Deepest fears: some form of cancer will affect one in three of us, yet it is not always lethal.
Show Hide image

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.

André Carrilho
Show Hide image

"Jeremy knows he can't do the job." What now for Labour and Britain's opposition?

Senior figures from all parties discuss the way forward: a new Labour leader, a new party or something else?

In the week beginning 13 March 2017, the Scottish National Party demanded a second referendum on indepen­dence, the Chancellor tore up his Budget and George Osborne was announced as the next editor of the London Evening Standard. One fact united these seemingly disparate events: the weakness of Her Majesty’s Opposition.

When Scotland’s First Minister, Nicola Sturgeon, addressed journalists at Bute House, her Edinburgh residence, she observed that Labour’s collapse entailed an extended period of Conservative rule. Such was the apparent truth of this statement that it went unchallenged.

Twenty minutes before Prime Minister’s Questions on 15 March, the Conservatives announced the abandonment of their planned rise in National Insurance for the self-employed. Their expectation that Jeremy Corbyn would be unable to profit was fulfilled. “Faced with an open goal, Jeremy picked up a tennis racket,” one Labour MP lamented of his leader’s performance. Rather than a threat, the government regards PMQs as an opportunity.

Two days later, Osborne was announced as the next editor of the Standard. “Frankly @George_Osborne will provide more effective opposition to the government than the current Labour Party,” the paper’s co-proprietor Evgeny Lebedev tweeted. His decision to hand the post to a Conservative MP was another mark of Labour’s marginalisation. In more politically competitive times, owners are warier of overt partisanship.

The Tories have a parliamentary majority of just 15 – the smallest of any single-party government since 1974 – but they enjoy a dominance out of all proportion to this figure. Nick Clegg, the Liberal Democrat former deputy prime minister, told me: “The fundamental pendulum swing of democracy, namely that the people in power are always worried that the other lot are going to hoof them out, has stopped.”

Labour is hardly a stranger to opposition: the party governed for just 20 years of the 20th century. But never in postwar history has it appeared so feeble. By-elections are usually relished by oppositions and feared by governments. But in Copeland in the north-west of England, a seat that had not returned a Conservative since 1931, the Tories triumphed over Labour. In recent polling the governing party has led by as much as 19 points and on one occasion it was leading in every age group, every social class and every region.

Corbyn’s MPs fear that were he to lead Labour into a general election, the attack dossier assembled by the Conservatives would push support as low as 20 per cent.

When David Miliband recently said that Labour was “further from power than at any stage in my lifetime”, he was being far too generous. After the forthcoming boundary changes, it could be left with as few as 150 seats: its worst performance since 1935.

The party’s plight was both predictable and predicted – the inevitable consequence of electing a leader who, by his own admission, lacked the requisite skills. “Now we made to make sure I don’t win,” Corbyn told supporters after he made the ballot in 2015. The lifelong backbencher stood with the intention of leading debate, not leading the party.

Neil Kinnock, Labour’s leader from 1983 to 1992, told me: “From the outset, I said that Jeremy [Corbyn] just can’t do the job . . . Now I think he knows that. He’s been a member of parliament for 34 years and will have a sense of self-examination. Both he and the people who work around him know that he just can’t do the job.”

Morale in the leader’s office has seldom been lower. “They’ve got the yips,” a Lab­our aide told me. Shortly after the Tories’ Budget U-turn, Corbyn’s director of strategy and communications, Seumas Milne, asked journalists whether there would be an early general election. He produced no evidence of any hope that Labour could win it.

Yet Corbyn’s leadership alone does not explain the crisis. In the early 1980s, when Labour was similarly enfeebled (but still strong in Scotland, unlike today), the creation of the Social Democratic Party provided hope. But the mere 23 seats won by the SDP-Liberal Alliance in 1983 (on 25.4 per cent of the vote, against Labour’s 209 seats from 27.6 per cent) acts as a permanent warning to those tempted to split.

With only nine MPs, the Liberal Democrats are too weak to function as an alternative opposition, despite their accelerating recovery. The third-largest party in the House of Commons – the SNP – is an exclusively Scottish force. The hegemony of the Nats, which cost Labour 40 seats in Scotland in 2015, has encouraged forecasts of perpetual Tory rule. “I don’t think there’s any way the Labour Party in this day and age can beat the Conservatives south of the border,” Clegg said.

To many eyes, the UK is being transformed into two one-party states: an SNP-led Scotland and a Conservative-led England. “The right-wing press have coalesced around Brexit and have transformed themselves from competitors into, in effect, a political cabal, which has such a paralysing effect on the political debate,” Clegg said. “You have a consistent and homogeneous drumbeat from the Telegraph, the Express, the Mail, the Sun, and so on.”

In this new era, the greatest influence on the government is being exercised from within the Conservative Party. “Where’s the aggravation? Where’s the heat coming from? Eighty hardline Brexiteers,” Anna Soubry, the pro-European former Conservative minister, told me. “They’re a party within a party and they are calling the shots. So where else is [May’s] heat? Fifteen Conservatives – people like me and the rest of them now. So who’s winning out there?”

Soubry added: “The right wing of the party flex their muscle against the only lead Remainer in the cabinet, Philip Hammond, for no other reason than to see him off. And that’s what they’ll do. They’ll pick them off one by one. These people are ruthless, this is their life’s work, and nobody and nothing is going to get in their way.”

Theresa May’s decision to pursue a “hard Brexit” – withdrawal from the EU single market and the customs union – is partly a policy choice; there is probably no other means by which the UK can secure significant control over European immigration. But the Prime Minister’s course is also a political choice. She recognised that the Conservatives’ formidable pro-Leave faction, whose trust she had to earn, as a Remainer, would accept nothing less.

