Interviews of March/April 2019

Interviews aired in March/April 2019

Interview of 20.3.2019

Dr. Gaura Kishor Rath: https://www.youtube.com/watch?v=5n8lyrZ-IP4. Radiation oncologist and head of NCI at Jhajjar-Haryana, an institute under AIIMS. MBBS from Utkal University and post-graduate in medicine (radiation oncology) from AIIMS. Joined AIIMS in July 1974. Dr. TVV says it is common for film stories to use cancer as the disease to kill a leading character and asks how true it is that it is a guaranteed killer. Dr. Gaura says that is a myth - especially if detected early, that disease needn't be a killer. Says it is a "fantastic" disease among the 4 major diseases - stroke, diabetes, and coronary heart disease being the other 3. Dr. TVV surprised - why is it "fantastic"?! Dr. Gaura says that the other 3 diseases are not preventable or curable (Is that true? Is Dr. Gaura being biased? But he does sound very optimistic!), but cancer is preventable in 60% of the cases and curable in 60% of the cases (is he being overly optimistic about the current situation?). Ovarian cancer preventable with HPV vaccination and is on the decrease due to vaccination. Breast cancer curable if detected early. Most cases of liver cancer also preventable with vaccination. Stomach malignancies are caused by a bacterial infection which is preventable (but how?). Oral cancers are caused by chewing tobacco and therefore can be prevented. Oral cancers are very common in eastern/north-eastern India where tobacco-chewing is common but quite rare in Punjab/Haryana region (where NCI is located) because tobacco-chewing is less common in that region. Most common cancers? Among mean, it is lung cancers (over 1 lakh cases), but if head and neck cancers are considered as one group, then that is higher (around 2 lakh cases). Among women, ovarian and breast cancers more common. Some of the risk factors for ovarian cancer seem to be the opposite of those for breast cancer (e.g. age of giving birth, number of births given, rural vs. urban). Says that the new hospital campus will not only be one of the biggest in the country but will also have facilities not found anywhere else in the world. Has a testing lab that can process hundreds of samples simultaneously. State of the art radiation treatment equipment - proton therapy, LINAC (linear accelerator),  brachytherapy, and the latest being carbon ion therapy, which is safer and more effective than other types of radiation therapy.

Dr. TVV asks - "[they] say you treat patients even when you go for a walk". Dr. Gaura replies - "if you are a policeman, everyone looks like a thief. If you are a doctor, everyone looks like a patient" :). Says that if he comes across someone on the road who looks ill, he asks them to go for tests immediately so that their condition can be diagnosed and treated early so that their chance of getting cured is high. Dr. TVV asks if there are any notable people who have been successfully cured of this disease. Dr. Gaura replies that there have been many famous people who have been cured of the disease but not all have been public about it. States the examples of cricketer Yuvraj Singh (who he says is his good friend and whom he cured) and actor Manisha Koirala who have been cured of the disease are now actively campaigning for prevention and early diagnosis. Says that if he or Dr. TVV advise people to get vaccinated, not many will obey, but if a celebrity like Manisha Koirala advises, people are very receptive. Appreciates the enthusiasm shown by these 2 celebrities in educating people about the need for prevention and diagnosis. Is hopeful of finding a cure for all cancers in the next 20 years - those which are preventable will be prevented and the remaining whose cause are unknown will be made curable.

