See this headline: "India has just 2,000 oncologists for 10 million patients" - Times of India
This's an overtly erroneous, partially misleading and only partially correct article. In fact this skewed hackneyed article deliberately demeans & hides away the real oncologists ie Radiation(Clinical) Oncologists & Surgical Oncologists. The so called 2000 oncologists this article claims to be hardly available in India are not proper oncologists but general physicians only who wrongly claim to be oncologists. Barely 300 of them have any training/degree in any kind of oncology if we strictly go by their claim. This article mentions in passing reference that ""surgeons & radiotherapists"" too are required during cancer treatment which nothing short of glaringly negative twist of information as if one "great" man is doing everything and others are there merely to help him at his beck & call. When the real picture is starkly different.
The "medical" oncologists which are the much eulogised doctors in this article by ToI are nothing but glorified general physicians doubling up as "oncologists". Around 96% cancers are solid tumours where they are NOT required at all while the 4% remaining cancers ie the haematogenous malignancies are managed by haematologists. Also, the childhood cancers which could be in both solid/blood categories are treated by paediatricians. This market driven "medical" oncology is a relatively new phenomenon in India which has actually shifted the focus from real oncology to largely non-mandatory yet fancy, extremely costly and American copycat free market laissez-faire corporatism which more often than not ruins the patients' families socioeconomically without providing much succour to the actual patients who keep oscillating between hospitals & their much distant homes. World over this American trend of throttling down the throats corporatist mercantilism in medicine has ruined as well as overburdened governments & countries needlessly.
In last many decades not more than a couple of chemotherapy drugs have successfully evolved,not even half a dozen, which could replace the original chemotherapy drugs. Yet we're inundated, rather bombarded with news and prescriptions of "newer generation" chemotherapy every three months or half yearly wherein all of such drugs have either failed spectacularly or just whimpered away scurryingly and most of them are/were promoted by not so scrupulous means. Patients are many a times needlessly treated with painful invasive procedures & highly toxic costly drugs just because "International data" says so. Chemotherapy is important but Neither the supreme Nor the sole modality. It's given only as an adjuvant/concomitant drug except for some blood cancers( <2% of all cancers). Such Chemotherapy has been a good tool in the hands of the real oncologists and not those foisted upon the world by the mercantile corporatist profiteers giving false hopes to patients & their families while sucking them dry of their hard-earned & money saved with great difficulty. This coerces governments misleadingly to make public health plans which are hollow and directionless passing the burden to the patients themselves.
Diabolically & deliberately demeaning, underestimating, undervaluing and ignoring the real oncologists ie surgical oncologists, radiation oncologists, haematological-oncologists & paediatric-oncologists has nefarious multidimensional adverse effects upon the patients, people, society, governments & countries for the sole pursuit of the global multi-trillion dollars profiteering, more so in the ill-informed, badly organized & misgoverned "developing & third" world. Interestingly & significantly the European countries(west & east block both), Canada, Russia(& some CIS countries) along with Japan have steadfastly kept away dollar guided oncology & self styled oncologists from their patient care system and have the best results in world in terms of patient survival, quality of life and disease free survival. Without surgeon no tumour could be removed and there's a dictum that 50% of cancers need to be irradiated(this percentage rises to above 80 in our country given the late presentation of cancer cases). To be blunt most "medical" oncologists are afraid to even touch a tumour, forget evaluating it, as they've as a thumbrule never done during their entire training itself! The World Health Organisation (WHO) as well as India's National Cancer Control Programme (NCCP) guidelines strictly stipulate that a cancer treatment centre cannot be started without radiation therapy set up, Radiation Oncologists, operation theatre & cancer Surgeons.
Who's the oncologist? It's not a mere rhetorical question but has trillion dollars quagmire involving people's lives. money, resources, sentiments, running of public healthcare system, governments & of course, our taxpayers money. Last but not the least it concerns the geopolitical things as well. Big pharma companies are known to even effect regime changes & foment civil wars in the third world. No one is beyond reproach, black sheep could be anywhere and they need be chastised/punished or weeded out, but those are rare sporadic individuals; they are not the norm. The real concern is the normative, sinister, heartless, ulterior, ideological, stupefying & universalising profit driven power-hungry greed called corporate healthcare,also manifesting in India as medical tourism which sadly is promoted by government(s) here!!
Footnote: Association of Radiation Oncologists of India(AROI, estd. 1973) alone has over 2500 qualified life-members. Then apart from AROI there're the respective associations of qualified surgical oncologists, haematological-oncologists & paediatric-oncologists with a possible total membership of nearly 3000. While this article claims erroneously, hope not purposely, that there're are not even 2000 "oncologists" in India. Corporate oncologists..?
Footnote 2: Clinical trials and studies have many conflicts of interests which are seldom shown and the medical/scientific journals too have funding from sources which directly/indirectly influence "data".
Indian medical sector is getting exponentially corporatised, not only in oncology but all disciplines. Today medicine is about investigations, reports & packages. Paradoxically govt hospitals, at least medical colleges, are not afflicted that much because the older generation has not retired yet. But the below 34 years age generation of doctors(from MBBS to post doctoral training level) are programmed like autobots. Soon they'll be the leading doctors. The 35-42 age group doctors like yours truly who got trained during the flux of change or at the cusp of "old vs new" show traits of both at individual levels within the spectrum. But ours is a minuscule cohort just like any junction point is small. The last Mohicans. Soon we'll be swarmed over by new generation doctors trained in mlEchCha ethos.
Preventive medicine is in curriculum , even MD degree and full fledged departments are there, but practically sidelined all over the country or to put it in right words it has become a salary generating NGO feeding department only. As a doctor trained in western medicine I advocate integrating AyurvEda with it but not segregating them or making them contradictory. Ayurveda itself was the modern medicine but was lost to us thanks to repeated invasions, destruction, abrahamic rule & colonialism. In our country the dominant discourse & practice is to posit AyurvEda against modern medicine, even the current govt promotes it. My patients ask a lot of questions pertaining to food & daily habits. I always recommend vegetarian diet & yOga under some expert(preferably) and seasonal fruits+vegetables. I prescribe only that much drugs+investigations which are minimum requirement to treat the diseases. Many patients actually complain I do not write much tablets/goliyan/syrups for their strength..and why I scold them when they ask themselves for investigations like CT scans etc..
And then there's "evidence based medicine"(EBM). Will write about it later in detail, for now one thing only: EBM should be used as a good guideline but it's being quoted & followed blindly like some abrahamic kitab with ferociously aggressive zealotry instead of applying it to respective peoples & patients tailored as per their multifactorial backgrounds. And why not? Most of the EBM guidelines come from the West after all while thanks to many intrinsic reasons owing to our own shortcomings we do not contribute anything significant to the dynamically updated international guidelines on EBM: slavish mindset, quotas with their multitude of ramifications, lack of funding for research, lack of stable jobs to pursue medicine and scientific research count amongst those significant many drawbacks on our side.
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