Source: Sallar, Anthony Mawuli Ph.D

On Tuesday, September 20th 2011, I read a publication on Ghanaweb entitled “NPP-USA Calls on President Mills to Come Clean”. My immediate reaction was to ignore the said publication since it might have been written by someone who had an axe to grind with the President and has resorted to it in this inimical way and pretended to be NPP-USA. Typical of me, I laughed at them since the internet has provided all who can type, a forum to express their views, genuine, decent, or loaded with ignorance. However, I was shocked to read that it was coming from NPP-USA which I thought would have conducted basic research of the literature before speculating and spreading falsehoods, innuendoes, vituperations, and diatribe on such an important issue (sexual orientation, health of an individual and cost of treatment). I therefore waited for 3 days to read a denial from NPP-USA.

Since none is forthcoming, I am therefore compelled to write a rejoinder. It is the inaccuracies and attempts to discuss a critical health issue in a public forum that made me write. To me it is immaterial whether or not the President has throat cancer. First and foremost let us remember, politics aside, it is un African or Ghanaian to discuss somebody’s health issue with such callous impunity whether it is true or not. In this rejoinder, for purposes of clarity, I will enumerate some of the issue raised by the NPP-USA release and address them.

1. The insinuation that the President is a homosexual
Let me ask “So what?” Are homosexuals not human beings? I was appalled at NPP-USA’s homophobic and stigmatization stance even though the members have lived in the USA and probably worked with a homosexual, treated by a homosexual when sick, taught by a homosexual, and ate a meal prepared by a homosexual. The only thing missing is that they were not told that the person providing the above service is/was a homosexual. I only pray that that no NPP-USA member has a child who will come and tell him/her one day that he/she is a homosexual. I hope they will unconditionally love that child. Of course Ghanaians know that the President is not a homosexual.

2. That the President has throat cancer
The NPP release sought to give credence to a statement made by Mr. Baba Jamal to an American official that the President has throat cancer. I am really disappointed to say the least that a political party worth its mettle in USA would rely on Mr. Jamal’s petty gossip and draw conclusion. I state so because I am wondering whether the president had appointed Mr. Baba Jamal as his personal health spokesperson or his private medical doctor.

3. According to the NPP “If this revelation is true, then President Atta Mills owes Ghanaians sincere apology because he has lied to the nation. When campaigning for the presidency, then candidate Mills concealed a pre-existing medical condition he had to the electorate. Now this condition is costing Ghanaians a whopping $5 million annually to treat.”

I am wondering what NPP-USA means by the above statement. On one hand it used the conditional clause of “if” which indicates that it was not sure if Mr. Baba Jamal’s “revelation” was true. Then in the next breath it gave an outrageous figure of the treatment costing “whooping $5 million annually”. Throwing $5 million figure in the public domain is a clear cut manifestation of how lazy we have become as a nation. If I recall correctly the $5 million a year treatment cost was thrown about with reckless abandon by the so called NPP youth in Ghana. I just chuckled and ignored it. But to have the same repeated by NPP-USA which I am inclined to believe have individuals who can do simple research and find out how ridiculous the amount is do nothing is very disheartening. I will let readers note that in USA, of the top ten cancer deaths of men, throat cancer is the 8th affecting 16.1 out of 100,000 men.

In order to show how obscene the $5 million is I have checked and have costs of cancer treatments for males using figures provided by the USA National Cancer Institute as shown in the table below. The table is entitled “Cancer Prevalence and Cost of Care Projections, Average Annual Costs of Care”

Cancer type Initial year after diagnosis The period between Year of death

Brain $115,250 $9,434 $134,244
Esophagus (Throat) $79, 822 $6,450 $103, 742
Pancreas $94,092 $11,697 $113,115
Stomach $78,453 $4,282 $107,130
Head/Neck $39,179 $4,001 $83, 662

From the table above brain cancer is the most expensive from diagnosis to year of death. Assuming an individual has throat cancer and lived for 15 years he would have incurred a total cost of $79,822 + 14 (6,450) + $103,742 = $273, 330.
From the above the cost is prohibitive in the first year of diagnosis and the year of death as is common with most diseases. As with other cancers, treatment is either chemotherapy which is expensive and is the treatment of choice if the cancer has spread to other parts of the body. Costs of chemotherapy may include how long the medication is given, dosage, type of drug where treatment is received (hospital, home, doctor’s clinic) etc. Other treatment is by radiation or surgery which is cheaper.

The question then becomes, NPP-USA where are you getting the $5 million a year treatment cost from !!!! Can you quote to the reading public an authentic source? It is also loaded with evil to put a price tag on the costs of caring for an individual especially if such costs are ridiculous to say the least.

4. [In the COOPERATE (emphasis mine) world, if a would-be employee conceals a preexisting condition in order to obtain a position, the employer reserves the right to fire the said employee who falsified his medical condition to be hired.]]

I am at a loss here. If the NPP-USA is referring to CORPORATE world then it is only left to Ghanaians who are now the “corporations” with the legitimate sovereign power that can elect or unelect the President and they will do so come December 2012. They have seen his performance, heard his policies, seen him on TV heard him or radio and seen him “filifili”. They will decide, end of story.
5. Even more damaging is the cause or throat cancer. From our research the throat cancer Baba Jamal revealed to the officer in the American Embassy is caused by excessive use of alcohol, excessive smoking or excessive male oral sex. But a study by Professor Maura Gillison of Ohio State University found that “oral sex is a bigger cause of throat cancer than tobacco.”

