Deepest fears: some form of cancer will affect one in three of us, yet it is not always lethal.
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Why it's time to ditch the word "cancer"

A former president of the Association of Surgeons of Great Britain and Ireland argues that the word “cancer” is unhelpful in efforts to lead patients away from quacks.

It is more than 12 years since the writer and broadcaster John Diamond wrote his cancer diary, recording all that happened to him from diagnosis to near-end. Starting as a sceptic, with a distrust of conventional medicine and its practitioners, he went on to explore the various complementary and alternative systems and concluded with his book Snake Oil and Other Preoccupations, a skilful and often very funny exposé of those who exploit vulnerable people by offering false hope.

There have been a number of accounts in the press, notably by Philip Gould, Christopher Hitchens, Iain Banks and others, who have undergone physical and mental ordeals in receiving treatment for a terminal illness. Perhaps the most poignant message came from the poet and translator James Michie, who wrote, just before he died, I used to fancy crabmeat as a treat: Now Crab’s the epicure, and I’m the meat.

These courageous and articulate people deserve our sympathy and respect but their experiences are not typical. While suffering and death are newsworthy, the stories of the thousands who are quietly cured never reach the headlines.

At this point, I should declare my credentials. During a lifetime’s work as a surgeon in the NHS, I treated many people with cancer in various parts of the body. About 30 years ago, mid-career, I was found to have a malignant tumour; my chances of surviving for five years were less than one in 20. Following chemotherapy, radiotherapy and eventually major surgery, I made a good recovery and am lucky to be able to write these words today. The experience taught me a lot and profoundly influenced my attitude to those of my patients with similar problems.

Then, many years later, I noticed a small lump beside my nose which I recognised as a basal cell carcinoma: a tumour that, left untreated, would have spread and destroyed my whole face. A colleague removed it under local anaesthetic and I have had no trouble since. In a letter to the Times in April 2011, I suggested that the practice of including these two conditions under the same emotive label of cancer (“the Crab”) was misleading and should be abandoned.

We now know a great deal about the causation and behaviour of cancer, far more than when I started my career in medicine. From the moment of conception when the sperm meets the egg, the embryo undergoes trillions of cell divisions, controlled by the code of its inherited DNA, eventually resulting in the birth of a complete human being with unique characteristics. Growth continues into adult life but is necessarily regulated and balanced by a process known as “apoptosis”, which involves cell death. Normal cells have a limited lifespan and when they have outlived their usefulness they are knocked out. Cancer cells are different, in that they are not subject to apoptosis and, having escaped from super­vision – either through a gene mutation or as a result of damage to the DNA by an aggressive chemical such as is found in tobacco smoke – they continue to multiply.

This process can be replicated in the laboratory. If you take a small sample of cells from your mouth and put them in a Petri dish with warm water and nutrients, they will continue to divide quite happily until one day you find that they have all died. In 1951, an African-American woman called Henrietta Lacks developed a growth on the cervix of her uterus. Cells cultured from her tumour did not die and, as far as I know, are dividing to this day in laboratories all over the world, providing us with a priceless means of studying the behaviour of cancerous tissues.

As cancer cells multiply in a human body, they form an expanding tumour, which compresses and damages neighbouring structures. Eventually, some of them may break off into the circulation and form colonies (metastases) in other parts of the body. 

The extent to which this happens defines the degree of malignancy of the tumour. 

Relatively benign lesions such as the one on my nose remain in the same place, whereas the one that I’d developed many years previously had the capacity to kill me, had it not been for the excellent treatment that I received from the NHS.

Today, not only do we understand how these diseases progress but we also have better means of combating them, whether by surgery, or radiotherapy, or drugs that block cell division. As a result, many tumours that were considered lethal in my day are now susceptible to treatment, if not curable. These include some forms of childhood leukaemia, Hodgkin’s lymphoma and the testicular cancer known as seminoma. We are making good progress with breast and bowel cancer and, to a lesser extent, with growths in the lungs and stomach.

