Dr M V Pillai, a professor of oncology at Thomas Jefferson University in the US, is passionate about everything in Kerala even after nearly five decades of life abroad. He currently heads the American chapter of the International Network for Cancer Treatment and Research and is an award-winning author as well. Dr Pillai shares valuable insights on the deadly disease and observations about Kerala.
Excerpts:
How did you start your medical career?
In 1961, I got admission on merit to the Thiruvananthapuram Medical College. I completed my MD from there, and later worked in Kottayam, Kozhikode and Thiruvananthapuram medical colleges. Ten years later, I moved abroad. But, let me tell you, I would not have gone abroad if it were today.
Why do you say so? How has Kerala improved?
There are plenty of opportunities for doctors in Kerala now, especially in the private sector. When we were working, all medicines were bought from outside; there were no lab facilities, the makeshift labs outside had no quality control. So, there was no job satisfaction.
You are saying this at a time when there is a spike in students migrating abroad…
People quit jobs when there is no self-satisfaction. The issue of money is only secondary. If a student pursuing a masters' in surgery does not get the opportunity for robotic surgery, he or she feels inadequate.
So, you mean to say students go abroad because they do not get enough opportunities?
Of course. However, now the new trend is that people who study abroad want to come back. Many highly skilled people want to come back to Kerala. Take the case of Dr Jose Chacko Periyapuram. People like him are doing a good job by helping government hospitals while working in the private sector.
Do you believe collaborations are good?
Yes, of course. Earlier, a doctor working in a private hospital was not allowed such tasks in government medical colleges. The present government is open to new ideas. Chief Minister Pinarayi Vijayan is good at implementation. He doesn’t talk much, but is good at grasping ideas and implementing them.
You have been associated with the government for various health initiatives. How did this association begin?
My association came as a recognition to my profession. People from different political parties and religions consult me on cancer and ask about public health challenges. I share my experiences on these topics.
You have also been involved in developing medical systems. The Institute of Advanced Virology (IAV), for instance…
The entire credit should go to Chief Minister Pinarayi Vijayan. You must understand that IAV came into being even before the Nipah outbreak. The idea originated from a scientist – Robert Gallo, who had discovered HIV. Gallo predicted in 2011 that it would not be nuclear wars or earthquakes, but a virus that could bring an end to the human race. Ebola, Nipah, Covid… all proved him correct.
He envisaged a network of virology institutes across the world to tackle this challenge. I conveyed this information to the then chief minister Oommen Chandy, with whom I had a very good rapport. He was interested, but two officials scuttled it. I have seen the governance style of the two chief ministers closely. Oommen Chandy was a good human being, but he lacked the decisiveness to implement things.
Then, what happened?
I tried my luck with various private hospitals, too. But nothing came out of that. I had almost given up. Then, I got a call from the current chief minister. Pinarayi asked me about my old project, and wanted me to set it up. I expressed my reservations because the project had earlier been rejected by the state government. I would lose credibility if it were to get rejected again by the health department. Pinarayi promised that the institute would come up, and I was happy to see the determination on his face.
And, after that?
Within two weeks, he informed me that land for the institute had been identified at the Life Science Park at Thonnakkal. He also secured an additional five acres to cater for future growth, and allocated Rs 50 crore in the next year’s budget.
Are you happy with the institute’s progress?
I would like to see the pace increase a bit more. The reason is that they still do not know the social commitment and global relevance of the institute. This is the largest such centre in India.
How would you explain Kerala’s ‘cancer capital’ tag?
We have become a prisoner of success. Our longevity has increased. About 66% of cancers occur after the age of 66. Our immune vigilance declines as we grow older. The average life expectancy of Malayalis is 79 for women and 76.9 for men. By that age, immune vigilance decreases. So, the longevity of Keralites is a major reason for the high number of cases.
Does our lifestyle have anything to do with that?
Yes, of course. Our eating habits have undergone a sea change. This is why lifestyle diseases are high here. Kerala is the diabetes capital of India as well. Since the lifestyle has changed, high-calorie diets and obesity have shot up. Breast cancer, endometrial cancer, rectal cancer and kidney cancer are due to obesity. Alcohol consumption has also gone up, resulting in 11 types of cancers associated with it.
