in point.  Though scarcely all the nuances of his position can be enunciated here, one might begin with his firm view that communal riots in India are largely an urban phenomenon.  There may be many reasons for this, among them, to use Gandhi’s phrase from an interview he gave to the Reverend Mott in the mid-1930s, ‘the hard heartedness of the educated’.  This was in response to the query, ‘What filled Gandhi with the greatest despair’.  The educated in India are also prone to deploy the idioms of historical thinking, and one cannot begin to understand the conflict over the Babri Masjid-Ram Janmasthan until one has an awareness of how middle-class Hindus, much like nationalists elsewhere, have mobilized history, with consequences that were to be seen in the aftermath of the destruction of the Babri Masjid, in the service of the nation-state.  Though myth is one of the ugliest words in the lexicon of Marxists, positivists, liberals, and modernizers alike, Nandy has argued eloquently that myths are a more reliable and humane guide to the past –– and link to the future.  One of the many hidden transcripts in his recent comments on corruption among OBCs, SCs, and STs, which have enraged some people, is the implicit suggestion that the liberation of the Dalits will be better achieved by their use of creative myth-making than by attentiveness to the history of their oppression.

 

In an essay that Nandy penned on ‘the alternative cosmopolitanism of Cochin’, he demonstrates amply the radical tenor of his thinking.  He set out to inquire why Cochin, which has large numbers of Hindus, Muslims, and Christians, has been free of communal riots for 500 years.  The people he met from these ‘communities’ do not even remotely describe themselves as secular; indeed, shocking as this might be to the liberal sensibility, which insists upon the ‘caring’ ethic, an anodyne form of good neighborliness, the elimination of prejudices, even (as in the United States) diversity workshops, nearly everyone Nandy met admitted to holding rather severe stereotypes about members of the other communities.  Nandy concludes that it is, in a manner of speaking, a healthy balance of prejudices that has sustained Cochin’s religious pluralism.

 

Cochin’s ‘cosmopolitanism’ has not been imposed from above, as a diktat of the liberal state, nor does it stem from the Enlightenment’s putative idea of the fellowship of liberated rational subjects thinking beyond themselves and invested in the fate of the earth.  While the vast bulk of liberal and left scholarship has been concerned with exposing the pathology of irrationality, Nandy has spent the better part of his life zeroing in on the pathology of rationality and its most characteristic outcomes ––development, the nation-state, vivisectionist science, an (aggrieved) sense of history, to name a few.  This has entailed immense risk-taking, even hazardous remarks on more than one occasion, but where is the ethical intellectual life without such provocations?

(Published under the same title in The Times of India – The Crest Edition, 9 February 2013, p. 9.)

See the related post:  From the Ludic to the Ludicrous:  The Affair of Ashis Nandy on this site.

 

*From the Ludic to the Ludicrous: The Affair of Ashis Nandy

 

The Jaipur Literary Festival is known to stir controversy.  So is Ashis Nandy, often celebrated as India’s most arresting and provocative thinker.  For well over three decades, Nandy has been in the business, shall we say, of unsettling received ideas, controverting the most established opinions, and deploying the tactics of a street fighter against institutionalized forms of knowledge.  He scandalized many in India who view themselves as progressive when, in the mid-1980s, he published ‘An Anti-Secularist Manifesto’, though it is no exaggeration to say that the substance of his critique of secularism has now become part of the new commonsense of informed scholarship. 

 

Appearing in this year’s edition of the Jaipur Literary Festival, one should have expected that Nandy would come up with one of his startlingly fresh insights –– more so when the discussion at a panel in which he was participating veered towards corruption, a matter which has greatly agitated the country, particularly its middle classes, since at least the time Anna Hazare launched his movement to deliver India from this menace.  The fact that Anna Hazare, however well intentioned he might be, is nearly clueless, and that the popular movement which he initiated generated, in intellectual terms, little more than platitudes made Nandy’s remarks seem all the more radical and even incomprehensible. 