Cancer is not a diagnosis. It is a label – and a misleading one at that, given the wide range of conditions that it covers. People labelled as cancer victims constitute a target group for hard-nosed entrepreneurs. An internet search for alternative cancer treatments leads to a huge range of products that are advertised as “natural ways in which to attack and kill your cancer”.

Note the use of the word “kill”, rather than “cure”. Most of these preparations do not claim to cure cancer because (in this country, at any rate) such a boast would be illegal. 

The terms “gentle”, “natural” and “without harmful chemicals or side effects” occur frequently. These advertisements are principally aimed at the terminally ill and those who have been told by their doctor that there is nothing more to be done.

These desperate people are the ones most likely to pay for alternative therapies and it is interesting to note that though there is plenty of advice on dosage (start with three bottles a day and increase as necessary, for example), there is no mention of price. The ugly little dollar sign appears only once an order has been placed.

Dr Stanislaw Burzynski of Houston, Texas, attracts desperate people from all over the world to his multimillion-dollar cancer clinic. His methods employ a group of substances that he identified and named “antineoplastons”, which are concocted from a mixture of amino acids found in urine. Some people have experienced a remission, albeit temporary, and their cases are backed up by enthusiastic endorsements from grateful relatives. However, although there have been many requests for a controlled trial, none has ever been conducted in a form acceptable to mainstream scientists and it is impossible to know how often these treatments result in failure.

Neighbouring clinics in Houston spend much time and money in caring for Bur­zynski’s former patients before they finally expire. Although his methods have been repeatedly criticised in the scientific literature, there seems to be no means of stopping him pursuing these questionable activities. He would be a comical figure – a kind of Donald Duck with a stethoscope – except that the life events in which he trades are pain, tragedy and bereavement.

We need to demystify the problem. Cancer is ordinary; it is normal; it affects all of us indirectly and one in three of us will get it. To treat it as a sort of fairy-tale giant to be fought and conquered is to fuel unnecessary fear. The journalist Matt Ridley wrote in the Times in June: “Cancer fights hard. We must be bold to beat it.” Yet what we need is not boldness but patient, objective, scientific study, building theories on the known facts, testing them and rejecting those that do not work.

According to members of the US National Cancer Institute, writing in the Journal of the American Medical Association this summer, the term cancer “invokes the spectre of an inexorably lethal process; however, cancers are heterogeneous and can follow multiple paths, not all of which progress to metastases and death, and include indolent disease that causes no harm during the patient’s lifetime”. The group urges that the word be used to describe only “lesions with a reasonable likelihood of lethal progression if left untreated”; pre-malignant conditions should not be labelled as cancers or neoplasia, nor should the word “cancer” feature in the condition’s name, it argued.

We badly need a new expression to replace an obsolete and misleading term. I suggest “dDNA” (damaged DNA), which, after all, does reflect what is going on. When people ask their doctor the question, “Have I or have I not got cancer?” they expect a straight answer, but the question is not straight.

A response might be: “We don’t use that word any more. What we do say is that you have a dDNA problem, which includes all sorts of tumours, some of them very dangerous and others much less so. In your case, we need to do further tests and investigations, at the end of which we will be able to get together and form a plan of action to put you right.”

Adrian Marston is a former president of the Association of Surgeons of Great Britain and Ireland. He published his first article for the New Statesman, on Portuguese politics, as a 20-year-old medical student in 1948. This is his second article.

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When it comes to responding to Islamic State, there is no middle ground

If Britain has a declared interest in curtailing Islamic State and stabilising Syria, it is neither honourable nor viable to let others intervene on our behalf.

Even before the brutal terrorist attacks in Paris, British foreign policy was approaching a crossroads. Now it is time, in the words of Barack Obama, addressing his fellow leaders at the G20 Summit in Turkey on 16 November, “to step up with the resources that this fight demands”, or stand down.