There is a perception that the Malayali’s fondness for ‘parotta and beef’ is a major reason…
That argument is both right and wrong. One parotta and a portion of chicken or mutton curry will not cause any problem. But our problem is that we do not stop with one. The problem with red meat is that if it’s burnt, a portion may get lodged at the hinges of the colon, and it could become mutagenic. If we keep gorging on overcooked red meat such as pork, lamb and beef, the chances of it getting lodged in the colon are high. The resultant organic chemical formed at the site can be carcinogenic. Rectal cancers are rare among Brahmins.
Do we have proper data to prove nonvegetarians are more prone to cancer?
Lots of studies held abroad substantiate this. Unfortunately, no such studies have been conducted in Kerala. We just go by foreign experts’ findings. We need to have proper data.
There are instances where people who smoke 10 - 15 cigarettes lead a healthy life. But there are non-smokers who get lung cancer. How do we explain this?
Lung cancer is an association of different types of cancers. There is an enzyme which helps remove the tar from smoke in our bronchi. We get these enzymes from our heredity. This varies from person to person. Similarly, there is another enzyme called alcohol dehydrogenase. If you have a good liver, you can keep on sipping scotch whiskey, rum and gin until someone beats you to death (chuckles).
It means genes plus lifestyle diseases trigger cancer?
Yes, cancer is both genetic and epigenetic (environment-related).
How crucial is gene therapy going to be in the coming years?
It’s already in practice. Gene therapy is done for sickle cell anaemia and haemophilia. By doing this, we will be able to identify the faulty gene. Early detection is the key.
How much has cancer treatment progressed globally?
I think, in 20 years time, chemotherapy would become irrelevant. Now, priority is given for early detection. If you have a family history of breast cancer, you need to check for BRCA (BReast CAncer gene) mutations that could lead to prostate or pancreatic cancer. It can be detected through screening. That’s what we intend to do through genetic markers. Looking at the family history, risk factors can be assessed. It’s called risk stratification.
Does that mean cancers are hereditary?
Hereditary cancers come to only 15% of the total cases. Certain cancers, such as breast cancers, are hereditary.
Hollywood actor Angelina Jolie chose to remove her breast to prevent cancer. Is that an advisable option?
It’s not advisable. There were three-four options, but she didn’t want to take any chances. It’s her personal right. Only when the cancer is at stage 3, one needs to remove the breast. If it’s stage 1, a patient needs to remove only the lump. Then, she will have to undergo radiation so as to preserve her breast. There are ways to conserve the breast.
At which stage does the journey come to an end?
Stage 4 is where the cancer mortality rate increases.
What are the latest treatments for cancer?
It depends on the stage and the organ affected. If it’s stage 1, the lump needs to be removed. For stage 1 and 2, hormone therapy can be given. Stage 3 means cancer has spread to the lymph nodes, where chemotherapy and immunotherapy can be provided.
Isn’t immunotherapy expensive? How can the poor and needy afford it?
Yes, it is. Health insurance that covers immunotherapy should be introduced. Efforts should be made to make it affordable.
Is there any truth behind the advice – even by some doctors – that jackfruit helps in cancer prevention?
This is not authentic information or advice given based on studies. Until proven true, these are just perceived notions.
Are alternative medicines good for patients?
There are some good alternative medicines. There is also scope for holistic treatment. Ayurveda doctors should come forward now.
You once said in a speech that spiritual leaders and astrologers had messed up the treatment system…
At a critical stage, even I might do so if my relatives advise me to see a spiritual leader or a parallel medicinal practitioner, as seen in the case of even a former chief minister.
Proponents of alternative medicine point out that, most of the time, cancer cannot be completely cured with modern medicine. Is cancer completely curable?
Therein lies the importance of early detection. The aim of cancer screening is to identify the disease in the first or second stage. By stage 3 and 4, the chances of cure decline. However, we can extend an individual’s life expectancy. Palliative care can do a lot; it is not just about pain management or managing abscesses.
How effective are anti-cancer vaccines?
There are preventive vaccines for certain types of cancers – Hepatitis B virus, oropharyngeal cancer and cervical cancer.
You have closely worked with many senior political leaders such as K Karunakaran, E K Nayanar and Pinarayi Vijayan through critical phases in their lives… Can you recall their approaches?
