Johanna V. Panagiotou
HISTORICAL, CULTURAL AND SOCIOLOGICAL APPROACHES OF THE WAR ON CANCER
Updated: Feb 26, 2021
Cancer And Communication(s): An Interdisciplinary Perspective
Politicians, mass media and cancer advocates frequently use war metaphors when approaching cancer issues. This paper reports on the political− and cultural history of cancer wars from the 1930s to the present. Aiming to examine the strategies of manipulation and their influence on society, we performed a review of the existing English literature, which was perused from a global and interdisciplinary perspective. Accordingly, we studied the communication(s) strategies since the declaration of war on cancer in 1971 by Nixon and its influence in Europe, without disregarding the related transformation of the social activism− and advocacy movement to a global lobby that goes now hand in hand with the industry. The highlighting of this interference and the critical analysis of the discourse on cancer constitute the main subject. Further, taking seriously into account various phenomena − multidimensional change of media, the tremendous rise of ‘Big Data’ initiatives and the potential abuse of science − we suggest the development of an interdisciplinary critical health literacy agenda in order to adequately communicate this exceptionally sensitive topic.
Keywords: #WaronCancer, #CriticalHealthLiteracy, #BigData, #USHealthsocialmovements(HSMs)
“The war on cancer is a dramatic rhetorical struggle as competing agents try to shape the language, beliefs, and experience of cancer” (Sulik, 2011). As the present essay does not approach the issue medically, but sociologically, let us define what after all ‘cancer’ is. James Ewing, one of the first academic pathologists in the United States, described cancer as a Public Health Problem. (Ewing, 1929). Faced with a problem, society reacts in different ways. There are groups who are concerned with finding answers, others who will apathetically observe it and a further group who will be in a panic, as no medical diagnosis evokes such universal fear as the one with the word ‘cancer’. Finally, the group that consists of politicians, NGOs and media will rationally deal with the problem; on the one hand to find solutions, on the other hand to use it for their own purposing. The decisive factor here is the use of language. “Language is a means we use to communicate feelings; we also reflect emotionally on the language we and others use” (Wilce, 2009). The media language used to inform the public about cancer is crucial. This is not an easy task regarding the abundant news we are daily ‘bombed’. Additionally, media reports underline certain cancers − according to their incidence in the general population − more than others. This view is encouraged by the dominant coverage for instance on breast cancer, which will also shape the content of this study. In order to explore the connection between the use of language and the sociopolitical and historical context in which they occur, we performed the methodology of critical discourse analysis, starting with cancer cultural history since the Second World War.
2. Nazis’ ‘Preventive’ War on Cancer
Adolf Hitler, Joseph Goebbels and the Reich Health Leader (Reichsgesundheitsführer) Leonardo Conti implemented the first well-organized public health policies aiming to control cancer in the early 1930s. Beside their racial hygiene approaches, the sterilization and the euthanasia of people with disabilities and many other atrocities, the Nazis declared cancer as ‘the number one enemy of the state’. The Nazi war on cancer focused mainly on prevention, improved diet and anti-tobacco campaigns, rather than treatment. It is not by chance that “the first case-control study of smoking and lung cancer originated in Nazi Germany in 1939 and found that heavy smoking was strongly related to the risk of lung cancerˮ (Smith, 2004).
Germany had also a strong tradition in the field of occupational (workplace) research in cancer and had passed protective legislation in the late nineteenth century. In 1926, it was the first nation to compensate uranium miners who developed lung cancer. Research on workplace carcinogens remained a central issue in Nazi cancer program and in 1938, several German scientific publications revealed strong evidence for the link between asbestos and mesothelioma. This led the Nazi government to recognize asbestos-induced mesothelioma and lung cancer as compensable occupational diseases in 1943.
