Dr V P Gangadharan is probably the most respected oncologist in Kerala if not India. Affectionately called the “saint with a stethoscope’’ by his admirers, Gangadharan’s expertise in the field is incomparable. He talks to The New Indian Express about the reasons for Kerala becoming the ‘cancer capital’, the Malayali’s obsession with parotta and beef, and new practices in cancer treatment. Edited excerpts:
Have heard that your childhood ambition was to become a railway guard…
Yes, trains have always been a great passion for me. My fascination for trains was such that I used to learn railway guide by heart (chuckles).
Is that craze still there?
Yes, indeed. I am happiest when I travel by train. I have travelled on Vande Bharat 3-4 times just to experience it (laughs).
So, how did you land yourself in MBBS?
After doing my BSc, there was confusion about what to pursue. My elder brother was an engineer, and my second brother was studying MBBS. My father said only one doctor was needed for a family, indirectly discouraging me. His plan was to induct me into the family textile dyeing business. But he very soon realised that I was not fit for that (chuckles). That was the time when my mother entered the scene. Her brother was a doctor — Dr Gangadharan — and he passed away before I was born. I was named after him. She said that it was her wish that I become a doctor. That’s how I became a doctor (smiles).
Why did you choose oncology?
That was also by chance. During the house-surgency period, we used to go to the cancer patient ward only to certify death. It was called the ‘doomed ward’. My plan was to pursue an MD in Medicine. But during the house surgency, I got married to Dr Chitrathara, and later she got admission for MD in gynaecology at Delhi University. While visiting her, I used to interact with doctors who were studying at AIIMS. Some were doing radiation oncology and they encouraged me to apply there. The only compelling reason for me to apply for radiation oncology was that if I got admission, I could stay with Chitra (laughs out).
Why was oncology not a sought-after stream then?
Oncology was considered a doomed specialty. Everyone used to say that it was a negative specialty because one saw only death. Many had advised against taking it.
Is cancer the most dangerous disease?
No. It is less dangerous compared with many diseases, as it can be prevented and is screenable. For example, 50% of heart attack victims die before reaching hospitals even in developed countries. But yes, cancer is the most feared disease and there is a lot of stigma associated with it.
Kerala is considered a cancer capital. Over 120 cases per day getting registered here. Why is it so?
Yes, 120-plus is a huge figure. There are multiple causes for this. One reason is that the overall life expectancy is high in Kerala and, as we age, the chances to get cancer is also high. Another reason is that we have a better healthcare system than many other states and here every case gets registered unlike in other places. The third reason is that cancer cases are, indeed, increasing for sure.
Why is this increase?
About 30 to 50% of cancer cases in men are tobacco-related. Excessive consumption of alcohol also increases the risk of cancer. The risk of cancer goes up in people who drink and smoke. One can reduce the risks of cancer by 50% through a good lifestyle and timely screening.
So, you mean to say cancer is preventable?
Certainly. About 30% of cancer cases are preventable if one says ‘no’ to smoking, alcohol and high-fat food. And the next 30% — like cervical, prostate and breast cancers — are screenable, and can be cured if detected early. There may be some overlap here. So we can safely say that 50% of cancers are preventable.
And for women?
It is breast cancer. Every third female who walks into our OPD has breast cancer. Also, it is now detected in a much younger age group. If the 45 to 50 age group was vulnerable earlier, it has now come down to around 25 years.
Can these be attributed to the lifestyle of Keralites?
I’ll give you an example. Just like my craze for trains, I love eating at Indian Coffee House outlets. At one such outlet, I saw a man having a meal. There was parotta and beef curry, and other 2-3 other items before him. Before eating, he opened several packets of medicines and gobbled them. I’m sure, one tablet was for diabetes, one for hypertension, one for cholesterol, and one for gas trouble… gastric issues are common here (laughs out). We, Malayalis, are not ready to change our lifestyle. But we have no issue in taking any number of medicines.
Is parotta the villain?
There is certainly an issue with maida. It is okay if you have it once in a while. But if you are on it continuously, there is a risk.
