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.

An artist's version of the Reichstag fire, which Hitler blamed on the communists. CREDIT: DEZAIN UNKIE/ ALAMY
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The art of the big lie: the history of fake news

From the Reichstag fire to Stalin’s show trials, the craft of disinformation is nothing new.

We live, we’re told, in a post-truth era. The internet has hyped up postmodern relativism, and created a kind of gullible cynicism – “nothing is true, and who cares anyway?” But the thing that exploits this mindset is what the Russians call dezinformatsiya. Disinformation – strategic deceit – isn’t new, of course. It has played a part in the battle that has raged between mass democracy and its enemies since at least the First World War.

Letting ordinary people pick governments depends on shared trust in information, and this is vulnerable to attack – not just by politicians who want to manipulate democracy, but by those on the extremes who want to destroy it. In 1924, the first Labour government faced an election. With four days to go, the Daily Mail published a secret letter in which the leading Bolshevik Grigory Zinoviev heralded the government’s treaties with the Soviets as a way to help recruit British workers for Leninism. Labour’s vote actually went up, but the Liberal share collapsed, and the Conservatives returned to power.

We still don’t know exactly who forged the “Zinoviev Letter”, even after exhaustive investigations of British and Soviet intelligence archives in the late 1990s by the then chief historian of the Foreign Office, Gill Bennett. She concluded that the most likely culprits were White Russian anti-Bolsheviks, outraged at Labour’s treaties with Moscow, probably abetted by sympathetic individuals in British intelligence. But whatever the precise provenance, the case demonstrates a principle that has been in use ever since: cultivate your lie from a germ of truth. Zinoviev and the Comintern were actively engaged in trying to stir revolution – in Germany, for example. Those who handled the letter on its journey from the forger’s desk to the front pages – MI6 officers, Foreign Office officials, Fleet Street editors – were all too ready to believe it, because it articulated their fear that mass democracy might open the door to Bolshevism.

Another phantom communist insurrection opened the way to a more ferocious use of disinformation against democracy. On the night of 27 February 1933, Germany’s new part-Nazi coalition was not yet secure in power when news started to hum around Berlin that the Reichstag was on fire. A lone left-wing Dutchman, Marinus van der Lubbe, was caught on the site and said he was solely responsible. But Hitler assumed it was a communist plot, and seized the opportunity to do what he wanted to do anyway: destroy them. The suppression of the communists was successful, but the claim it was based on rapidly collapsed. When the Comintern agent Gyorgy Dimitrov was tried for organising the fire, alongside fellow communists, he mocked the charges against him, which were dismissed for lack of evidence.

Because it involves venturing far from the truth, disinformation can slip from its authors’ control. The Nazis failed to pin blame on the communists – and then the communists pinned blame on the Nazis. Dimitrov’s comrade Willi Münzenberg swiftly organised propaganda suggesting that the fire was too convenient to be Nazi good luck. A “counter-trial” was convened in London; a volume called The Brown Book of the Reichstag Fire and Hitler Terror was rushed into print, mixing real accounts of Nazi persecution of communists – the germ of truth again – with dubious documentary evidence that they had started the fire. Unlike the Nazis’ disinformation, this version stuck, for decades.

Historians such as Richard Evans have argued that both stories about the fire were false, and it really was one man’s doing. But this case demonstrates another disinformation technique still at work today: hide your involvement behind others, as Münzenberg did with the British great and good who campaigned for the Reichstag prisoners. In the Cold War, the real source of disinformation was disguised with the help of front groups, journalistic “agents of influence”, and the trick of planting a fake story in an obscure foreign newspaper, then watching as the news agencies picked it up. (Today, you just wait for retweets.)

In power, the Nazis made much use of a fictitious plot that did, abominably, have traction: The Protocols of the Elders of Zion, a forged text first published in Russia in 1903, claimed to be a record of a secret Jewish conspiracy to take over the world – not least by means of its supposed control of everyone from bankers to revolutionaries. As Richard Evans observes, “If you subject people to a barrage of lies, in the end they’ll begin to think well maybe they’re not all true, but there must be something in it.” In Mein Kampf, Hitler argued that the “big lie” always carries credibility – an approach some see at work not only in the Nazis’ constant promotion of the Protocols but in the pretence that their Kristallnacht pogrom in 1938 was spontaneous. (It is ironic that Hitler coined the “big lie” as part of an attack on the Jews’ supposed talent for falsehood.) Today, the daring of the big lie retains its force: even if no one believes it, it makes smaller untruths less objectionable in comparison. It stuns opponents into silence.

Unlike the Nazis, the Bolshevik leaders were shaped by decades as hunted revolutionaries, dodging the Tsarist secret police, who themselves had had a hand in the confection of the Protocols. They occupied the paranoid world of life underground, governed by deceit and counter-deceit, where any friend could be an informer. By the time they finally won power, disinformation was the Bolsheviks’ natural response to the enemies they saw everywhere. And that instinct endures in Russia even now.

