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BMJ. 2007 April 14; 334(7597): 776.
PMCID: PMC1852014
Yankee Doodling

The cancer diagnosis that has gripped America

Douglas Kamerow, former US assistant surgeon general and the BMJ's US editor

The unpredictability of cancer may partly explain the media obsession with the wife of a presidential candidate

I have been surprised by the extensive and continuing media coverage of the announcement that Elizabeth Edwards, wife of the US presidential candidate John Edwards, has recurrent breast cancer. It was front page news here when it was announced. The Edwards's decision to continue his campaign despite the cancer was then analysed and discussed endlessly, with multiple follow-up stories and interviews in the newspapers, on the network news programmes, and in the blogosphere. Why all the fuss?

First, a bit of background. John Edwards, a former US senator, ran for president in 2004 and was beaten by John Kerry, who then picked him as his vice presidential running mate. On election day 2004 Mrs Edwards found out that she had breast cancer. She subsequently had surgery and radiation therapy and was pronounced cured. John Edwards is running again for president in the 2008 election and generally has been third in public opinion polls, after Hillary Rodham Clinton and Barack Obama.

Further relevant background. The Edwards's had two teenage children. Their 16 year old son died in 1996 in a car crash. In her late 40s Elizabeth Edwards then had two more children, who are now aged 6 and 8.

On 22 March, Elizabeth and John Edwards held a press conference to announce that her breast cancer had returned. It has metastasised to her bones and possibly to internal organs as well. Although the cancer is stage IV and incurable, her cancer burden is small, and her doctors told her that it is “completely treatable.” She said that she feels well, is planning to undergo unspecified treatments to control her cancer, and that she and her husband had jointly decided to press on with his campaign.

The pundits are having a field day with this one. Elizabeth and John Edwards were immediately called courageous and forthright by many, but others have criticised their decision to carry on with the campaign under such uncertain circumstances. Some thought it callous to focus on his career instead of her health. Others say that they are short changing their young children by not spending every possible minute with them. Katie Couric, a television network news anchor who famously lost her own husband to colon cancer, interviewed them and asked whether they were in denial and being unrealistic in their expectations. Many wondered how candidate (let alone president) Edwards could focus on the affairs of the world while his wife's health is so precarious. Others saw this as a plea for a sympathy vote.

Mrs Edwards responded by saying that all of us are dying; her only difference is that she now knows what she will die from. She wants to be seen as living with cancer rather than dying from it, and to her the only choice is whether to “push forward or start dying.” She and her husband have spoken about their young children and how they told them the news. John Edwards says that he wants no one to vote for him out of sympathy but that voters may learn something important about him from this. He feels that he has shown his ability to continue to function in his job during periods of family stress because he has done it twice before: when their elder son died and at the time of his wife's first cancer diagnosis.

So why all the press furore in America over this news? I think there are three reasons. Firstly, Americans are obsessed with the domestic affairs of their political leaders. Nothing that Hillary Rodham Clinton does as a candidate for president engenders greater interest and attention than her role as wronged wife during her husband's presidency. Similarly, the Republican candidate Rudy Giuliani, former mayor of New York, gets more press for the ongoing saga of his wives and their previous husbands than for his policy statements. John Edwards only made it onto the network news shows when his wife's cancer recurrence was revealed.

Secondly, this was a recurrence of cancer, not a primary diagnosis. As one of my friends, herself a cancer survivor, said, “Everyone's got breast cancer—it's no big deal.” It is commonplace to hear about a celebrity with breast cancer who undergoes treatment and announces that she is cured. Recurrence, however, is not part of the public drill. It is scarier, and terms such as “stage IV,” “metastases,” and “incurable” upset the press and the public. In a world full of media consultants and carefully scripted appearances, everyone understands that the future for this couple is not predictable. It is going to play out in real time in front of the country.

Finally, and related to that, there is clearly something very special about Elizabeth Edwards. Her direct, no-nonsense approach is genuine and appealing. Her intelligence, thoughtfulness, and toughness come through clearly. She is a woman who has been given much but has also been put through much. We all wonder how we would deal with such unhappy news in private and in public. At least some of us, myself included, would hope for her strength and grace. It is as much about us as them.

As the actor Tim Robbins's character Andy Dufresne said in the film Shawshank Redemption, “It usually comes down to a simple choice, really—get busy living or get busy dying.”

Everyone understands that the future for this couple is not predictable. It is going to play out in real time in front of the country


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