Do you eat parotta and beef?
I used to eat during my college days. Not now.
You stopped because it is bad?
Yes. I stopped after realising the danger.
But it is argued that Westerners eat more meat and maida than us…
Yes. But they club every meal with salads. They consume a lot of vegetables and fruits. We have copied only the bad part from them. We don’t eat enough fruits and vegetables. We used to have ‘avial’, ‘thoran’ etc., which contained turmeric, fibres, and curry leaves. How many parents would pack pindi thoran (A dish made of banana stem) for their child’s meal at school? Our health issues were aggravated when we stopped eating traditional foods.
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It is said Kerala tops in meat consumption in the country…
All red meats are a problem. Small fish is okay. You can also have chicken once in a while, and mutton rarely. I advise people who have a weakness for meat to enjoy watching others eat. 'Passive smoking is injurious to health, but passive eating is healthy' (laughs out). A healthy plate must contain 50% fruits and vegetables, 25% grains of choice, and 25% protein of choice. Colon cancer comes when you slip into a low-fibre diet. Fast food kills fast. Equally vital is physical exercise.
What should be the government’s role in tackling the issue of cancer?
In my opinion, instead of building cancer hospitals, the government should conduct regular screening programmes. But governments are reluctant because the results of such an approach will be visible only after 15 to 20 years. What they want is a big building for cancer treatment so that they have something to show.
Are e-cigarettes a relatively safer option as compared to regular cigarettes?
Comparatively, yes. But any form of smoking is dangerous. The reason why I am saying this is, we just need one single stimulation in the cell. Once triggered, there will be a cascading effect. The process continues even after one stops smoking.
Can we identify that progression?
As of now, no. The problem is there is no single pathway. Once the initiation is over, all the pathways are complex. So it is difficult to identify. But maybe 15 or 20 years from now, I think there is going to be a breakthrough.
The medical world has been obsessed with miracle drug trials...
Chronic myeloid leukaemia comes under the umbrella of the miracle drug trial. It has totally changed the concept of the disease. After 25 years, there might not be any oncologists; there will be molecular biologists who can prescribe medicines. Cancer treatment is changing fast.
You said vegetarianism is better. But there are pesticides in fruits and vegetables...
Yes. There are problems. But it is not an excuse to avoid fruits and vegetables. If we go to buy vegetables, go for the bad-looking ones. I would say the ones that the vegetable vendor throws out – small and lean ones – will be the best (laughs). Also, keep your veggies and fruits dipped in saline warm water for some time.
Have heard that many doctors diagnosed with cancers do not go for treatment. Is that true?
There are still some doctors who believe that cancer is not curable. One has to understand that the only aim is not a ‘cure’. For example, you don’t cure any diabetics or hypertension patients. Diabetes and hypertension are controlled, and the patient lives on. Like that, cancer patients, too, can extend 30% of their lives with treatment. For example, Balan K Nair, despite having cancer, acted until his last breath. So did Innocent.
The cost of treatment is a major concern. We have seen people forced to sell their houses to fund treatment... All modern treatments are expensive.
When prescribing a drug, we have to think about two-three things. One is whether you want an imported drug or an Indian drug. There are Indian drugs available that are much less expensive and equally good these days.
Also, doctors should not allow the patient to go bankrupt if the case is hopeless. So the doctor’s discretion is important. I would also urge every institution – say, an office or college – to raise corpus funds to aid cancer patients associated with them. This can be easily done.
At times, doctors may have to stop treatment if the case is hopeless. There will also be situations where the patient does not want to be treated. How do you deal with these kinds of situations?
We disclose the whole thing to the patient’s close relatives. If the case is hopeless, we tell them that there is no point in taking treatment. But if the patient insists on getting the treatment, then we are obliged to do that. In the West, it is mandatory to share all details with the patient. They also tell if the patient is about to die in a week or so. We have not reached that stage. So, we avoid sharing such details. But we never give false hopes.
Does everyone get shattered when they are diagnosed?