The jihadist threat metastasises, and international order continues to unravel at an alarming rate. A Russian civilian charter plane is blown out of the sky over the Sinai Peninsula in Egypt, killing 224 people, most of them returning from holiday, and the various offshoots of Islamic State bare their teeth in a succession of brutal attacks in France, Lebanon, Tunisia, Turkey and further afield. Our enemies are emboldened and our friends want to know to what extent we stand with them. The UK can no longer afford to postpone decisions that it has evaded since the Commons vote of August 2013, in which the government was defeated over the question of joining US-led air strikes against President Bashar al-Assad’s regime following a chemical weapons attack on Syrian civilians. MPs’ continued introspection is on the verge of becoming both irresponsible and morally questionable. There is no fence left to sit on.

On Sunday night, two days after the Paris attacks, the French – with US support – launched a series of bombing raids against Islamic State targets in Raqqa. With much more to come, the choice facing this country may not be easier but it is certainly clearer. Britain must determine whether it wants to be a viable and genuine partner in the fight against Islamic State, and in the long-term efforts to bring an end to the assorted evils of the Syrian civil war; or whether we are content to sit on the sidelines and cheer on former team-mates without getting our knees dirty. We can join our two most important allies – France and the United States, at the head of a coalition involving a number of Arab and other European states – in confronting a threat that potentially is as grave to us as it is to France, and certainly more dangerous than it is to the US. Alternatively, we can gamble that others will do the work for us, keep our borders tighter than ever, double down on surveillance (because that will certainly be one of the prices to pay) and hope that the Channel and the security services keep us comparatively safe. There is no fantasy middle ground, where we can shirk our share of the burden on the security front while leading the rest of the world in some sort of diplomatic breakthrough in Syria; or win a reprieve from the jihadists for staying out of Syria (yet hit them in Iraq), through our benevolence in opening the door to tens of thousands of refugees, or by distancing ourselves from the ills of Western foreign policy.

That the international community – or what is left of it – has not got its act together on Syria over the past three years has afforded Britain some space to indulge its scruples. Nonetheless, even before the Paris attacks, the matter was coming to the boil again. A vote on the expansion of air operations against Islamic State has been mooted since the start of this year, but was put on the back burner because of the May general election. The government has treated parliament with caution since its much-discussed defeat in the House in summer 2013. The existing policy – of supporting coalition air strikes against Islamic State in Iraq but not Syria – is itself an outgrowth of an awkward compromise between David Cameron and Ed Miliband, an attempt to reverse some of the damage done by the 2013 vote in parliament.

The Conservatives have waited to see where the ground lies in a Jeremy Corbyn-led Labour Party before attempting to take the issue back before the Commons. Labour pleaded for more time when Corbyn was elected, but there is no sign that the Labour leader is willing to shift in his hostility to any form of intervention. More significantly, he has now ruled out Labour holding a free vote on the matter.

If anything, the coalition of Little Englanders, anti-interventionists and anti-Americans in the House of Commons seems to have dug its trenches deeper. This leaves the Prime Minister with few options. One is to use the Royal Prerogative to announce that an ally has been attacked, and that we will stand with her in joining attacks against Islamic State in Syria. The moment for this has probably already passed, though the prerogative might still be invoked if Isis scores a direct hit against the UK. Yet even then, there would be problems with this line. A striking aspect of the killing of 30 Britons in the June attacks in Sousse, Tunisia, is just how little domestic political impact it seems to have made.

Another option for Cameron is to try to make one final effort to win a parliamentary majority, but this is something that Tory whips are not confident of achieving. The most likely scenario is that he will be forced to accept a further loss of the UK’s leverage and its standing among allies. Co-operation will certainly come on the intelligence front but this is nothing new. Meanwhile, the government will be forced to dress up its position in as much grand diplomatic verbiage as possible, to obfuscate the reality of the UK’s diminishing influence.