Which research in a peer reviewed journal are you quoting, NPP-USA. Another very disturbing thing I found from the newspaper article that you referenced the very last sentence in that article reads 'Yet most oral cancers diagnosed in people over 50 in the UK are still related to tobacco and alcohol use.' However, you deliberately copiously quoted from the paper but ignored the last sentence.
It is imperative to have some basic education first on what causes throat cancer. It has been established that the risk factors for throat cancer include smoking, drinking alcohol (especially when combined with chewing tobacco), exposure to the human papillomavirus (HPV), and exposure to asbestos. In the United States each year, 1,500 women and 5,600 men who get HPV-associated oropharyngeal cancers (cancers of the back of throat including base of tongue and tonsils). HPVs are a group of more than 150 related viruses, of which more than 40 can be sexually transmitted most often during vaginal and anal sex or during oral sex. The types of HPV that can cause genital warts are not the same as the types that can cause cancers. There is no way to know which people who get HPV will go on to develop cancer or other health problems.

Furthermore, HPV can be passed on between heterosexuals and same-sex partners. Since there are no symptoms most men and women can get HPV, spread it to their partners without knowing. Also, it is important to note that even people with only one lifetime sexual partner can get HPV, if their partner was infected with HPV. Thus you do not necessarily need to be promiscuous to get HPV even though the more sexual partners you have the more your risk of infection increases.
The HPV virus also causes genital warts and cervical cancer. Since the cause of throat cancer is multi factorial, the best scientific method to use to determine role played by any of the risk factors is computation of what is known as the Attributable Proportion among the total population (APt). The APt describes the proportion of the disease among the total population that would be eliminated if the exposure were eliminated. I do not know the APt for throat cancer relating to HPV, or smoking or asbestos. I will be glad if NPP-USA can provide us with that information before making that biased insinuation it did. After all, not everyone with throat cancer smokes or drink alcohol or engage in oral sex with men as the NPP-USA piece seeks to erroneously imply.

6. In an ignominious way of suggesting that the President acquired his throat cancer through homosexual activity, the NPP-USA stated that the President stopped drinking years ago. It added that he quit “smoking decades ago”. The press release went further to state that “if smoking was the main cause of throat cancer, the ailment would afflict many more Ghanaians than its current levels suggest.”

Here again I realize that my good friends in NPP-USA have grossly exhibited their ignorance about some demography concepts. First of all let us remember that the life expectancy of Ghanaians is about 56 years. Readers when you take your minds back will remember people dying off in their 40s and 50s in Ghana. When we discuss the epidemiology of throat cancer we are aware that it affects those aged 60-65 years plus. Thus in Ghana those heavy smokers or drinkers who could have developed lung cancer in their 60s have been dead long ago (15-20 years ago). They had died from what we call “competing causes” (motor vehicle accident, malaria, TB, HIVAIDS, typhoid fever, cholera, some chronic diseases, and other conditions which were not amenable to medical intervention). Those aged 60 and above are survivors and only few will develop throat cancer. That is why Ghanaians are not likely to see their counterparts die from diseases that afflict people in their 80s in the western world because the percentage of Ghanaians who live to age 80 may be less than 0.5% of the population. Thus to conclude that because we don’t have a battalion of previous heavy smokers and drinkers afflicted with throat cancer trooping to Korle Bu, 37 Military, or Komfo Anokye hospitals for treatment means the President’s alleged throat cancer is caused through homosexual activity is tantamount to rats coming out sewer. How debased can we go to score political points.

As to the threat of lawsuit by Mr. Ato Ahwoi when he was accused of homosexuality by an NPP youth activist, does the NPP-USA rather prefer the activist being arrested? Mr Ahwoi is a private citizen and can seek relief from the legal system. Is NPP-USA worried. If i were them I would be happy because it would give NPP the chance to cross examine Mr. Ahwoi and show evidence of his homosexuality with the President. You should rather be happy because Mr. Ato Ahwoi is opening himself up and you can show evidence of his homosexuality with the President. Why use Mr. Ahwoi’s rapid response threat of seeking legal redress as confirmation of his homosexuality.
In conclusion, political chicanery and sophistry should be confined to politics. However, in the realms of science, especially health-related matters we cannot play politics especially if we are not adept with the facts and hence resort to manipulate it to suit our whims and caprices. Thus people will read the distortions and think they are gospel. Any wonder my grandpa in Agbozume used to tell me that half education is dangerous and can blind people from seeking the truth. NPP-USA next time do some research before wading into deeper waters of issues you know little about or at best contact an expert.

The writer has a doctorate in Epidemiology and has interests in public health, political economy, and political strategy. He can be reached via email on masallar@hotmail.com


References
1. CDC, 2011 (www.cdc.gov)

2. D'Souza G, Kreimer AR, Viscidi R, et al. Case-control study of human papillomavirus and oropharyngeal cancer. New England Journal of Medicine 2007; 356(19):1944–1956.

3. Mayo Foundation for Medical Education and Research (MFMER) ©1998-2011
4. Parkin DM. The global health burden of infection-associated cancers in the year 2002. International Journal of Cancer 2006; 118(12):3030–3044.