***

The UK is entering the most complex negotiations it has undertaken since the end of the Second World War with the weakest opposition in living memory. Though some Tories relish an era of prolonged one-party rule, others are troubled by the democratic implications. Neil Carmichael MP, the chair of the Conservative Group for Europe, cited Disraeli’s warning: “No government can be long secure without a formidable opposition.” It was in Margaret Thatcher’s and Tony Blair’s pomp that calamitous decisions such as the poll tax and the invasion of Iraq were made. Governments that do not fear defeat frequently become their own worst enemy and, in turn, the public’s. The UK, with its unwritten constitution, its unelected upper chamber and its majoritarian voting system, is permanently vulnerable to elective dictatorships.

As they gasp at Labour’s self-destruction, politicians are assailed by Lenin’s question: “What is to be done?” Despite the baleful precedent of the SDP, some advocate a new split. In favour of following this path, they cite an increasingly promiscuous electorate, a pool of willing donors and “the 48 per cent” who voted Remain. Emmanuel Macron – the favourite to be elected president of France in May, who founded his own political movement, En Marche! – is another inspiration.

A week after the EU referendum, the Liberal Democrat leader, Tim Farron, was taken by surprise when a close ally of George Osborne approached him and suggested the creation of a new centrist party called “the Democrats” (the then chancellor had already pitched the idea to Labour MPs). “I’m all ears and I’m very positive about working with people in other parties,” Farron told me. But he said that the “most effective thing” he could do was to rebuild the Liberal Democrats.

When we spoke, Nick Clegg emphasised that “you’ve got to start with the ideas” but, strikingly, he did not dismiss the possibility of a new party. “You can have all sorts of endless, as I say, political parlour game discussions about whether you have different constellations or otherwise.”

Anna Soubry was still more positive about a new party, arguing: “If it could somehow be the voice of a moderate, sensible, forward-thinking, visionary middle way, with open minds – actually things which I’ve believed in all my life – better get on with it.”

However, Labour MPs have no desire to accept that the left’s supremacy is irreversible. But neither do they wish to challenge Corbyn. An MP distilled the new approach: “There is a strategy to give Jeremy [Corbyn] enough rope to hang himself. So it has not been about popping up in the media and criticising him in the way that colleagues did a year or so ago.” By giving him the space to fail on his own terms, rather than triggering another leadership contest, MPs hope that members will ultimately accept a change of direction.

Corbyn’s opponents acknowledge the risks of this approach.

“People are incredibly mindful of the fact that our brand is toxifying,” one told me. “As each day goes by, our plight worsens. Our position in the polls gets worse and the road back gets longer.”

Shadow cabinet ministers believe that Corbyn’s allies will never permit his departure until there is a viable successor. An increasingly influential figure is Karie Murphy, the director of the leader’s office and a close friend of Unite’s general secretary, Len McCluskey. “She’s holding Jeremy in place,” I was told.

Leadership candidates require nominations from 15 per cent of Labour MPs and MEPs, a threshold that the left aims to reduce to just 5 per cent through the “McDonnell amendment” (named after the shadow chancellor, who failed to make ballot when he stood in 2007 and 2010).

Should the rule change pass at this year’s party conference – an unlikely result – the next leadership contest could feature as many as 19 candidates. Labour has no shortage of aspirant leaders: Yvette Cooper, Dan Jarvis, Clive Lewis, Lisa Nandy, Keir Starmer, Emily Thornberry, Chuka Umunna. (Rebecca Long-Bailey, the shadow business secretary and Corbynite choice, is said to believe she is “not ready” for the job.)

All are clear-sighted enough to recognise that Labour’s problems would not end with Corbyn’s departure (nor did they begin with his election as leader). The party must restore its economic credibility, recover in Scotland, or perform far better in England, and bridge the divide between liberal Remainers and conservative Leavers.

Lisa Nandy, one of those who has thought most deeply about Labour’s predicament, told me: “I do think that, for many people, not being able to have time with their families and feel secure about where the next wage packet is coming from, and hope that life is going to get better for their kids, is really pressing as a political priority now. They will vote for the political party that offers real solutions to those things.

“That’s why power is such an important unifying agenda for the Labour Party – not just through redistribution of wealth, which I think we all agree about, but actually the redistribution of power as well: giving people the tools that they need to exert control over the things that matter in their own lives,” she says.

But some Labour MPs suggest even more drastic remedial action is required. “In order to convince the public that you’ve moved on, you have to have a Clause Four-type moment,” one member told me. “Which would probably involve kicking John McDonnell out of the Labour Party or something like that.

“You have a purge. Ken Livingstone gone, maybe even Jeremy [Corbyn] gone. That’s the only way that you can persuade the public that you’re not like that.”

Political commentators often mistake cyclical developments for structural changes. After Labour’s 1992 election defeat it was sometimes said that the party would never govern again. It went on to win three successive terms for the first time in its history. In March 2005 Geoffrey Wheatcroft published his book The Strange Death of Tory England. Less than nine months later, the Conservatives elected David Cameron as leader and returned to winning ways. As the US political journalist Sean Trende has archly observed, if even the Democrats recovered “rather quickly from losing the Civil War” few defeats are unsurvivable.

From despair may spring opportunity. “It is amazing how this Brexit-Trump phase has really mobilised interest in politics,” Nick Clegg said. “It’s galvanised a lot of people . . . That will lead somewhere. If in a democracy there is a lot of energy about, it will find an outlet.”

Editor’s Note, 30 March 2017: Len McCluskey of Unite wishes to point out that Karie Murphy is his close friend not his partner as the piece originally said. The text has been amended accordingly.

George Eaton is political editor of the New Statesman.

This article first appeared in the 30 March 2017 issue of the New Statesman, Wanted: an opposition