In a competitive field, perhaps the show trial is the Soviet exercise in upending the truth that is most instructive today. These sinister theatricals involved the defendants “confessing” their crimes with great
sincerity and detail, even if the charges were ludicrous. By 1936, Stalin felt emboldened to drag his most senior rivals through this process – starting with Grigory Zinoviev.

The show trial is disinformation at its cruellest: coercing someone falsely to condemn themselves to death, in so convincing a way that the world’s press writes it up as truth. One technique involved was perfected by the main prosecutor, Andrey Vyshinsky, who bombarded the defendants with insults such as “scum”, “mad dogs” and “excrement”. Besides intimidating the victim, this helped to distract attention from the absurdity of the charges. Barrages of invective on Twitter are still useful for smearing and silencing enemies.


The show trials were effective partly because they deftly reversed the truth. To conspire to destroy the defendants, Stalin accused them of conspiring to destroy him. He imposed impossible targets on straining Soviet factories; when accidents followed, the managers were forced to confess to “sabotage”. Like Hitler, Stalin made a point of saying the opposite of what he did. In 1936, the first year of the Great Terror, he had a rather liberal new Soviet constitution published. Many in the West chose to believe it. As with the Nazis’ “big lie”, shameless audacity is a disinformation strategy in itself. It must have been hard to accept that any regime could compel such convincing false confessions, or fake an entire constitution.

No one has quite attempted that scale of deceit in the post-truth era, but reversing the truth remains a potent trick. Just think of how Donald Trump countered the accusation that he was spreading “fake news” by making the term his own – turning the charge on his accusers, and even claiming he’d coined it.

Post-truth describes a new abandonment of the very idea of objective truth. But George Orwell was already concerned that this concept was under attack in 1946, helped along by the complacency of dictatorship-friendly Western intellectuals. “What is new in totalitarianism,” he warned in his essay “The Prevention of Literature”, “is that its doctrines are not only unchallengeable but also unstable. They have to be accepted on pain of damnation, but on the other hand they are always liable to be altered on a moment’s notice.”

A few years later, the political theorist Hannah Arendt argued that Nazis and Stalinists, each immersed in their grand conspiratorial fictions, had already reached this point in the 1930s – and that they had exploited a similar sense of alienation and confusion in ordinary people. As she wrote in her 1951 book, The Origins of Totalitarianism: “In an ever-changing, incomprehensible world the masses had reached the point where they would, at the same time, believe everything and nothing, think that everything was possible and that nothing was true.” There is a reason that sales of Arendt’s masterwork – and Orwell’s Nineteen Eighty-Four – have spiked since November 2016.

During the Cold War, as the CIA got in on the act, disinformation became less dramatic, more surreptitious. But show trials and forced confessions continued. During the Korean War, the Chinese and North Koreans induced a series of captured US airmen to confess to dropping bacteriological weapons on North Korea. One lamented that he could barely face his family after what he’d done. The pilots were brought before an International Scientific Commission, led by the eminent Cambridge scientist Joseph Needham, which investigated the charges. A documentary film, Oppose Bacteriological Warfare, was made, showing the pilots confessing and Needham’s Commission peering at spiders in the snow. But the story was fake.

The germ warfare hoax was a brilliant exercise in turning democracy’s expectations against it. Scientists’ judgements, campaigning documentary, impassioned confession – if you couldn’t believe all that, what could you believe? For the genius of disinformation is that even exposure doesn’t disable it. All it really has to do is sow doubt and confusion. The story was finally shown to be fraudulent in 1998, through documents transcribed from Soviet archives. The transcripts were authenticated by the historian Kathryn Weathersby, an expert on the archives. But as Dr Weathersby laments, “People come back and say ‘Well, yeah, but, you know, they could have done it, it could have happened.’”

There’s an insidious problem here: the same language is used to express blanket cynicism as empirical scepticism. As Arendt argued, gullibility and cynicism can become one. If opponents of democracy can destroy the very idea of shared, trusted information, they can hope to destabilise democracy itself.

But there is a glimmer of hope here too. The fusion of cynicism and gullibility can also afflict the practitioners of disinformation. The most effective lie involves some self-deception. So the show trial victims seem to have internalised the accusations against them, at least for a while, but so did their tormentors. As the historian Robert Service has written, “Stalin frequently lied to the world when he was simultaneously lying to himself.”

Democracy might be vulnerable because of its reliance on the idea of shared truth – but authoritarianism has a way of undermining itself by getting lost in its own fictions. Disinformation is not only a danger to its targets. 

Phil Tinline’s documentary “Disinformation: A User’s Guide” will be broadcast on BBC Radio 4 at 8pm, 17 March