They were never anxious. K Karunakaran and E K Nayanar resorted to humour. Susheela Gopalan was very mature in her approach. Pinarayi Vijayan has strong will power. Many still advise him to change the stream of treatment, but he will never budge.
Oommen Chandy…?
He, too, was strong-willed till a certain point of time. But later, he got influenced. I may get influenced if my wife and children insist.
What is the role of will-power in overcoming the disease?
Will-power plays a very important role.
As a doctor with 46 years of experience in treating cancer, what is your message to Malayalis?
Smoking should be avoided at all costs. Try avoiding alcohol, too. There are some people who claim a little alcohol is okay. That’s not right. If our denaturing enzymes are bad, a little alcohol is also dangerous. There is nothing like ‘responsible drinking’.
Now, some non-medical questions... You have been based in the US for more than four decades. What’s the general political leaning of Keralites settled in the US – Republican or Democrat?
I would say 75% of them are Democrats.
You are the product of Kerala’s public education and health system. How will you assess the current performance of these two sectors?
Our schooling system excels, but we lag in the higher education sector. We have knowledgeable people, but they lack skills. Theoretical knowledge is very good, but we do not teach them practical skills. Teaching is mostly exam-oriented here.
It has been 45 years since you left Kerala. What are the major qualities and drawbacks of Keralites from your viewpoint?
Keralites are always willing to learn. It shows that there’s nothing wrong with the seeds (smiles).
What about the flipside?
We have lost our sense of humour. Once upon a time, we had great cartoonists. We had people like Panampilly, Lonappan, Chazhikadan and Nayanar who knew the art of using humour without hurting anybody. Nowadays, nobody knows how to crack a joke.
Is it because there’s a sense of fear in society?
It is the other way around. The sense of fear could be due to the absence of sense of humour. There’s no need for us to politicise everything. There’s a tendency to brand people. Since my name is M V Pillai, many see me as a Sanghi (smiles).
You knew actor Mohanlal, right from his childhood. How do you view his transformation?
Lalu is still the same, a bigger child perhaps (chuckles). He hasn’t changed a bit.
What’s his foremost quality?
Humility. If he’s left to himself, he is a very shy person. His parents were also like that.
During his childhood days, did you ever think he would become an actor?
Never. Not even once. But, he was always very observant. He has an amazing ability to transform into a character, and then come out of it. That’s an extraordinary talent. His son has got some of his qualities. He’s never enamoured by material things. Mohanlal is also very passionate about medicine. If not an actor, he would have become a doctor.
.jpg?w=640&auto=format%2Ccompress)
Did you ever expect your nephews Indrajith and Prithviraj to enter cinema?
Never. Had Sukumaran been alive, the chances of these two entering filmdom would have been remote. Both of them used to be bright students. My brother-in-law, Sukumaran, was a scholar. His passing away changed their lives. I believe both of them are doing well. Still, it’s like operating a Dreamliner aircraft designed for international travel on the Chennai-Thiruvananthapuram route.
Your attempts to start a Johns Hopkins University campus in Kerala created a row in the state. What led to the controversy?
I would partly blame the media for the controversy. I first met E K Nayanar in connection with this project. A decision was taken to set up the campus in Munnar. It was decided that 10% of the seats would be reserved for Keralites. Nayanar even came to the US and was about to sign an MoU. That’s when three intellectuals came out alleging that it was an attempt to enable the CIA to learn the genetic secrets of Keralites.
Who were they?
I have decided not to make that public. I would say they are not intellectuals, but pseudo-intellectuals. They were worried of losing their prominence. We could have accommodated them in the task force. But, the trouble with armchair critics is that they are not keen to take up any responsibility.
There was another controversy over drug trials at RCC...
That, too, was completely unnecessary. We have reached this stage only through clinical trials. They were conducting trials as per stipulated norms. They were testing a new medicine for a disease that didn’t have any cure till then. It was done after taking consent from all scientific bodies. I am sure such attitudes will change. I am very hopeful about the new generation.
Do you want to return and settle here?
Yes, Of course. I would like to spend more time here. Let people from here go abroad. Some of them will certainly come back and contribute to their homeland (smiles).