A claim by an oncologist linking Kerala’s high cancer incidence to beef curry and parotta consumption has sparked debate online, with another medical expert invoking “Simpson’s Paradox” to challenge the interpretation of the data.
Dr Rajeev Vijayakumar, Senior Consultant Medical Oncologist, said in a recent podcast discussion that cancer is often caused by red meat consumption and alleged that Kerala leads India in cancer incidence per capita because of dietary habits such as beef curry and parotta consumption.
Citing global health classifications, he said processed meat is classified as carcinogenic to humans (Group 1), while unprocessed red meat is classified as probably carcinogenic (Group 2A) for colorectal cancer, according to the World Health Organization (WHO). The classification is based on evaluations by the International Agency for Research on Cancer (IARC), which reviewed over 800 epidemiological studies.
Remarks go viral, hepatologist pushes back
The remarks quickly went viral, reigniting discussions on food habits and cancer risk.
Hepatologist Cyriac Abby Philips, who is popular online as ‘TheLiverDoc’, responds, citing ‘Simpson’s Paradox’
Responding to the viral reel on X, a hepatologist and medical educator posted a detailed rebuttal, arguing that the oncologist’s conclusion reflects a misunderstanding of epidemiological principles.
Sharing a long post, he wrote, “Hello Tuluva Techie with zero critical thinking skills. This is a frequently cited statistic that often gets misinterpreted as ‘Kerala has the worst cancer problem.’ It is not like that. Yours and that useless man Rajeev’s (who calls himself an Oncologist in the reel), ignorance is known as Simpson’s Paradox Analogy. Let me explain.”
He went on to explain Simpson’s Paradox by comparing Kerala’s cancer statistics to hospitals with better ICUs that report higher death rates because they handle more severe cases. According to him, higher reported cancer incidence may reflect stronger detection systems rather than a higher underlying disease burden.
“This is a classic lesson in epidemiology: incidence is a function of both disease occurrence AND detection capacity. You must always account for the denominator and the measurement system before drawing causal conclusions,” he added.
Detection capacity and cancer registries
The hepatologist further noted that Kerala has some of India’s oldest and most comprehensive population-based cancer registries. Public health experts have often pointed out that states with weaker registry systems may underreport cases due to limited diagnostic access and lower rates of formal medical certification.
“You cannot report what you do not detect,” the hepatologist wrote, emphasising that surveillance and reporting capacity significantly influence recorded incidence rates.
He also highlighted Kerala’s higher life expectancy — estimated at around 75–77 years — which approaches levels seen in many developed countries. Since cancer risk increases with age, states where people live longer are likely to report more cases.
In contrast, regions with higher mortality from infections, maternal health issues or malnutrition may see fewer cancer cases simply because fewer individuals survive into older age groups.
Debate over red meat and cancer risk
Concluding his explanation, the post mentioned, “There is ZERO evidence to equate unprocessed red meat to cancer causation. None of the data from the WHO shows causation of unprocessed red meat use and cancer. The associated RISK is from processed/ultra-processed meats. The most common reasons for increased cancer is tobacco, alcohol, and obesity.”
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