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Panacea For Cancer

By Shambhavi Naik

It’s a beautiful morning, where I proceed to unlock my phone to see the various ‘good morning’ messages on my WhatsApp. Amidst a host of forwards, I spot the latest one which tells me about the ‘amazing’ anti-cancer properties of bananas bearing black spots on their skin.

These spots, the message says, contain a protein that can prevent cancers. Now, I usually ignore such forwards, but this message was scientifically illogical at so many levels that I was prompted to reply. But more importantly, it got me thinking of the reason why such forwards make rounds so frequently; against the dread of cancer, any hope of prevention or cure is welcome news indeed. Every few days we come across articles claiming that the panacea for cancer has been discovered. It is true that cutting-edge research is being carried out to find a one-stop cancer treatment, but really, how close are we to it? I started my postgraduate research in cancer in 2006 with the utopian idea of finding the cure (and hopefully, winning the Nobel Prize in the process). After a few years of active research, I realized that the notion of finding an all-out cure for cancer might be impractical.

Instead I was reposed to ask another question: do we really need a pill that would cure all cancers? We are currently spending significant amounts of effort and money trying to figure out this panacea; but is the killing of the last remnants of cancer really so essential to warrant the scope of ongoing studies? A critical point to understand here is that having cancer cells in the body does not mean a person will immediately die. (Equally important is to take into perspective the fact that not having cancer does not make one immortal).

Let us take a practical approach to this: when does a cancer become a problem to the body? Cancer is the uncontrollable growth of cells which have lost their ability to correctly function. However, it is only when essential functions start getting affected, that we may realize that something is wrong with the body. Cancer cells are formed in our body nearly everyday, but these get killed or do not grow enough to cause trouble. But only when they start overtaking the healthy cells in the lung, does our breathing get affected.

So the question is, should our research really focus on managing cancer rather than trying highly aggressive methods to kill each and every cancer cell present in the body? At the molecular level, cancer is a fairly complicated disease. Not only is each person’s cancer different, but cells within the same patient’s disease are also not the same. What this simply means is that when we treat a person with one drug, it might not kill all of the cancer cells. Hence, doctors prefer giving patients multiple drugs. A common problem with most drugs is that they cannot distinguish between normal and cancer cells and result in all sorts of side-effects. A way to tackle this issue is to give drugs that would target the underpinning cancer-causing mechanism of the cells.

This approach has yielded promising results and is reforming cancer therapy into a personalized regime where each person’s cancer is mapped and treated correspondingly. A major success story has been Novartis’ Gleevec in the treatment of a certain type of leukemia. But this is not as easy as it seems – finding the cancer-driver is like finding a needle in a hay stack. This is also complicated by the heterogeneity of cancer; that is, not all cells within the cancer will have the same driver. And if this was not enough, the property that makes a cancer really dangerous is its ability to evolve. Cancer cells follow Charles Darwin’s “Survival of the Fittest” rule to the book and show a capacity to overcome most stresses thrown at them. This explains why a cancer reappears after extensive chemotherapy – some cells adapt to survive the chemotherapy and eventually grow out even in the presence of drugs. Another way to look at this is, what comes out of an aggressive therapy regime is probably a worse cancer than its predecessor. This also feeds into why I think finding the one-stop cure for cancer is impractical. As Dr. Malcolm says, “Life, uh… finds a way”.

But then, the question remains on how do we tackle cancer? In a nutshell, cancer is a genetic disease with strong effects on physiology and social facets of an individual. However, we see that different factions of our healthcare system; the physicians, scientists and social care workers approach this disease as individual groups and rarely engage in crosstalk. For treating such a complex and evolving disease, it is essential that a more holistic approach be implemented. It is particularly important that goals of these groups be aligned: to reiterate, the goal of treatment should be to make the patient cancer-free (preferably and this now works in select types of tumors) but with minimal compromise on their standard of life post-therapy. Simply damaging a patient’s system with a host of drugs to get rid of all cancer cells cannot be a good way forward. The approach should encompass picking up the cancer at an early stage, assessing the cancer pathology and following up post treatment.

The most successful treatment for cancer is surgery, that is, to remove the tumor mass completely before it spreads. For this, it is important to catch the tumor early on – increased access to screening and an awareness of its importance are critical for identifying cancer patients at an early stage. Basic research in cancer has to focus on effective delivery of existing drugs, identifying key cancer drivers and biomarkers which can diagnose cancer before it becomes pathological. An increased co-ordination between doctors and scientists is a pivotal point in delivering expert and efficient cancer treatment. There are multiple options for treating cancer patients currently; what is needed now is a more focused and directed approach. Emphasis needs to be given to create awareness towards development in the cancer field to alleviate fear regarding cancer. A stronger role played by the media to correctly communicate developments of cancer treatments is required to prevent raising false hopes amongst the public.

