Topic 1 : Changing cancer nomenclature can improve treatment outcomes: doctors
Introduction
The way we classify metastatic cancers may need to be revamped, scientists have said, proposing in its place a classification system that places the molecular characteristics of the cancer over the tissue of origin.
Treating cancer
- Traditional approaches to treating cancer — including surgery and radiation — target the organs in which the tumour is present.
- This practice formed the basis of classifying cancers after the organ in which they originate.
- But most deaths due to cancer are the result of the disease metastasising beyond the organ of origin; individuals with metastatic cancer are almost always treated systemically with drugs that enter the blood.
The need to change
- With technological improvements, doctors are also able to find which genetic mutations are responsible for a tumour in many cases, and target them with drugs.
- All cancers from the same organ don’t always share the same mutations, and these mutations aren’t limited to cancers of a single organ.
- This development in precision oncology requires cancers to be classified based on their molecular and genetic characteristics rather than the organ in which they originate.
- This way, according to them, cancer patients can also access life-saving drugs sooner.
Sequential testing and delays
- The drug nivolumab included people with different types of cancers, including melanoma and kidney cancer.
- Nivolumab targets the receptor of a protein found in some tumours. It ameliorated symptoms in individuals with tumours with that particular protein.
- Since cancers are classified based on their organ of origin — breast, kidney, lung, etc.— researchers had to conduct trials one after the other for each type of cancer.
- As a result, for many years, people with tumours expressing that particular protein couldn’t access nivolumab because the drug hadn’t been trialled for their specific type of cancer.
Significance of the new scheme
- Naming cancers according to their biology rather than their anatomy will reduce the time needed to run clinical trials because you only need a few randomised trials, instead of testing the drug in each disease defined by the organ of origin.
- A trial for a drug targeting a particular genetic mutation will cover all cancer types with those mutations.
- Naming cancers with biological mechanisms would decrease such heterogeneity, and will also help the patient to better understand the rationale for his/her therapy.
- A particularly important requirement is for institutions to establish teams that will focus on analysing patients’ molecular profiles irrespective of the cancer type, the researchers wrote in their paper.
- Medical students must be trained to understand the molecular basis of cancers instead of memorising the characteristics of primary tumours.
Way forward
- The proposed change for classifying cancers can’t happen unless patients can access tests that reveal molecular alterations in their tumour.
- This is particularly relevant in the Indian context, where we must take the proposed change with a pinch of salt.
- The availability and accessibility of genetic tests should be wider. Only then can we jump to this diagnostic nomenclature.
Topic 2 : Guaranteed MSP is an ethical imperative
Context
As the general elections draw closer, agrarian concerns have once again taken centre stage. Farmers from the heartland of the Green Revolution have travelled to the border of the capital to not only voice their distress, but also to shape the electoral discourse.
The issue of MSP
- The perennial issue of fair pricing of farm produce reigns supreme, now coupled with calls for legal assurances of Minimum Support Price (MSP).
- However, beyond mere legal mandates lies the pressing concern of maintaining self-sufficiency in food production and addressing the ongoing challenge of distribution.
- This underscores the ethical imperative of anchoring a legal guarantee for MSP.
- The MSP regime was a vital instrument for ensuring food security in India.
- Given the unique nature of agriculture, farmers lack the ability to exert significant influence, let alone determine the price of their produce. This constitutes a ‘market failure.’
- Thus, MSP ensures that agricultural commodity prices remain above a predetermined benchmark to facilitate remunerative price discovery.
Produce and perish trap
- The MSP is announced annually for 23 crops covering both the kharif and rabi seasons, well in advance of sowing, with 21 of them being food crops.
- However, despite the announcements, the implementation of MSP remains poor.
- Only 6% of farmers, primarily those cultivating paddy and wheat in States such as Punjab, benefit from MSP.
- Most transactions involving these essential food commodities occur below the MSP, rendering farming economically unviable for the majority of producers in India.
- As a result, farmers are trapped in a dangerous cycle of produce and perish, leading to crippling debt and deaths by suicide.
- All these emphasise the pressing need to ensure MSP, including the one recommended by the eminent agricultural scientist M.S. Swaminathan (with a 50% profit margin).
Legal courses guaranteeing MSP
- Several articles under the Constitution, as well as the United Nations Declaration on the Rights of Peasants, support the legal recourse to guaranteeing MSP.
- Sugarcane growers already benefit from a ‘statutory’ MSP, which sugar factories strictly adhere to when purchasing cane from farmers.
- The Farmers’ Right to Guaranteed Remunerative MSP for Agricultural Commodities was tabled in Parliament in 2018.
- These efforts show that the objective of establishing a legal recourse to MSP has not emerged suddenly, nor is it impossible to attain.
The solution
- A minor amendment to respective State APMC Acts or the Centre’s Essential Commodities Act would suffice to introduce a law ensuring that no transactions of farmers’ produce occur at prices below the MSP.
- Crop planning, market intelligence (including price forecasts), and other pre-sowing measures, along with the establishment of post-harvest infrastructure for efficient storage, transportation, and processing of farm commodities, greatly assist in managing the post-harvest glut in the market.
- Therefore, a legal route to MSP, complemented by the development of such linkages, would provide protection against “market failures” in addressing the surplus, rather than leading to “market distortion,” as claimed by some mainstream economists.
- Finally, effective procurement and distribution, as envisaged under the National Food Security Act, 2013, is the most appropriate means to not only ensure MSP but also address hunger and malnutrition.
- The PM-AASHA comprises schemes for price support and price deficiency payment, along with incentives to private traders to ensure MSP.
Conclusion
At present, farmers hardly get 30% of the price paid by the consumers; this will increase if MSP is guaranteed. Establishing a legally binding MSP will anger intermediaries as their share will get reduced.