Indian Journal of Medical Ethics

LETTERS

‘Evidence-biased therapy’

Regarding our article (1), and Meenal Mamdani’s critique of it (2), our article ought to have been titled ‘Evidence-biased therapy’ just to drive home the simple fact that modern medicine with all its diagnostic/therapeutic wizardry, treats, according to its knowledge of cancer, merely some evidence and nothing save the evidence.

From the pre-Christian times to Charaka (3) through the Scottish physicians (4), Cheatle (5), Kiricuta and Bucur (6), down to Logan (7) as recently as 1975, there is enough and clear evidence that breast cancer by itself is mere evidence, the removal of which does not in any way alter the basic process, and often worsening it. The therapeutic restraint that the authorities quoted here emphasised was more than vindicated by the candour of Nobel laureate Pauling (8): “Everyone should know that the war on cancer is largely a fraud, and that the National Cancer Institute and the American Cancer Society are derelict in their duties to the people who support them”.

All cancer therapy is glorified palliation (9, 14), the chief raison d’etre of which is to ease if there is disease. Our Mrs Kothari had a large lump but no disease so she was profitably left alone. The other patient was sailing in the same boat, but her well intentioned doctors chose to “attack” her disease less tumour and forthwith dispatched her to her maker. Dr Mamdani should see the evidence that this small controlled trial provides.

Leslie Foulds (15), the noted oncologist and author who died of undiagnosed, advanced colonic cancer, classified cancers into ‘good’ and ‘bad’, but on a retrospective basis, depending on how they behaved post-treatment. The many parameters that cancer doctors are searching for to help them predict the behaviour of a particular tumour are just not there. That being so, it is good to follow a general rule: “When in doubt, don’t”.

M L Kothari, L A Mehta, V M Kothari, G S Medical College, Parel, Mumbai 400 012.

References

  1. Kothari Manu et al : Ethics and evidence-based therapy, Issues in Medical Ethics, 1999; 16-18.
  2. Mamdani M : Anecdotes do not make evidence. Issues in Medical Ethics, 1999; 7:36.
  3. Das Gupta D, Kothari ML, Mehta LA. Cancer Pain : An Indian Perspective,in ‘Cancer Pain Management – Principles and Practice.’ Editor : Winston CV Butterworth – Heinemann Paris, 1997, 567-74.
  4. Cancer problems 160 years ago. Institution for investigating the nature of cancer. Int. J. Cancer, 2:281, 1967. This article originally appeared in the Edinburgh Medical and Surgical Journal, 2:382,1806.
  5. Cheatle, GL : Important early symptoms in diseases of breast. Brit. Med. J., 2:47, 1927.
  6. Kiricuta I and Bucur M : Prognostic value of malignant evolution. Onset in breast cancer. Tenth International Cancer Congress. Abstracts, Houston, Texas, 1970, (Abstract 1199), p. 732.
  7. Logan WPD; Cancer of the breast : no decline in mortality.WHO Chronicle, 29:462, 1975.
  8. Pauling L : Quoted by Moss RW : The Cancer Syndrome, Grove Press, NY, 1980 Front Cover.
  9. Kothari ML and Mehta Lopa A : The nature of Cancer (Bombay: Kothari Medical Publications, 1973).
  10. Kothari ML and Mehta LA : Cancer Myths and Realities of Cause and Cure, Marion Boyars, London, 1978.
  11. Kothari ML and Mehta LA; Kanker – Fabels en feiten, Het Wereldvenster, Amsterdam, 1981.
  12. Kothari ML and Mehta LA : 1st # Kerbs eine Krankheit, Rowohlt, Hamburg, 1979.
  13. Kothari ML and Mehta LA : Death – A new Perspective on the Phenomena of Disease and Dying, Marion Boyars, London, 1986.
  14. Kothari ML and Mehta LA : Violence in modern medicine. In, Science, Hegemony, and Violence, (Ed:Nandy A), OUP, Oxford, 1988.
  15. Foulds L : Neoplastic Development. I. Academic Press, London, New York, 1969.7