Interview of 27.3.2019

Dr. Uma Kumar: https://www.youtube.com/watch?v=guhcBHZcXeM. Founder and Head of the Department of Rheumatology at AIIMS, Delhi. Joined AIIMS as a resident doctor in 1994 and was elevated to the position of prefessor in the early 2000s. Says that rheumatism refers to not just one disease but a group of almost 100 similar or related diseases. They can affect many organs from head to toe, such as eyes and lungs, not just joints as is commonly believed. The two most common rheumatic diseases are rheumatoid arthritis and spondyloarthritis (?). It is a myth that rheumatic diseases are the diseases of the aged - they can occur at any age. Not all joint pain is a case of arthritis is - other conditions like thyroid hormone imbalance may also cause joint pain. Rheumatic diseases are characterized by inflammation and are mostly a result of an autoimmune disorder. Many rheumatic diseases are more common among women than among men. Women have a more active immune system since immune response is mostly determined by genes in X chromosome and women have 2 X chromosomes. Spondyloarthritis (not to be confused with spondylitis (?), which is neck pain caused by wear and tear that is not sufficiently repaired by the body) one exception as it is more common among young men - it is characterized by lower back pain with inflammation and stiffness in the morning that gets better during the day as the patient engages in more physical activity. There is a genetic factor involved in autoimmune diseases but usually something like an infection is needed to trigger an autoimmune disorder. Even when a trigger occurs and an immune response is fired, it does not always lead to a disorder. The chance and extent of autoimmune disorder may be affected by factors such as the intensity or type of the trigger. Autoimmune disorders occur when a foreign body causes the immune system to launch a response to eliminate that foreign body but that response fails to distinguish between the foreign body/particle and the person's body's own cells. Also says that people with autoimmune disorders have a higher risk of developing malignancies. Some of the rheumatic disease conditions may end up becoming a pre-malignancy condition, such as in breast or pancreas. Says that her team noticed that even among patients whose rheumatic disease was in remission following treatment, there would be flares in certain season of the year, November-January in Delhi. Her team hypothesized that this could be the result of increased air pollution in Delhi during this period could be triggering an autoimmune response leading to flares. Further studies have found that certain markers of  autoimmune condition are found to be elevated among residents of Delhi and this too is likely to be due to high levels of air pollution in Delhi. Dr. TVV - "So air pollution causes not just respiratory diseases, but also rheumatic diseases". Dr. Uma Kumar adds that besides respiratory and rheumatic diseases, it is now a well-accepted fact that pollution also causes some malignancies.

On why she started the Department of Rheumatology at AIIMS. Rheumatology was a late entrant in India, gaining attentions only in the late 1970s. Felt that the amount of attention given to diabetes and heart diseases was not being given to rheumatic diseases even though the burden of this group of diseases was high. Hence a separate department was needed so that more human resources can be dedicated to treatment and research for this disease group.

Other topics briefly discussed - she has lived in several parts of India, with early studies in Kolkata. Her father worked in Indian Railways and would be transferred to different work locations and therefore she got to live at different places in India and this shaped her ideas. Originally from Varanasi - says that during holidays in her younger days, she would go to Varanasi and she often felt a special sense of calmness when there. Dr. TVV adds that Varanasi has a special place in history as it is one of the oldest continuously inhabited towns/cities in the world and had been popular even at the time of Buddha. Dr. Uma Kumar narrates an incident that had a great impact on her - during her early days as a resident doctor, she had as a patient a young boy who was in a vegetative state following a malarial infection affecting the brain. She didn't know how to convey to the boy's parents that he may never come back to normalcy and his life may end while he continue to be in a vegetative state. The boy was discharged after a few days without any improvement. After a few years, the boy's father brough him along to Dr. Uma and asked if she recalled the boy. She didn't recall as the boy was in good health and was active. The boy's father reminded her of his being in a vegetative condition years ago and she not being hopeful of his surviving or returning to normal health and pointed out how the boy had disproved that. Dr. Uma realized that doctors can only offer treatment and cannot determine whether a patient will live - that is determined by God. Dr. TVV's asks her message to listeners. Messages - maintain a positive outlook and stay hopeful even if affected by rheumatic disease, follow healthy diet, remember that you "use or lose joints" (importance of exercise), go for timely and proper diagnosis and treatment (non-traditional systems of medicine that claim to cure rheumatism aren't backed by proper studies and their efficacy is highly doubtful), keep smiling!