Yes, definitely. Whoever we are, the moment we hear that we have cancer, we will be shattered. It is like a 360-degree turn in our lives. There are different emotional phases: first one is shock, then comes refusal, then aggression, then withdrawal and, finally, acceptance.
How did you present this to actor Innocent?
Innocent was at a shooting location when I called him. I told him I wanted to see him the next morning. He understood and was shattered. He had a 10-minute-long funny scene to complete. He told me later that he couldn’t utter even one word after that. Some people try to hide it; but some accept it after the initial shock. Innocent did that openly, and eased the burden.
Why do some people try to hide this disease?
Firstly, it is because of the social stigma. I will give you an example. A woman who was diagnosed with cancer told me that she would come back after four months because her daughter was getting married soon. She did not want the groom’s family to know about her illness. I believe things are changing with the new generation.
Is cancer hereditary?
Only 5 to 10%. That, too, only in the case of certain types of cancer. We can identify the track of hereditary genes in cases of breast cancer. There is something called genetic counselling.
How effective are cancer vaccines?
Vaccine for cervical cancer is very effective. Two doses give life-long immunity from the virus. Cervical cancer numbers have dropped due to the vaccine.
You have treated thousands of patients. How important are one’s willpower and attitude?
They are crucial. There are many studies that have proven that positive thinking helps in the production of biochemicals that improve one’s immunity. These components are higher in people with a positive attitude. So meditation, yoga, music, etc., are very important. We advise patients to return to their normal lives in whichever way possible. That always helps.
Do you remember anyone in particular here?
Innocent was one such case. So is Sidharth Siva. Sympathy is the last thing a cancer patient needs.
You have seen people in different critical life situations. Is there any difference between people with faith and atheists in dealing with the illness?
It is not easy to handle the reality when one is diagnosed with cancer. Most atheists, by the time they come for the treatment, would reach a stage where they realise that things are beyond them. Belief in some positive energy, something more powerful does help some people. It enhances hope. And there have been miracles, too. But prayer alone won’t cure cancer.
Do you also believe that there is something beyond us?
Yes... There have been many instances that I can’t explain. The only thing I pray every morning is that no patient should die because of my fault.
Several allopathy doctors slam alternative medicine. What are your views?
No, I don’t agree with that. Alternative medicine, too, can help patients. Also, people who practise them – especially Ayurveda – have learnt a form of science; that should be respected. However, when it comes to efficacy, we do ask for supportive data.
So, you believe only allopathy has treatment for cancer?
I don’t, but authenticity is important. There must be proper studies and documentation.
But the traditional system of medicine has been in practice here for ages. Do we need to suspect their efficacy?
Any chemical can be analysed and put on trial these days. I wish there was a better mechanism to collate and analyse data in such streams as well.
When you resigned from RCC, many were dismayed. That is probably because of the perception that doctors in government hospitals are service-minded and those in private are money-minded...
There are good doctors who are service-oriented in both government and private hospitals. In government service, there is a lot of hierarchy that curbs one.
But you could help many poor patients while at RCC...Here also I am doing that through our Cochin Cancer Society. We provide free shelter, food and treatment to patients.
You have spoken against the current entrance exam system. Could you please explain?
Only the rich can afford to go to entrance classes these days. This will result in such a situation that all doctors will be from rich families. During our times, pre-degree marks were the primary criterion. Due to that most of my classmates were from different strata of society. I feel it is very important to have such a mix.
You also had become a patient a few years back. How did it change your perception as a doctor?
I would say that every doctor should be admitted in a hospital as a patient (chuckles). Then only one will realise how the other side is. It has made me a more empathetic doctor and a person with a better lifestyle.
How do you unwind?
I watch films once in a while. I love music. I always carry a harmonica with me and play it while travelling in my car.
You don’t use WhatsApp. But recently a WhatsApp post in your name that was doing the rounds....
(Laughs) I have come across many. I wonder who comes up with these fake posts. Some first-time patients say they have been following my advice to the T – advice via WhatsApp! (chuckles).