*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