 

Commencing his remarks with the critical observation that he was going to make a ‘vulgar statement’, Nandy added:  ‘It is a fact that most of the corrupt come from the OBCs, the Scheduled Castes, and now increasingly the Scheduled Tribes.  And as long as this is the case, the Indian Republic will survive.’  Not surprisingly, the first line alone has been replayed in the media over and over again.  Nandy’s fellow panelist, the TV journalist Ashutosh, immediately pilloried him as a representative of ‘elitist India’, characterizing his remarks as ‘the most bizarre statement’ he had ever heard ‘in this country’.  Mayawati has called for Nandy’s arrest, and a FIR has been lodged against him under the Schedules Castes and Scheduled Tribes (Prevention of Atrocities) Act.  In Patna, members of organizations of SCs and STs marched from the High Court to Dak Bungalow Square, where they burnt an effigy of Nandy.

 

It is, of course, a feature of our times that attentive reading of texts and the work of interpretation are seen as luxuries that can be ill afforded when the country is thirsting for ‘change’, ‘fast’ track courts, and the speedy resolution of complex social issues.  The dedicated do-good activist types, in particular, are generally without humor and find irony a hindrance to whatever noble cause they wish to espouse.  Nandy had not spoken in a vacuum:  preceding him as a speaker, Tehelka’s editor Tarun Tejpal had argued that ‘corruption’ should be recognized as a strategy by means of which the poor and the marginalized, operating in a hierarchical society with deeply encrusted forms of oppression, are able to enter into the public domain and do precisely what the upper castes have been doing for centuries, namely leveraging their power and privileges to advance their own interests.  The most eminent sociologist of the previous generation, the late M. N. Srinivas, would perhaps not have balked at the suggestion that this might be viewed as a form of what he called ‘Sanskritization’, the emulation of the upper castes by lower castes on a trajectory of upward social mobility.

 

It is these ideas with which Nandy was signifying his agreement, adding his own inimitable touch to the discussion.  Scholars have long been familiar with debates about text vs. context, and critics of Nandy might reasonably argue that he should have known that his remarks would be, as is commonly said, ‘taken out of context’.  Moreover, the most insistent Indian tradition of intellectual argumentation insists that one’s reasoning should anticipate, and account for, objections to one’s argument.  But, to understand Nandy, we can even do without the context:  not only was he showing self-reflexivity in prefacing his remarks with the observation that he was going to make a ‘vulgar statement’, he delivers a resounding defence of how the Dalits and the poor have mobilized electoral democracy with the suggestion that the resort to corruption by the OBCs, SCs, and STs ensures that ‘the Indian Republic will survive.’

 

We need not even enter into the other nuances of Nandy’s argument, such as the proposition that the corruption of the rich and powerful is largely invisible.  Having lagged behind for generations, the poor and the deprived will certainly have to be ‘more’ corrupt if they are to make inroads into India’s political system.  There are, however, more critical questions at stake here.  How did we come to have such fragile sensibilities? What kind of intellectual culture do we seek?  Should we be party to the epidemic of apologies that has swept the West and insist that Nandy take back everything he has said?  Nandy’s fellow Bengali, the writer Nirad Chaudhuri, dedicated his autobiography to the memory of the British Empire in India since Pax Britannica shaped ‘all that was good and living within us’.  Should we have insisted that Chaudhuri apologize to the nation for implicitly denigrating the nationalist movement? 

 

To enter into Nandy’s works is to encounter a mind that is not only deeply thoughtful but also forever engaged with the suppleness and play of ideas.  It is the ludic or playful element in Nandy’s work, which seldom leaves him satisfied with the certitudes of received intellectual opinion, that easily distinguishes him from his intellectual contemporaries.  The tragedy of if it is that, judging from the shallow and profoundly unreflective response to Nandy’s provocations, we have moved from the ludic to the ludicrous.

(Also published in Outlook magazine, at http://www.outlookindia.com, 29 January 2013,

as “From the Ludic to the Ludicrous”)