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Why do we use aggressive language concerning health and disease in general, but cancer in particular?
‘A Pacifist’s Guide to the War on Cancer’ by Bryony Kimmings and Brian Lobel (book) with Tom Parkinson (music) is not a brand-new piece of theatre, any more, with performances in Great Britain starting in 2016 (National Theatre, London) and in Australia (2018).
According to the critics’ view of ‘The Guardian’ (Canberra) and ‘The Canberra Times’ in spring 2018, the latest version of this ‘guide’ had somewhat changed in character from an originally downright musical to a more serious drama dealing with questions of life and death, of health and disease represented by cancer, and, finally, how people who have just turned into patients by the diagnosis can or do react. How do their colleagues in business, how do their friends and relatives behave when confronted with this information?
But the show goes further. It ‘examines the language that surrounds cancer which is often masculine, hostile, war-like, and focused on the frontline. Why, it asks, do we ‘fight’ cancer? Why is it a ‘battle’ that is won or lost? Why is someone ‘brave’ just because they have a disease, which they didn’t ask for and can’t control?’, Clarissa Sebag-Montefiore asked in ‘The Guardian’ (Canberra).
The British critic Mark Shenton wrote after the first night at London’s ‘National’: ‘This show calls itself ‘an all-singing, all-dancing celebration of ordinary life and death,’ but there’s nothing ordinary about it: it’s an extraordinary, sometimes weird, but wonderful portrait of cancer, and its diagnosis and treatment, in all its terror and everyday mundanity, too.’
Medicine’s language: a mirror of belligerence?
Having a closer look into this matter, language and medicine/science happen to use belligerent wording quite often. Many of us have read Paul de Kruif’s world famous book ‘Microbe Hunters’ (1926). Aaron Klug and Charles Weissmann later confessed they had been inspired by de Kruif’s—a microbiologist by training—work.
A hunter looks out for game to shoot. Death is at the end of hunting. Microbiologists have always been more keen on living (bacterial) cells in research and doing their daily business. Anyway, Paul de Kruif chose this wording, while he could also have named his book ‘Detectives in Search for Microbes’ or something more peaceful.
With cancer, this imagined hunter’s aiming and shooting can easily be associated with Paul Ehrlich’s ‘magic bullet’, a phrase the Nobel Prize Laureate of 1908 used the same year during the Harban Lecture in London: ‘In chemistry we need to learn how to target our aims,’ he said. Ehrlich primarily thought of antibodies.
But at that time the search for methods to stain cells and microbes as well as looking for chemotherapeutics against infections (derived from synthetic dyes from industry and nothing very ‘targeted’) was much more successful than the search for ‘magic bullets’.
Yet, this hunter-like and military-like choice of wording has persisted in medicine through decades starting at a time when doctors and scientists were usually men and hierarchies in medicine resembled more army ranks than civil life, which—unfortunately—persisted in some countries until the 1990s.
Expectations of society and media fulfilled
Media always love drama: it is the patient in critical condition who ‘fights’ to escape death which tries to get a final hold of his potential victim. The doctors are portrayed as ‘brave hearts’ who ‘combine forces’ against the evil. And cancer represents the ultimate evil to be fought—no surrender of the beleaguered which would only mean ‘defeat’ in a lost battle.
A pacifist’s standpoint would result in a sober and more adequate view: wars never end in final victory. US President Richard Nixon’s ‘War on Cancer’ initiative launched in January 1971 foresaw extra funds of then US$100 million to the National Cancer Institute to ‘find a cure for cancer’ and conquer ‘this dreadful disease’. This has admittedly helped basic and clinical science—but the challenge continues, while other ‘wars’ (eg, the ‘War on Drugs’) totally failed in accomplishing the aims they had been started for. In fact, the choice of words like ‘War on Cancer’ or ‘War on Drugs’ represents slogans of political propaganda rather than to be of medical or scientific relevance, where efforts to understand and cure a particular malignant disease are something very different. These efforts advance step by step and seldom claim victory, but have provided important progress in various forms of cancer.
What about the patients—do they need to fight a battle against something that grows out of their own cells? In Canberra, Lara Veitch was one of the actors in ‘A Pacifist’s Guide to the War on Cancer’. Lara is not a professional actress, and suffers from Li-Fraumeni syndrome. On stage, she told the audience that her mother, grandmother and great-grandmother had died from consequences of this genetic disorder, and she herself had survived cancer six times already—with double mastectomy and many diagnostic and therapeutic procedures to keep the disease under control.
What is the optimal concept in wording for patients with cancer—is it belligerent ‘propaganda’ or a pacifist’s attitude? Or do they not care about wording when life is at stake? And does society at large not give in to simplistic public views and expectations addressing cancer inadequately?
Whatever it might be, medicine, media and public should be careful in choosing their words, particularly in oncology.
Contributors WW is the sole author.
Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.
Competing interests None declared.
Patient consent Not required.
Provenance and peer review Commissioned; internally peer reviewed.
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