Jerome Groopman, one of the most celebrated veteran teachers and researchers of Harvard Medical School, recalled his days of being a student, an intern and teacher in a stirring article “A Great Case” (published in the New England Journal of Medicine, November 11, 2004). He recounted – “It’s a really great case,” the neurology resident said. “Gerstmann’s syndrome”. I was a third-year medical student, and neurology was my first clinical rotation.” Initial enthusiasm and avid search for “a great case” took a different meaning and turn in the later years of his career. His first child survived narrowly from near-death situation. He experienced extreme anxiety, great pain of losing the most beloved one and all his sufferings – all those characteristics shared by his patients he had seen and which were unknown layers of medicine-being interaction to him until the time. At that critical moment, Groopman narrates, “A surgical resident in the emergency room began taking the history. Suddenly, an intern in scrubs burst into the room. “What have you got in here? What is it? A good case?”
I fixed on the intern’s expectant eyes and lost control. “Who the hell are you? My son is not a ‘good case!’” He felt that it was foolish to deny the profound intellectual excitement that came from medicine. It was also a hollow form of medicine that was practiced without factoring in the ultimate outcome. He finally came to his lifetime conclusion, “I still find myself unable, except in retrospect, to retrieve the language of my youth and speak about “a great case.” It is as if medicine at this stage of my life has split into two streams — a current of marvellous biology and an undertow that pulls at the soul. From the bank where I stand, it is hard to imagine that these two streams can ever again flow as one.”
Though against an altogether different perspective, perhaps this realization echoes on Sthabir Dasgupta’s life too – embodying many streams in his life, namely, a doctor by passion and profession, once a political activist and whole-timer of CPI (ML) of the late 1960s and early 19070s, an activist against inherent maladies of medicine by equal passion, a relentless writer against the dehumanizing face of techno-medicine controlled by corporate, a strong upholder of public health programs and who always endeavoured to put people at the centre stage of health policy (not effusing from the top brasses ensconced in air conditioned rooms), sometimes against vaccination, lending his implicit and reticent favour for ‘conspiracy theories’ around COVID epidemic, and, moreover, a prolific writer. At the same time, he, often in his later years, went at length against the present practice of technology and medicine, even to the point of dismissing it.
He was born on 14 January, 1949 and died in ventilation on 5 September, 2023. Truly speaking, he was the son or product of a tumultuous time of the Naxalbari period (1967-1972) in which he fully breathed in and assimilated the spirit – critical analytical capacity, relentless queries to any sort of power game, be it in material political world, be it in the realm of medicine, with his unquestionable dedication to general populace arising out of that time. His commitments and inheritance are explicitly contained in the Swapner Sottor: Maya Rohiya Gelo (The Memories from the Insurgent Revolution of the Seventies). He lived in the period he has depicted in his book. He was also an active actor of the time.
After so many years, many people who believed in the revolutionary dream are bereft any vestigial commitment to that legacy of the time – power to the hands of people. But Sthabir Dasgupta did not belong to that degraded genre. He carried it forward as a private oncologist (trained in oncology from UK), doctor and social scientist.
In one of his early books (among so many books written by him) Cancer: Purono Bhoy, Notun Bhabona (Cancer: Old Fears and New Thoughts), published in 2010, seemingly like a soothsayer relating myths around conquering cancer and consistent robust propaganda to perpetuate it to Nazi propaganda machinery. In his own words, “Nazism also operates in a subtle way. Nazism is a faith. Apparently its activities initially produce many ‘benefits’ in its initial phase. Those who are believers get increasingly obsessed with those illusions. More and more, these beliefs get stronger and stronger. In course of time, its intensity make the person gets petrified and beefy immune to all logic.” (pp. 223-224) Such an analysis for cancer-victory propaganda seems to be truer for today’s India’s state propaganda.
To note at this juncture, the turn to cheer of technologically wining over cancer was not because the picture was improving. Rather, the mood of post-war America was optimistic. Popular belief in technology and scientific progress overwhelmed thoughtful counter-messages based in scepticism and caution.
