Cancer & Terrorism a Simulation
Thanks to Dr. David L. Katz, MD, MPH, FACPM, FACP, FACLM
Dec 30, 2015
Terrorism is commonly, and aptly, I think, compared to cancer. Generally, however, those making the association fail to follow where the logic of it leads, and even insinuate the merit of bravado belied by it. That’s my proposition to you here; let’s explore, to the limits of its validity, this oft-invoked resemblance.
I recognize that neither cancer nor terrorism may seem opportune grist for the New Year mill, when thoughts turn first on revelry, then resolution, perhaps redemption, and most notably the reveries of hope. But I believe that where the resemblances of the two commingle, there is indeed an uplifting message, and lessons for more enlightened action across the full expanse from war, to love, entirely concordant with just such reveries. Suspend disbelief accordingly if amenable, and stick with me.
Cancer is to some extent a native disposition of cells in their multitudes, subject to mutation at varying rates. This notion was rather exaggerated at us a year ago, when headlines told of the primacy of random factors. This year, we received the corrective, opposing reaction, in a study asserting the importance of factors we ostensibly control. We are left knowing what we have long known, that we and our circumstances have considerable influence over our oncological destiny, but never perfect control.
Terrorism, too, is to some extent a native disposition of people in their multitudes, subject to radicalism at varying rates, prone to primal impulses of tribalism, xenophobia, and territoriality.
In both cases, that native rate is deterred or accelerated by the balance of exposures, salutary or seditious. In the case of cells, the salutary exposures are products of lifestyle and environment: diet, sleep, and exercise; air, water, and shelter. The noxious exposures are toxins, from tobacco to pathogens to pollution, degraded environments, all manner of duress, and the many adulterations of diet. In the case of people, radicalism is fomented by destitution, privation, hopelessness, helplessness, and the insularity of echo chambers. Such forces are opposed by opportunity, self-actualization, kindness, security, equity, education, and the unimpeded flow of competing ideas.
Viewed with an eye for such resemblances, the feigned heroics of hawkish political aspirants and impetuous demagogues reveal themselves readily for what they are: boastful, bellicose nonsense. Just substitute “cancer” for “terrorism” and see for yourself. We will carpet bomb your tumor back to the Stone Age! We will blast your cancer until your skin glows in the dark!
This is absurd bombast unheard in the halls of medicine. An excess of brutality may cure the disease, but kill the patient. Unrestrained aggression may recruit more rogue cells to mutation and mayhem than it dispatches from them.
Cancer, of course, invades our bodies; terrorism, the body politic. But for the divergence of this provenance, the analogy is remarkably robust. It cannot be invoked so blithely, without respect for its implications.
Those implications point both ways, to the limits of love and war. They argue for restraint and cautious respect for the costs of collateral damage. But they argue as well for sufficient force to do the essential.
Perfect cannot be the enemy of good. At times, in the absence of good options, even good cannot be the enemy of the best we can manage. It is when the best possible care is neglected that cancer is most prone to spread throughout the body. It is when good people do nothing, or far too little, that evil is apt to prevail in the world- and the cancer of terrorism to metastasize throughout the body politic.
Our President is among the many to tell us terrorism is cancer. As a physician, I am merely following where that leads.
There is a spectrum of appropriate responses to cancer. Active surveillance, in the form of cancer screening, is a first defense, allowing at times for prevention. When cancer is established, but isolated and prone to indolence- we may merely monitor it closely. Cancer has taught us to be wary of unnecessary “cures,” worse than the natural history of the untreated disease.
When injurious to surrounding tissue, and threatening more of the same, however, cancer demands a harsh, if localized reprisal. If resurgent thereafter, invading locally, or propagating distally, it requires a commensurate, systemic remedy. Across this expanse, there is established benefit in nurturing the vitality, resilience, and resistance of the body in which a cancer has gained purchase.
There are quixotic defenders of science, listing at windmills with good but misguided intentions, who seemingly view holism as some kind of threat. Holistic care is no more an enemy to evidence and the effective treatment of cancer than is a functioning state nurtured in the space of a toppled, rogue regime.
Science argues decidedly for care of the whole person, not just their pathology. Effective attention to the whole person can foster recovery, reduce the risk of recurrence, and favorably alter the propensity for future mutations at their origins. The same is true, presumably, of terrorism.
To some extent, this debunks the implied merits of the-greater-the-force-the-better propaganda. Such is the stuff of campaign trail hucksterism, bought only by the gullible. But paradoxically, it hints at danger in the opposite direction as well, the price of timorousness.
When cancer is localized and limited, targeted therapies are preferred and may suffice. Surgery, at times, is curative. Radiation, regionally channeled, can be as well. Cancers of notorious virulence, however, or those already seen to have spread, demand systemic treatment, chemotherapy the most familiar. At times, good tissue is willfully sacrificed to banish the bad, as when bone marrow is ablated and replaced.
The intensive care of a person, as seen in ICUs, requires rather complete medical governance. For the sake of potential, eventual recovery, the individual, in extremis, must at times surrender all control. Does the terrorism analogy extend this far?
If so, it argues, against prevailing notions of political correctness, for a doctrine extending all the way to annexation, at least in the short term. The local threat of terrorism might be contained from without. The expression of terrorism might be met with a greater, targeted force. Recurrence or spread, however, seemingly demands true hegemony, the real estate in question subject to the political, military, and civil analogues of intensive care. What might that look like in Afghanistan? Perhaps even the hawks among us manage to be far too bellicose, yet insufficiently bold.
While still far from where we wish to be, we are making stunning strides against cancer. We are ever more capable of preventing it, ever more effective at treating it, ever more deft at forestalling its dire consequences. We are ever more attentive, as well, to the needs of the body in which the cancer resides, ever more respectful of the dividends such gentle attentions pay. All such progress is courtesy of science and genuine understanding. None of it derives from grandstanding.
Terrorism either is to the body politic as cancer is to the body, or it is not. The frequency of the simile, across the political spectrum, invites us to grant the benefit of doubt. This, in turn, invites the application of attendant logic.
Science and understanding, not demagoguery, guide our progress against cancer. Effective treatment is as harsh as necessary on the cancer, but not harsher; as gentle as possible on the innocent cells surrounding, but no gentler. The best of care is proactive rather than merely reactive, holistic rather than reductionistic, and attentive to the origins of wayward tendencies. In human terms, we wage war against cancers within bodies we seek to show nothing but love.
How vapid and calamitously foolish proclamations about carpet-bombing terrorists, or making desert sands glow when terrorism is viewed as cancer. Our pontificating political aspirants seem utterly ignorant to the implications of their own rhetoric.
As promised at the start, this is not, with one year winding down, an invitation to dark reflection. Rather, as another wells up before us, it is an invitation to most, if sadly never quite all, of us to use what we know about lifestyle and defense against cancer to far greater effect. It is an invitation to renounce political bombast and apply methods born of comparable understanding to the scourge of terrorism, too. Those methods may at times be even bolder than we seem inclined; gentle whenever possible; and always thoughtful. We are invited to recall that wherever there is a cancer to hate, there is almost certainly a patient to love.
The iron fist demagogues wave in our faces and use to pound the table could be put to far better use. That hand should wield the requisite armaments with all due force, but with the best approximations of surgical precision. It should be bold, but not brutal. It should incline toward tenderness for the common humanity, most vulnerable to mutating radicalisms when preferable alternatives are most elusive. It should proffer just such alternatives at every opportunity. It should, whenever possible, be a gentle hand; a comforting hand; a guiding hand.
It should, indeed, when necessary, be an iron fist- but even then, it should wear the oft-forgotten velvet – or perhaps surgical – glove.