With the beginning of the War II, the need for a rapid build-up of the military industry shifted Nazi leaders’ attention away from the hazards of cancer and efforts to eliminate illness were replaced by efforts to eliminate sick workers, as was the practice at IG-Farben’s Auschwitz plant. The Nazis’ war on cancer was the most vigorous one until that time and some of its preventive measures, as the aggressive anti-smoking campaigns (‘hazard to the race’, ‘masturbation of the lungs’) in magazines like ‘Auf der Wacht’ (on watch) and ‘Reine Luft’ (pure air) may have contributed to the lower mortality from lung cancer among German women after the war.
2.1. From Cold War Propaganda to the War on Terrorism
After the victory of penicillin over the most important infectious diseases, during the cold war, cancer has become the dominant metaphor in anti-communist propaganda, terrorizing the masses with its creepy connotation. “Communism is like a malignant parasite that only feeds on disease tissue“, wrote 1946 George Kennan, American Diplomat in Moscow, in his influential telegram, setting the basis for the US’s aggressive containment policy against the Soviet Union (Leopold, 2009).
In the aftermath of the Cold War, the media lost a dominant enemy image: Communism. Hence, they had to construct a new stereotype. Since September 11, 2001, the enemy has a new name: Terrorism. This ‘psychological warfare’ is paradoxically not only waged by the established media. The above-mentioned narrative is repeated even in professional journals, where the association of the disease with an existed threat is enhanced. To allege two examples: “Cancer is to the patient and their family what terrorism is to a free society, a deeply personal threat that must be overcome,”  states The Oncologist. A further example was found in the Frontiers in Oncology. “We may one day safely drag out our patients’ war on their cancer – as we do in the war on terrorism: far into unforeseeable future, turning it into a well-tolerated, barely unnoticed chronic ill”.
2.2. The US War On Cancer
“Surely, the war against cancer has the support of 100% of the people. It is a war in which we lost 21 times more lives last year than we lost in Vietnam last year. A war we can win and put the entire human race in our debt.” Richard Nixon.
The signing of the National Cancer Act of 1971 by President Nixon marks the start of the ‘War On Cancer’, although the term war is not explicitly mentioned in the legislation. To the historical context: The US achievement of the first manned moon landing in 20 July 1969 generated enthusiasm in US society. On 9 December 1969, the Citizens’ Committee for the Conquest of Cancer, published full-page advertisements in The Washington Post and The New York Times entitled: Mr. Nixon: you can cure cancer. The advertisement envisaged ‘conquest of cancer by America’s 200th birthday,’ just 7 years later and quoted Dr. Sidney Farber, oncologist and past president of the American Cancer Society: “We are so close to a cure for cancer. We lack only the will and the kind of money and comprehensive planning that went into putting a man on the moon.” Further, the advertisement “compared the annual number of US cancer deaths with the number of US deaths in a real, contemporary war that had lost a great deal of public support” (Coleman, 2013). The lobbying was effective. With the assignment of the National Cancer Act on Dec. 23, 1971, a $1.6 billion federal crusade to find a cure for cancer began.
The War narrative was continued by President Barack Obama. In July 2009 he described his mother’s battle with ovarian cancer; inter alia he stated: “Now is the time to commit ourselves to wage a war against cancer as aggressive as the war cancer wages against us” (Lennon, 2009). In one sentence the former US President − who 2016 drew loud criticism regarding his inconvertible initiative Cancer Moonshot − uses twice the phrase ‘against us’, which was already ‘rooted’ in the mind of almost every American citizen after 9/11.
2.3. The Political and cultural history of the US cancer activism and advocacy movement
The US war on cancer is closely connected to the human rights’ movement and social activism of the 1960s and 1970s. In the 1970s, many local grassroots organizations were founded, in order to support women with cancer − mainly ovarian and breast cancer. Influenced by a number of social, environmental-workplace, and rights-based movements, cancer advocacy became more and more action-oriented at the beginning of 1980s.