In his early years, following the footsteps of Dr. Manu Kothari and Dr. Lopa Mehta (Nature of Cancer, published in 1973, and the second book The Other Side of Cancer, 2009), Dasgupta strongly raised his voice against existing understanding and treatment of cancer, even to an extent to stick to old drugs and therapies instead of more effective newer ones. Is this a kind of orthodoxy replacing his avowed principles of critical thinking? Later in his years he stressed on the understanding of epigenetic theory of cancer causation. In a research paper “The history of cancer epigenetics”, published in 2004 in no other journal than Nature Reviews, it was observed, “Since its discovery in 1983, the epigenetics of human cancer has been in the shadows of human cancer genetics. But this area has become increasingly visible with a growing understanding of specific epigenetic mechanisms and their role in cancer”.
A few interested readers might also be interested to go through my article “Commerce and Corporate Capital Exceeding Science – Cancer: The Disease of Modernity” published in the webzine Doctors’ Dialogue for a comprehensive appraisal of cancer research where corporate greed and avarice for unquenchable profit deem patients as guinea pigs to conduct all kinds of experiments through medicine or new technologies (https://thedoctorsdialogue.com/cancer-disease-of-modernity/#comments).
But it should be emphasized here that what we – including me, Sthabir Dasgupta and others – are doing is not any fundamental research works in this field. What we produce always comes from rigorous researches of western scholars’ papers or books or monographs. Following this logic, it can be said that we are making an ‘Indian version’ of critiques already in circulation in western academic world.
Actually, one must not think that medicine up until now has remained an individual or contractual type of activity that takes place between patient and doctor, and which has only recently taken social tasks on board. On the contrary, medicine has been a social activity since the eighteenth century. In a certain sense, ‘social medicine’ does not exist because all medicine is already social. Medicine has always been a social practice. What does not exist is non-social medicine, clinical individualizing medicine, medicine of the singular relation. All this is a myth that defended and justified a certain form of social practice of medicine: private professional practice. Thus, if in reality medicine is social, at least since its great rise in the eighteenth century, the present crisis is not really new, and its historical roots must be sought in the social practice of medicine.
At this juncture, we need to make distinctions between (1) Clinical Health (or patients being treated privately as an individual) and Public Health (taking community as the point of intervention), (2) Health (following the historical Alma-Ata Conference of 1978) and Health Care (as a commodity with varying costs), and (3) viable primary health care system for every citizen and super-specialty hospitals.
What emerged at the beginning of the twentieth century, was the fact that medicine could be dangerous, not through its ignorance and falseness, but through its knowledge, precisely because it was a science. This characteristic phenomenon of the history of modern medicine has acquired a new dimension today in so far as that, until the most recent decades, medical risk concerned only the individual under care. At most, one could adversely affect the individual’s direct descendants, that is, the power of a possible negative action limited itself to a family or its descendants. Nowadays, with the techniques at the disposal of medicine, the possibility for modifying the genetic cell structure not only affects the individual or his descendants but the entire human race. Every aspect of life now becomes the subject of medical intervention. We do not know yet whether man is capable of fabricating a living being which will make it possible to modify the entire history of life and the future of life.
Sthabir Dasgupta tried his best to bring to our most of these aspects of lacunae in health policy-making and great influence of corporate tributaries in shaping false perceptions about our own need for being healthy. He fought tooth and nail against ‘medicalization’ of life in all its aspects. But sometimes he, in my opinion, failed to acknowledge due recognition of devoted new researches for the betterment of mankind. Better to keep in mind all the scientific researches are not dictated by corporate and all scientists are not stooges of giant MNCs.
In the decades ahead, the pace of biomedical discovery will accelerate. The state of an individual person will be characterized with increasing precision from the molecular level to the genomic level to the organ level and by interactions with medications, nutrients, the microbiome, therapeutic devices, and the environment. This “precision medicine” will become possible because of huge data sets on large populations, with millions of characterizations of each person. Study populations will grow to millions, which will allow observational studies with novel statistical methods that will allow discovery of useful, reproducible patterns and relationships from these data.
This will give answer to the question raised by Sthabir Dasgupta – why all patients do not respond equally to chemotherapy? Medicine will proceed towards personalized treatment when Sthabir Dasgupta will remain physically left behind.