Already, speaking at the G20 Summit, the Prime Minister emphasised the need to show MPs a “whole plan for the future of Syria, the future of the region, because it is perfectly right to say that a few extra bombs and missiles won’t transform the situation”. In principle, it is hard to argue with this. But no such plan will emerge in the short term. The insistence that Assad must go may be right but it is the equivalent of ordering the bill at a restaurant before you have taken your seat. In practice, it means subcontracting out British national security to allies (such as the US, France and Australia) who are growing tired of our inability to pull our weight, and false friends or enemies (such as Russia and Iran), who have their own interests in Syria which do not necessarily converge with our own.

One feature of the 2013 Syria vote was the government’s failure to do the required groundwork in building a parliamentary consensus. Whips have spent the summer scouting the ground but to no avail. “The Labour Party is a different organisation to that which we faced before the summer,” Philip Hammond, the Foreign Secretary, has said. It is ironic, then, that the Prime Minister has faced strongest criticism from the Labour benches. “Everyone wants to see nations planning for increased stability in the region beyond the military defeat of the extremists,” says John Woodcock, the chairman of the Parliamentary Labour Party defence committee, “but after two years of pussy-footing around, this just smacks of David Cameron playing for time when he should be showing leadership.”

The real story is not the distance between the two front benches but the divisions within both parties. There are as many as 30 Conservative MPs said to be willing to rebel if parliament is asked to vote for joining the coalition against Islamic State in Syria. It seems that the scale of the Paris attacks has not changed their position. A larger split in the Labour ranks also seems likely. Even before Paris, there were rumoured to be roughly 50 MPs ready to defy their leader on this question.


At first, in the wake of last week’s attacks, it seemed as if the Prime Minister might force the issue. To this end, he began the G20 in Turkey with a bilateral meeting with President Putin. His carefully chosen words before and after that discussion, in which he was much more emollient about Moscow’s role, showed the extent to which he was prepared to adapt to the changing situation. Cameron hoped that if he could show progress in building an international coalition on the diplomatic front, that might just give him enough to get over the line in a parliamentary vote.

This new approach has not had the desired effect. At the time of writing, the government believes it is too risky to call another vote in the short term. It calculates another defeat would hugely diminish Britain’s standing in the world. In truth, the government was already swimming upstream. On 29 October, the Conservative-
dominated Commons foreign affairs select committee, chaired by Crispin Blunt, released a report on the extension of British military operations into Syria, in anticipation of government bringing forward a parliamentary vote on the question. The report recommended that Britain should avoid further involvement unless a series of questions could be answered about exit strategy and long-term goals. The bar was set deliberately high, to guard against any further involvement (even the limited option of joining the existing coalition undertaking air strikes against IS in Syria).

The most flimsy of the five objections to further intervention in the report was that it will somehow diminish the UK’s leverage as an impartial arbiter and potential peacemaker. This is based on an absurd overestimation of the UK as some sort of soft-power saviour, valued by all parties for its impartiality in Middle Eastern affairs. Britain cannot hope to have any influence on policy if it is always last to sign up while others put their lives on the line. As so often in the past, what masquerades as tough-minded “realpolitik” is nothing of the sort. It is just another post-facto rationale for inaction.

Although it is sometimes said that Britain has yet to recover from the consequences of the invasion of Iraq, the committee report had a retro, 1990s feel. Many of the objections raised to burden-sharing in Syria were the same as those raised against humanitarian intervention in the Balkans two decades ago, when Blunt was working as special adviser to Michael Rifkind as defence and foreign secretary, and the UK was at the forefront of non-intervention. Likewise, two of the committee’s Labour members, Ann Clwyd and Mike Gapes, were veterans of the other side of that debate, and strong supporters of the Nato intervention in Kosovo in 1999. They expressed their dissent from the report’s conclusions but were voted down by their Conservative and SNP fellow committee members. “Non-intervention also has consequences,” said Gapes when he broke rank. “We should not be washing our hands and saying, ‘It’s too difficult.’”