Coming back to incorrect and misinterpreted information, I will conclude with what is wrong with the banana WhatsApp message. Firstly, if a protein is present in the skin of the banana, it’s not going to get into your tummy by eating the banana. Secondly, if the protein does find its way to your tummy, it will get broken down into its constituent building blocks by enzymes. So, the protein is not going to enter into your blood or reach the cancer cells at all. Thirdly (and most importantly) the protein that the WhatsApp message talks about is in fact known to do both block and cause cancer. This is true of many food products, where contradicting studies show prevention or causation of cancer. Please take these studies with a pinch of salt and let common sense prevail when making lifestyle choices. The take home message here is that instead of waiting for the perfect cure/prevention to arrive, we have to better channelize our existing knowledge to get a more effective regime to prevent and manage cancer.

Shambhavi is a Research Scholar with the Takshashila Institution

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Protests in Bangalore and Kashmir — Manifestation of Radically Networked Societies?

What most of the commentators have missed out during the recent protests in Kashmir and Bangalore is that the traditionally organised power structures are being challenged by radically networked societies and governments need to restructure better to respond

Two recent protests in the country demonstrated how radically networked societies (RNS) challenge the conventional, bureaucratic and hierarchical power structures. Last week, after a girl was allegedly molested by a soldier in Handwara, Kashmir saw a deluge of protests by the locals. The army later released a video in which the girl gave a statement exonerating the army. But the incident was enough to snowball into a major law and order problem in which police had to resort to firing on protesting mobs resulting in five dead and scores injured. It culminated in the dismantling of army bunkers after more than two decades.  In the second incident, violence erupted across Bangalore on April 18 and 19 by garment factory workers that left more than a hundred injured, two of them seriously.  A police station was attacked and vehicles were set on fire. Reportedly, this was a reaction to amendment to Employees’ Provident Fund (EPF) by the central government as part of its budget announcement for 2016. The new norms barred employees from withdrawing their entire provident fund corpus before retirement. On April 19, the government announced a complete and unconditional rollback.

The striking feature of both the incidents is that they were leaderless. In Kashmir, mobs of protesters were assembled based on “news” circulated in WhatsApp groups.   The dismantling of bunkers has been seen as a victory for locals. But the government’s response was typical of bureaucratic knee-jerk reaction. In an order dated April 18, the Kashmir government has instructed all WhatsApp groups to register within ten days.  There were even government employees who were part of the groups. WhatsApp has emerged as a potent tool for gathering of protesters. The statement by Divisional Commissioner, Asgar Samoon reported in newspapers is produced as below:

There are many unauthorised news groups on WhatsApp that disseminate news. It’s not restricted to just chatting, they have thousands of followers who post news without verification and many times lead to law and order problems. Government employees are for implementation of policies, if they have grievances or suggestion they can be put forward through proper channel not in public forms. In many cases government employees were seen instigating violence.”

Even in Bangalore, the protests were first planned and circulated in WhatsApp groups among the garment industry workers.  Most of the protesters were women. About three and a half years ago, Bangalore had a similar incident concerning the migrant working population from northeastern part of India. In August 2012, more than 30,000 people left the city over rumours of impending attack on them.

According to my colleague Nitin Pai, corruption, economic distress, political oppression, and elite control of political power, among others have always been there. He goes on to add that the proliferation of public protests might be the first signs of clash between radically networked societies and hierarchically ordered states. This is true whether the polity is democratic or authoritarian.

In 2011 Arab Spring, protests spread like wildfire in Tahrir Square in Egypt and Tunisia that resulted in ousting of authoritarian political leaders. The onset of social media like facebook, twitter, whatsapp, Snapchat etc. have radically transformed the speed with which information is transmitted and processed. In many ways, this is the epitome of Marshall McLuhan’s ‘medium is the message’  theory.

Bangalore and Kashmir present a contrast and similarity. Contrast, because Bangalore city police is one of the most tech savvy forces in the country with an active twitter handle and social media presence. Kashmir police has not demonstrated such a capability. In addition, Kashmir has a heavy presence of other security forces like Central Reserve Police Force (CRPF) and army which have their own typically rigid hierarchical organisations. Similarity, because both got checkmated by very similar radical networks.

Responding to the RNS also entails a trade-off between liberty and national security. To what extent can personal freedoms and liberty can be contained is a matter to be seriously debated. Left purely to governments, they will only enact policies to strengthen the hand of the state, however draconian it may be. This will be an incremental tail chase in perpetuity. The latest order in Kashmir is evidence of this.

One reason the United States emerged on top of the world order is because it had the best political system for post-Enlightenment industrial age societies. It can be argued that the nation that best restructures itself for the information age will have a shot at being the next great superpower. Across the world, governments are grappling with this phenomenon. We certainly have a long way to go.

Guru Aiyar is a Research Scholar with Takshashila Institution and tweets @guruaiyar.

Featured Image: Network, licensed by creativecommons.org


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