The “Dubya” Word

Following the appalling episode in Nice, Mr Trump has issued a couple of interesting statements, first, that IS is a cancer, and second, that if elected President, he would ask Congress to declare war on IS.  There has even been mention of “World War 3” – though this may be mere Fox News hype.

I recently read The Laws of Medicine by Siddhartha Mukherjee, author of The Emperor of All Maladies.  Prof Mukherjee is an oncologist and the emperor of all maladies is, of course, cancer.  In The Laws of Medicine, Mukherjee describes the work of William Halsted, a Baltimore surgeon who championed radical mastectomy in the treatment of breast cancer.  In the early twentieth century the surgical treatment of breast cancer was achieving poor results.  Halsted thought this was because the surgeon was not being aggressive enough.  Tumour was being left behind.  What was needed was surgical “extirpation”.  Radical mastectomy involved the removal not only of all breast tissue, but of underlying muscle and associated lymph nodes.  Outcomes remained poor.  But it took 80 years until the conventional wisdom that it was good to be aggressive was questioned in the form of a controlled clinical trial.

The results of the trial showed that radical mastectomy offered the patient no benefit over more conservative surgery, but did cause myriad unwanted side effects and complications.  It seems sensible that a surgeon should choose to be “radical”, but there is a sound pathophysiological reason why it won’t work.  The breast cancer cells that are life-threatening metastasise early.  Long before the condition becomes clinically evident, cancer cells have left the primary tumour and travelled via blood and lymph vessels to take up residence in far distant sites, all over the body.

So Mr Trump’s first assertion, that IS is a cancer, is actually quite apposite.  When you think of all the recent terrorist atrocities – Nice, Paris, Brussels, Orlando, most of the perpetrators have been citizens of the countries they have attacked.  Their links with any putative Middle Eastern Caliphate are tenuous.  The frightening thing about the threat we face is that it is coming from a fifth column which has infiltrated any and every country.  Metastatic disease indeed.

Can the metaphor of international terrorism qua mitotic lesion usefully be extended further?  Modern cancer therapies focus very much on immune surveillance.  The immune system is constantly identifying and “taking out” aberrant cells.  When cancer cells survive and multiply this is seen as a failure of the immune system.  Therapies are directed towards supercharging the immune system to identify tumour cells as alien, as “non-self”, and destroy them.  If the metaphor is going to stand up, we might suppose that in the fight against the cancer of terrorism, the intelligence services fulfil the role of the immune system, but already the metaphor is beginning to look hackneyed and threadbare; I wonder whether it is useful to think of a terrorist as other, as “non-self”.  We do this all the time.  When you hate your enemies, you tend to think, “These people are not like us; they are scarcely human.”

This takes us on to Mr Trump’s second statement, advocating a declaration of war.  It’s not new.  George Bush did exactly the same after 9/11.  He declared a “war on terror”.  That Mr Trump should wish to ask Congress for a formal declaration of war suggests that he is not thinking metaphorically.

Yet how would you conduct such a war?  Who would you bomb?  Who would you invade?  Where would the front line be?  How would you even know if you’d won?  Politicians should pause before they use the word “war” – call it the Dubya word.  Since 2001, the war on terror hasn’t gone very well.

We tend to be a bit smug, complacent, and superior about Mr Trump on this side of the Pond, but watch what happens in Westminster today.  The renewal of Trident will be debated, and – I dare say – £167,000,000,000 (£205,000,000,000 if you believe CND) will be spent over the lifetime of the system on its refurbishment and upkeep.  The advocates of “deterrence” will draw heavily on the events of the past week.  “Now, with all these international threats, is not the time to be destabilising the fragile balance of power.”  There will be no mention of precisely how a 100 kiloton bomb could possibly stop a loner from choosing to drive a truck into a crowd of people.

What’s in the mind of a man who chooses to mow down a whole lot of innocent people with a heavy goods vehicle?  We don’t really know.  The cancer metaphor comes in handy again.  If our treatments of some specific cancers remain very poor, it’s because we don’t understand the disease.  But we know that “extirpation” is not going to work.  We need to think again.  We need to think afresh, laterally, and creatively.  Is there any leader currently on “the world stage” who is doing this?

The worrying thing is, Mr Trump might be President of the USA in six months.  “Events” have come at an awkward time for the UK.  Everybody’s on a steep learning curve.  Mr Hammond was asked what he thought of the Bank of England holding interest rates at 0.5% and he said, wait for the Autumn Statement – that is, give me a chance to master my brief.  The Foreign Secretary wanders around Whitehall mumbling and bumbling.  Is Boris Goodenough? (That’s a pun: see Saturday night’s Albert Hall Prom.) Boris, the Donald… I keep reverting to W B Yeats:

The best lack all conviction, while the worst

Are full of passionate intensity. 

Where’s Abe Lincoln when you need him?

The occasion is piled high with difficulty, and we must rise to the occasion.  We must think anew, and act anew…                                             

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