By the 1990s, some changes in public policies enabled a ‘cultural shift’ from the feminists’ approaches into the current ‘pink ribbon culture’. The answer to this ‘pink hysteria’ came from Professor Barbara L. Ley and her work ‘From Pink to Green’ – a milestone in the filed ‘Sociology of Cancer’ that highlights the environmental causes of breast cancer, which are tremendously important and overshadowed by the pink culture.
In September 1998 the historical march ‘The March: Coming Together to Conquer Cancer’ that was held in Washington, D.C. attracted 300,000 to 500,000 people who have demanded a national cancer research agenda from which all cancer patients will benefit. Moreover, they urged that all Americans should have access to quality cancer care, especially the medically underserved and minority populations.
2.4. The pink ribbon culture
Jacqueline Clark, Chair of the Sociology and Anthropology Department at Ripon College, does not confine herself only to a theoretical approach of the ‘pink ribbons culture’ – a term by Gayle Sulik. Clark does not even hesitate to explicitly mention the co-operation partners by name. In her article How “Pink Ribbon Culture” Harms Breast Cancer Patients and Survivors the historical the Associate Professor of Sociology primarily highlights the historical background.
The starting point was, according to Clark, when Zeneca Pharmaceuticals (now AstraZeneca) declared the month October “National Breast Cancer Awareness Month” by promoting mammography screenings and self-breast exams in 1985. Six years later, 1991, the Susan G. Komen Breast Cancer Foundation distributed at a New York City fundraising event the ubiquitous pink ribbons that activists pin since then onto their cause every October.
“The following year, 1.5 million Estée Lauder cosmetic customers received the promotional reminder, along with an informational card about breast self-exams. The awareness campaign also opened the floodgates for other companies to capitalize on the disease” (Clark, 2016). Clark lists following companies: Avon, New Balance, Yoplait, and KitchenAid.
Among the sociocultural aspects of this phenomenon, Clark reminds us on two factors that are very important in a critical view: Firstly, the fact that these companies take the easy way out: Would they get the same way involved in those activities also for HIV/AIDS patients facing with stigma and discrimination? Secondly, she also criticizes the hidden hypocrisy. While over 40,000 women die from breast cancer each year in the United States,“ breast cancer patients are expected to present a feminine self, and to also be positive and upbeat, despite the pain and suffering they endure as a result of being ill” (Clark, 2016).
2.5. A new type of (s)hero : Angelina Jolie and the preventive breast amputation
In order to reduce the risk of getting breast cancer, Hollywood Star Angelina Jolie wrote 2013 an op-ed in The New York Times about her decision to have both of her breasts removed. Jolie had not yet been diagnosed with cancer. She (just) carried a genetic mutation in the BRCA1 gene that increased the risk to get cancer, as she had lost her mother, aunt, and grandmother to the disease. The superstar chose to undergo a preventative double mastectomy. Subsequently, she had her breasts cosmetically reconstructed. “After Jolie announced publicly her decision to have both of her breasts removed, cancer centers nationwide noticed a significant uptick in requests for double mastectomies. They began to call it the Angelina Jolie effect.” Among them were women who probably could not afford a cosmetic reconstruction, but ready to ‘sacrifice’ an important part of female body, inspired or influenced by their hero.
Noticeably, through her writing, is how she attaches importance to familial values. Jolie lets her readers (mainly women she wants to give encouragement) feel her strong willing not to fail in her quad-role as a woman, professional actress, spouse, and mother. She seems to have – despite a potential illness – everything under control; appears calm and self-confident:
“I passed those five days in a haze, attending my children’s soccer game, and working to stay calm and focused.”
“I called my husband in France, who was on a plane within hours. The beautiful thing about such moments in life is that there is so much clarity. You know what you live for and what matters. It is polarizing, and it is peaceful.”
“I feel feminine, and grounded in the choices I am making for myself and my family. I know my children will never have to say, Mom died of ovarian cancer.”