Polling figures have shown majority public support for air strikes against IS since the spate of gruesome public executions that began last year, but nothing seems to change the calculus of the rump of anti-interventionist MPs.

All this promises an uncertain future for British foreign policy. On 6 November, the Defence Secretary, Michael Fallon, suggested that the UK’s existing position, of joining the coalition in Iraq but stopping at the borders of Syria, is “morally indefensible”. The killing of Mohammed Emwazi, aka “Jihadi John”, by a US predator drone on 12 November demonstrates what he meant. Emwazi was a Briton who was responsible for the beheading of British and American citizens, as well as countless Syrians. While the UK government was closely involved in that operation – and has previously used the justification of “self-defence” to “take out” targets in Syria – such are the restrictions placed upon it that we are forced to ask our allies to conduct potentially lethal operations (which are in our core national interests) on our behalf. The very act of “self-defence” is subcontracted out once again.

How long can this last when Islamic State poses a much greater threat to the UK than it does to the US? There is an issue of responsibility, too, with hundreds of British citizens fighting for and with Islamic State who clearly pose a grave danger to other states.


The very notion that Britain should play an expansive international role is under attack from a pincer movement from both the left and the right. There are two forms of “Little Englanderism” that have made a resurgence in recent years. On the left, this is apparent in the outgrowth of a world-view that sees no role for the military, and holds that the UK is more often than not on the wrong side in matters of international security, whether its opponent is Russia, Iran, the IRA or Islamic State. The second, and arguably just as influential, is the Little Englanderism of the right, which encompasses a rump of Tory backbenchers and Ukip. This is a form of neo-mercantilism, a foreign policy based on trade deals and the free movement of goods that regards multilateralism, international institutions and any foreign military intervention with great suspicion, as a costly distraction from the business of filling our pockets.

The time is ripe for long-term, hard-headed and unsentimental thinking about Britain’s global role. The country is not served well by the impression of British “decline” and “retreat” that has gained ground in recent times; and it is no safer for it, either. Given how quickly the security and foreign policy environment is changing, the publication of the Strategic Defence and Security Review in the coming week, alongside an update of the National Security Strategy, is likely to raise more questions than it answers. The officials responsible for its drafting do not have an easy brief, and news forecasting is a thankless task. Strategic vision and leadership must come from our elected politicians.

For all the talk of British decline, we are still one of the five wealthiest nations in the world. What we do matters, particularly at moments when our friends are under attack. However, until a new broad consensus emerges between the mainstream Labour and Conservative positions on foreign policy, the Little England coalition will continue to have the casting vote.

Syria continues to bleed profusely and the blood seeps deeper into different countries. There will be no political solution to the civil war there for the foreseeable future; to pretend that there is a hidden diplomatic solution is to wish to turn the clock back to 2011, when that might have been possible. Nor is the security situation any easier to deal with. A few hours before the attacks in Paris began, President Obama gave an interview in which he argued that he had successfully “contained” Islamic State. For the wider Middle East and Europe, that is simply not the case. Now, France will escalate its campaign, and the US will do more. Russia already has troops on the ground and will most likely send reinforcements.

The war in Syria is becoming more complicated and even more dangerous. The best that can be hoped for is that the Syrian ulcer can be cauterised. This will be achieved through the blunting of Islamic State, simultaneous pressure on Assad, and the creation of more safe places for Syrians. All roads are littered with difficulties and dangers. Yet, in the face of this ugly reality, is Britain to signal its intention to do less as every other major actor – friend and foe alike – does more? If we have a declared national interest in curtailing Islamic State and stabilising Syria – both because of the growing terrorist threat and because of the huge flow of refugees – then it is neither honourable nor viable to let others take care of it on our behalf.

John Bew is an NS contributing writer. His new book, “Realpolitik: a History”, is newly published by Oxford University Press

This article first appeared in the 19 November 2015 issue of the New Statesman, The age of terror