Dr. Rajendra Badwe
I take over as Dr K.A. Dinshaw superannuates after an illustrious career of 13 years. The years have been well utilized to evolve the process necessary to run for the quest of cancer (QC) and we now address ourselves to that purpose. The quest for cancer will have implications on affordability, innovation on one hand and delivery dissemination of standard of care, development of infrastructure and human resource on the other.
Affordable medicine is a magic word for all healthcare systems whether it is developing world cancer care or developed world nationalized health or insurance based system. Devising affordable intervention can be one plausible road for clinical research. Under this umbrella would be novel indications for existing drugs (reducing the time and cost of such drugs when proven successful), comparing affordable to expensive but proven technology and challenging dogma to trim and redefine standards of care.
Innovation would not only be in the well trodden roads of genomics, proteomics, metabolomics and stem cell with its associated molecular technology but also in less explored avenues of herbal medicine. The drug discovery program would induce clinicians to interact with experts in medicinal chemistry, molecular biology and would harness relationship between industry and academia. A platform for interaction between medicine and other discipline like physics, chemistry, nuclear medicine through newly formed Homi Bhabha National Institute would facilitate drawing designs/solutions from these disciplines that might have evolved in different directions. Such interaction will also allow assessment of viability of any new idea amongst experts across the spectrum of biology of cancer from laboratory to clinic to epidemiology.
Innovation in cancer medicine will be induced by evolving and appreciating ‘correlator’, an individual or group of individuals that have the capability to put together all the facts into a road map. ‘Clinical Scientist’ a rare breed of individuals will be cultivated with all facilities to put the jigsaw in place. The process that is most pivotal in research is to ‘Unify’. This process needs to be in harmony with the dividing or reductionist’s approach that has been so very successful in service and education, the other two parts in the trilogy that supports cancer care. I am reminded of the harmony that pervades the illusions of Escher where two opposing processes remain juxtaposed to each other in perfect unison.
The reductionist’s knife in service and education would evolve groups with organ specific focus,a well trodden path that has improved patient care and education. A gap analysis has been well utilised in evolving evidence based care to define standards and disseminate them across the country and the rest of the developed world. The process will continue with greater vigour as well as rigour. Evidence from well conducted research will be discussed for its robustness, applicability across the urban, semi-urban and rural India and if so will be adopted as guidelines if cost-effective. If not the same will be forwarded to policy makers as a suggestion for creating infra-structure or as a referral guideline. Lastly lack of evidence or equanimity about clinical practice would form a nucleus for a national clinical trial. The well machinery of clinical research will be put to use to answer questions of national importance and will also harness relationship with industry.
Inroads into health care by market systems has escalated the cost of health care for the distress of policy makers and for the consumers it means rationing of health care interventions and also ‘Creating disease’ by the act of observation. Screening and prevention studies well proven will be exploited for public good with utmost caution.Finally the goal would be to put in every effort to make every cancer patient feel cared for and offer all facilities to those who offer care or cure so that they have the sense of belonging to the commune that is striving for the Quest of Cancer.