2.6. The Masculine Survivorship Ideal as a response to the Feminine Survivorship
Exempli gratia that embodies the masculine ethos and the image of victorious heroism: Lance Armstrong. Following the medial success story of cancer (s)hero, the champion cyclist was for a long time the masculine counterpart. Through the LIVESTRONG charity he founded, Armstrong disseminated highly valued in the American culture image: heroism, victory, sporting competition, individualism, and emotional suppression. (Sulik, 2011).
When Lance Armstrong, however, fell from grace after a doping scandal in 2012, he was stripped of the seven Tour de France titles he won from 1999 to 2005. By October of that year, he resigned as chairperson of the Lance Armstrong Foundation and from the board of directors a month later. Attempting to separate the LIVESTRONG brand from the person who later admitted doping in an interview with Oprah Winfrey, the foundation officially changed its name to the Livestrong Foundation in November 2012. Aside from the ‘Our Founder’ section, the once young, healthy, masculine and tough Armstrong has been almost completely erased from the LIVESTRONG website. Yet the perseverance, strength, and courage that form the organization’s culture remain: “We are charting a strong, independent course forward that is focused on helping people overcome financial, emotional and physical challenges related to cancer.”
‘War on cancer’ is a simplistic metaphor that has long outlived the cold war. Nevertheless, it is still nowadays used; even in regions that are affected by real wars, which raises ethical questions. The metaphor has not only been shaped by the media, but also by the US social activism- and advocacy movement, which admittedly contributed to the de-stigmatization of the disease, to the improvement of survivors’ social status and to the funding hike for cancer research and −care. Gradually, it had been nonetheless transformed and became a powerful lobby, influencing global health policies.
Specifically, we must keep an eye on the global breast cancer lobby and its emotional awareness campaigns, which are sponsored by the pharmaceutical and cosmetics industries. At first view, their aim is to reduce the burden of the disease and to save human lives. With a critical view, most of them are co-responsible for the constant rise of breast cancer incidence due to over diagnosis.
Further, the communication strategies used by the coalition of the breast cancer advocacy and the pharmaceutical industry as well as the language of cancer used by politicians and media distract the masses from environmental and socioeconomic causes of cancer and drown the voices calling for a ban on carcinogenic chemicals (see ‘pink washing’). In this way, and despite the flow of billions of public money recourses into cancer research since the early 1970s, we deviate from the initial goals. This does not speak against the continuation of scientific research, which is still very crucial.
However, we have arrived at a moment, where a complete rethinking is necessary – beginning from the terminology. Instead of the misused term, we suggest ‘global cancer strategy’. Considering similarly the uncontrollable expansion of the media, including the social networks and their tremendous power of disinformation and manipulation, we argue for more interdisciplinary efforts that will enhance critical health literacy. Simultaneously, we put the emphasis on the threats related to the Big Data initiatives.
In November 2013, IBM announced the start of its cooperation with the Union for International Cancer Control (UICC) to “create the world’s largest and most comprehensive clinical dataset on cancer patients by building cancer registries in developing nations”. This strategic partnership between one of the biggest multinational information technology companies and the world’s largest alliance of cancer societies, patient advocacy groups, influential policymakers, researchers and cancer experts, marks the start of the modern global war on cancer. The question that arises in this context is the following:
Are citizens in a position to permit their personal medical history, diagnostic imaging and genetic data to be used, as BAYER proclaims, as ‘a key tool in the battle against cancer’, or do they consider that “Hiding within those mounds of data is knowledge that could change the life of a patient, or change the world”?
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Citation: Panagiotou, Johanna; Bagatzounis, Thanasis (2019):
HISTORICAL, CULTURAL, SOCIOLOGICAL APPROACHES ON THE WAR OF CANCER.
Cancer and Communication(s): An interdisciplinary perspective. Heraklion: IAKE, 5th International Conference on Interdisciplinarity, p.p. 676-681.
First published in the following conference proceeding: