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Wednesday, February 5, 2025

Anti-Zionism

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https://en.wikipedia.org/wiki/Anti-Zionism
The first large-scale anti-Zionist demonstrations in Palestine, March 1920, during the Occupied Enemy Territory Administration. The crowd of Muslim and Christian Palestinians are shown outside Damascus Gate, Old City of Jerusalem.

Anti-Zionism is opposition to Zionism. Although anti-Zionism is a heterogeneous phenomenon, all its proponents agree that the creation of the modern State of Israel, and the movement to create a sovereign Jewish state in the region of Palestine—a region partly coinciding with the biblical Land of Israel—was flawed or unjust in some way.

Until World War II, anti-Zionism was widespread among Jews for varying reasons. Orthodox Jews opposed Zionism on religious grounds, as preempting the Messiah, while many secular Jewish anti-Zionists identified more with ideals of the Enlightenment and saw Zionism as a reactionary ideology. Opposition to Zionism in the Jewish diaspora was surmounted only from the 1930s onward, as conditions for Jews deteriorated radically in Europe and, with the Second World War, the sheer scale of the Holocaust was felt. Thereafter, Jewish anti-Zionist groups generally either disintegrated or transformed into pro-Zionist organizations, though many small groups, and bodies like the American Council for Judaism, conserved an earlier Reform tradition of rejection of Zionism. Non-Jewish anti-Zionism likewise spanned communal and religious groups, with the Arab populace of Palestine largely opposed to what they considered the colonial dispossession of their homeland. Opposition to Zionism was, and continues to be, widespread in the Arab world, especially among Palestinians.

Many anti-Zionists seek to replace Israel and its occupied territories with a single state that would give Jews and Palestinians equal rights. Anti-Zionists have argued that a binational state would still realize Jewish self-determination, as self-determination need not imply a separate state. Some supporters of Zionism highlight that some antisemites hold anti-Zionist views. The relationship between Zionism, anti-Zionism and antisemitism is debated, with some academics and organizations that study antisemitism taking the view that anti-Zionism is inherently antisemitic or new antisemitism, while others reject any such linkage as unfounded and a form of weaponization of antisemitism in order to stifle criticism of Israel and its policies, including its occupation of the West Bank and blockade of the Gaza Strip.

Anti-Zionism before 1948

Early Jewish anti-Zionism

The August 1917 memorandum by Edwin Montagu, the only Jew then in a senior British government position, stating his opposition to the pro-Zionist Balfour Declaration, which he described as "antisemitic in result"

Formal anti-Zionism arose in the late 19th century as a response to Theodor Herzl's proposal in The Jewish State (1896) to create an independent country in Palestine for Jews subject to persecution in the "civilized nations" of Europe, but even before Herzl, the idea of Zionism – of Jews as constituting a nation rather than a people constituted by their religion – promoted by Moses Hess (1862) and Leo Pinsker (1882) elicited fierce opposition within European Orthodox Jewry. Samson Raphael Hirsch, for one, considered the active promotion of Jewish emigration to Palestine a sin. The creation of a Jewish state before the appearance of the messiah was widely interpreted in Jewish religious circles as contradicting the divine will, a programme, furthermore, that was visibly driven by Jewish secularists. Until World War I, across Central Europe, Jewish religious leaders largely perceived the Zionist movement's aspirations for Jewish nationhood in a distant "New Judea" as a threat, in that it might encourage paradoxically the very antisemites, with their treatment of Jews in their midst as "aliens", whose fundamental rationale Zionism itself sought to undermine.

When Herzl began to propound his proposal, many, including, secular Jews, regarded Zionism as a fanciful and unrealistic movement. Some antisemites even dismissed it as a "Jewish trick". Many assimilationist Jewish liberals, heirs of the Enlightenment, had argued that Jews should enjoy full equality in exchange for a pledge of loyalty to their respective nation-states. Those liberal Jews who accepted integration and assimilationist principles saw Zionism as a threat to efforts to facilitate Jewish citizenship and equality within the European nation-state context. Many in the intellectual elite of the Anglo-Jewish community, for example, opposed Zionism because they felt most at home in England, where, in their view, antisemitism was neither a social or cultural norm. The Jewish establishment in Germany, France (and its Alliance Israelite Universelle), and America strongly identified with its respective states, a sentiment that made it regard Zionism negatively. Reform rabbis in German-speaking lands and Hungary advocated the erasure of all mentions of Zion in their prayer books. Herzl's successor, the Zionist atheist Max Nordau, whose views on race coincided with those of the antisemitic Drumont, lambasted Reform Judaism for emptying ancient Jewish prayers of their literal meaning in claiming that the Jewish diaspora was a fact of destiny.

Herzl's proposal initially met with broad, vigorous opposition within Jewish intellectual, social and political movements. A notable exception was the religious Mizrachi movement. After the Tenth Zionist Congress moved to expand in Palestine, many Orthodox Jews left the Mizrachi movement and formed Agudat Yisrael as a bulwark against secularists, including Zionists. In Palestine, the Agudah sought complete separation from secularists, though one key leader, Rabbi Yosef Sonnenfeld, was amenable to limited cooperation with local Zionists. In his essay Mauschel, Herzl called Jews who opposed his project "yids", and not true Jews. Among left-wing currents within diaspora Jewish communities, strong opposition emerged in such formations as the Bundism, Autonomism, Folkism, Jewish Communists, Territorialism, and Jewish-language anarchist movements. Yevsektsiya, the Jewish section of the Communist Party in the Soviet Union created to combat "Jewish bourgeois nationalism", targeted the Zionist movement and managed to close down its offices and place Zionist literature under a ban, but Soviet officials themselves often disapproved of anti-Zionist zeal.

Early Arab anti-Zionism

Arab mayor of Jerusalem Yousef al-Khalidi who in 1899 wrote a letter to Theodor Herzl arguing against Zionism. "... in the name of God," he wrote, "let Palestine be left alone."

Arabs began paying attention to Zionism in the late Ottoman period. In 1899, compelled by a "holy duty of conscience", Yousef al-Khalidi, mayor of Jerusalem and a member of the Ottoman Parliament, wrote a letter to Zadok Kahn, the chief rabbi of France to voice his concerns that Zionism would jeopardize the friendly associations among Muslims, Christians and Jews in the Ottoman Empire. He wrote: "Who can deny the rights of the Jews to Palestine? My God, historically it is your country!" But Khalidi suggested that, since Palestine was already inhabited, the Zionists should find another place for the implementation of their political goals: "in the name of God", he wrote, "let Palestine be left alone."

According to Rashid Khalidi, Alexander Scholch and Dominique Perrin, Yousef Khalidi was prescient in predicting that, regardless of Jewish historic rights, given the geopolitical context, Zionism could stir an awakening of Arab nationalism uniting Christians and Muslims. Kahn showed the letter to Theodor Herzl, who on 19 March 1899 replied to Khalidi in French arguing that both the Ottoman Empire and the non-Jewish population of Palestine would benefit from Jewish immigration. As to Khalidi's concerns about the non-Jewish majority population of Palestine, Herzl replied rhetorically: "who would think of sending them away?" Rashid Khalidi notes that this was penned four years after Herzl had confided to his diary the idea of spiriting the Arab population away to make way for Jews.

The Maronite Christian Naguib Azoury, in his 1905 The Awakening of the Arab Nation, warned that the "Jewish people" were engaged in a concerted drive to establish a country in the area they believed was their homeland. Subsequently, the Palestinian Christian-owned and highly influential newspaper Falastin was founded in 1911 in the then Arab-majority city of Jaffa and soon became the area's fiercest and most consistent critic of Zionism. It helped shape Palestinian identity and nationalism.

The vignette in the Falastin newspaper suggests Zionist insincerity is protected by British complicity, with Zionism as a crocodile under the protection of a British officer telling Palestinian Arabs: "don't be afraid!!! I will swallow you peacefully...".

Palestinian and broader Arab anti-Zionism took a decisive turn, and became a serious force, with the November 1917 publication of the Balfour Declaration – which arguably emerged from an antisemitic milieu – in the face of strenuous resistance from two anti-Zionists, Lord Curzon and Edwin Montagu, then the (Jewish) Secretary of State for India. Other than assuring civil equality for all future Palestinians regardless of creed, it promised diaspora Jews territorial rights to Palestine, where, according to the 1914 Ottoman census of its citizens, 83% were Muslim, 11.2% Christian, and 5% Jewish. The majority Muslim and Christian population constituting 94% of the citizenry only had their "religious rights" recognized.

Given that Arab notables were almost unanimous in repudiating Zionism, and incidents such as the Surafend massacre (perpetrated by Australian and New Zealand troops serving alongside the British) stirred deep resentment against Britain throughout the area, the British soon came to the conclusion, which they confided to the Americans during the King–Crane Commission, that the provisions for Zionism could only be implemented by military force. To this end, the British Army calculated that a garrison of at least 50,000 troops would be required to implement the Zionist project on Palestinian soil. According to Henry Laurens, uneasiness among British troops stationed in the region over the task of ostensibly supporting Zionism, something that clashed with their customary paternalistic treatment of colonial populations, accounted for much of the anti-Zionist sentiment that UK military personnel based in Palestine expressed.

Reactions to the Balfour Declaration

Wilson and his cabinet in 1916

American approval of the Declaration came about through the direct and secret mediation of the antisemitic anti-Zionist Colonel House with President Woodrow Wilson by bypassing Robert Lansing, the United States Secretary of State. The last sentence in the draft proposal passed to Wilson, mentioning Jews "who are fully contented with their existing nationality and citizenship", was struck from the final British version. This recognition by Wilson stirred great anxieties among numerous leaders of the American Jewish community, which had made the adoption of its country a "theological substitution for the return to Zion" and was highly satisfied with its prosperous lives in this "new Zion". 299 prominent rabbis registered their disapproval in a submission to the forthcoming Paris Peace Conference, rebuffing the notion that there could ever be a Jewish Palestine. When he found out, Lansing thought that Zionism contradicted Wilson's own declared principle of self-determination for the peoples of the world. One other effect was that of laying the grounds for an anti-Zionist tradition in the US State Department.

Once the Occupied Enemy Territory Administration (OETA) began to implement the Balfour Declaration, both sides had reason to accuse the authorities of partisanship. Several contemporary sources credit the notion that English administrators were partial to Arabs, and diffident about, if not outright disliking, Jews. One Zionist complaint was that among the higher functionaries of the British Mandatory administration were several officials who countenanced anti-Zionist and even antisemitic policies. The energetic arguments of Jacob Israël de Haan on behalf of sectors of the Orthodox yishuv who disagreed with Zionism also played an important role in getting Mandate authorities to grasp that Zionists did not represent the entire Palestinian Jewish community. The Haganah assassinated him in 1924.

The British press during the Mandate period was often critical – the Northcliffe Press was openly anti-Zionist, and the newspaper baron Lord Beaverbrook was opposed to the Mandate itself – and complaints were made of the heavy burden it was to govern the land with competing national interests. It was claimed that Zionism's promise of a homeland for the Jewish people with civil rights for its Arab citizens was impossible to realize. Much of this anti-Zionist sentiment and diffidence about Jews in the early Mandate years, limited in scope like British antisemitism, was also tinged with anti-Bolshevism, since the Russian revolution had earlier engendered a sharp spike in antisemitism in the British press. Official sponsorship of Zionism, as evidenced by the Balfour Declaration, had been influenced by the communist takeover of Russia, which Anglo-Jewry itself abhorred, in which Jews were alleged to have played a major role. Palestinians raised the spectre of possible communist infiltration in the guise of Zionism before the horrified British administration with some success.

OETA and the British government took these claims seriously and addressed them in the Palin Commission report in August 1920, an investigation into the reasons behind the subsequent anti-Zionist riots at Nebi Musa. The Commission found that there was a widespread perception among the Arabs, reflected also among British residents and officials, that the Zionists' attitudes and zealous behaviour exacerbated hostilities, being perceived as "arrogant, insolent and provocative."

Anti-Zionism in the 1920s–1930s

Some members of the Jewish-Marxist Poale Zion, which advocated under Ber Borochov a separate Zionist organization for Jewish workers and advocated emigration to Palestine as a solution to antisemitism, found to their surprise on making aliyah that Palestine was a predominantly Arab country. By the early 1920s, the realization that Zionism would be discriminatory had turned Poale militants like Yaakov Meiersohn and Joseph Berger into anti-Zionists. In 1922 the Comintern's disowning of Poale Zion spurred the growth of a Jewish anti-Zionist left in Palestine, culminating with the formation of the Palestine Communist Party (PCP), which retained some residual Zionist traces. This anti-Zionist Jewish PCP was recognized by the Comintern in 1924, and, that same year, the first Palestinian Arab joined the party.

The Yiddish-speaking General Jewish Labor Union of Eastern Europe, the largest Jewish left-wing organization in Europe between the two wars, focused on a practice of doykayt (hereness) as the key to Jewish identity; that is, it advocated addressing practical issues Jews faced all over the diaspora in their respective national contexts. It dismissed its antagonist Zionism's vision of resolving matters definitively by emigrating to Palestine as marked by a "separatist, chauvinist, clerical and conservative" outlook, values diametrically opposed to Bundism's secular, progressive and internationalist principles.

The Communist Party USA (CPUSA) was resolutely anti-Zionist throughout this period, believing that "that the only way Zionism would be able to emerge in Palestine was through a colonial project and through the expulsion of the indigenous Palestinians from the land". Under CPUSA general-secretary Earl Browder, a clear distinction was drawn between anti-Jewish pogroms in Europe, which were likened to the activities of white supremacist groups in the U.S. such as the Ku Klux Klan and Black Legion, and Arab resistance to Jewish settlers in Palestine. At the time, around half of the CPUSA's membership was Jewish, with perhaps 10% of the U.S. Jewish population joining the group over a decade. Throughout the 1930s and '40s, members of the American Jewish left and its intelligentsia were almost all anti-Zionists, an exception being Meyer Levin. Mike Gold's 1930 novel Jews without Money depicts a Zionist entrepreneur's fatal extortion of a poor Jew and can be read as a proletarian critique of both American capitalism and, tacitly in its subplot, of Zionists in both the U.S. and Palestine.

As well as left-wing critiques of Zionism, many mainstream liberal and conservative communal organisations in the diaspora continued to promote an assimilationist anti-Zionism. In Germany, for example, the Centralverein deutscher Staatsbürger jüdischen Glaubens (Central Union of German Citizens of Jewish Faith) argued that German Jews should be primarily loyal to Germany and identify as Jews only on religious terms. Soon after Hitler was appointed Chancellor in January 1933, Jews, and anti-Zionists among them, were galvanized to organize global protests against the new regime's discrimination against their German confreres.

Similarly, as Italian fascism came to identify Zionism with enemies of the country abroad, in 1934 the Italian-Israeli Community Union responded to pressure by solemnly affirming the community's allegiance to their country. Italian anti-Zionists such as Ettore Ovazza reacted by creating their own newspaper, La Nostra Bandiera (Our Flag), whose editorial line maintained that the establishment of a Jewish nation in Palestine was anachronistic.

The Biltmore programme and its anti-Zionism fall-out

In May 1942, before the full revelation of the Holocaust, the Biltmore Program proclaimed a radical departure from traditional Zionist policy by adopting a maximalist position in calling for the creation of a Jewish commonwealth in an unpartitioned Palestine to resolve the issue of Jewish homelessness. At the American Jewish Conference in late August-early September the following year, Zionists received 85% as opposed to 5% for the anti-Zionists. Opposition to official Zionism's firm, unequivocal stand caused some prominent Zionists to establish their own party, Ichud (Unification), which advocated an Arab–Jewish Federation in Palestine. Ichud represented a very small minority of Jewish Palestine; there were only 97 party members in 1943. Opposition to the Biltmore Program also led to the founding of the anti-Zionist American Council for Judaism, which, according to Noam Chomsky was the only Jewish group in America immediately after WW2 to lobby for the immigration of Jewish Holocaust-survivors to the United States, rather than Palestine.

Religious anti-Zionism

Orthodox Judaism, which stressed civic responsibilities and patriotic feelings in religion, was strongly opposed to Zionism because Zionism espoused nationalism in a secular fashion and used "Zion", "Jerusalem", "Land of Israel", "redemption" and "ingathering of exiles" as literal rather than sacred terms, endeavouring to achieve them in this world. According to Menachem Keren-Kratz, the situation in the United States differed, with most Reform rabbis and laypeople endorsing Zionism. Dina Porat holds the opposite view of Orthodox Jewish opinion generally.

Elaborating on the work of David N. Myers, Jonathan Judaken states that "numerous Jewish traditions have insisted that preservation of what is most precious about Judaism and Jewishness 'demands' a principled anti-Zionism or post-Zionism." This tradition dwindled in the aftermath of the Holocaust and the establishment of Israel, but is still alive in religious groups such as Neturei Karta and among many intellectuals of Jewish background in Israel and the diaspora, such as George Steiner, Tony Judt and Baruch Kimmerling.

Anti-Zionism after World War II and the creation of Israel

There was a shift in the meaning of anti-Zionism after the events of the 1940s. Whereas pre-1948 anti-Zionism was against the hypothetical establishment of a Jewish state in Palestine, post-1948 anti-Zionism had to contend with the existence of the State of Israel. This often meant taking a retaliatory position to the new reality of Jewish sovereignty in the Middle East. The overriding impulse of post-1948 anti-Zionism is to dismantle the current State of Israel and replace it with something else.

1947–1948

On the eve of the foundation of Israel in 1948, Judah Magnes, president of Jerusalem's Hebrew University, adopted an anti-Zionist position in opposing the imminent establishment of a Jewish state. His opposition was grounded on a view, anticipated in the 1930s by Arthur Ruppin, that such a state would automatically entail a situation of continuous warfare with the Arab world, an inference Moshe Dayan later endorsed.

Soviet Union

By 1948, when the Soviet Union recognized Israel, Jewish institutional life within its borders had been effectively dismantled. The Soviet Union nonetheless played a leading role in recognizing the state of Israel, was harshly critical of Arab states opposing it and enabled Israel to procure substantial armaments in 1948–1949. But at roughly the same time, in early 1948, Ilya Ehrenburg had been co-opted to write an article for Pravda that set forth what later became the authoritative rationale for Soviet hostility to Zionism, as aspiring to create a dwarfish state of capitalism. Virulent antisemitism, particularly after the fabricated Doctors' plot affair in 1953, and with clear parallels to the content of The Protocols of the Elders of Zion, came to the fore, conflating anti-Zionism and antisemitism despite the conceptual distinction between the two. A deep-seated antisemitic strain within Russian culture influencing the Soviet state's approach to events in the Middle Easts emerged to intensify the Soviet leadership's anti-Zionist hostility to Israel as a major threat to the communist world, especially in the aftermath of the Six-Day War, when official documents and party connivance resuscitated antisemitic imagery related to Zionism.

Two waves of mass Russian-Jewish immigration to Israel, the Soviet Union aliyah and 1990s post-Soviet aliyah, took place from the 1970s onward. According to Anthony Julius, in 1989, "Soviet anti-Zionism was credibly considered the greatest threat to Israel and Jews generally. ... This 'anti-Zionism' survived the collapse of the Soviet system." In the 21st century, factions within American academia have supported boycotts of Israel using language that is Soviet in origin.

Arab and Palestinian anti-Zionism

Arab women protestors holding pro-Palestinian signs in front of the Israeli embassy in Amman, 2021

In a retrospective analysis of Arab anti-Zionism in 1978, Yehoshafat Harkabi argued, in a view reflected in the works of the anti-Zionist Russian-Jewish orientalist Maxime Rodinson, that Arab hostility to Zionism arose as a rational response in historical context to a genuine threat, and, with the establishment of Israel, their anti-Zionism was shaped as much by Israeli policies and actions as by traditional antisemitic stereotypes, and only later degenerated into an irrational attitude. Anne de Jong asserts that direct resistance to Zionism from the inhabitants of historical Palestine "focused less on religious arguments and was instead centered on countering the experience of colonial dispossession and opposing the Zionist enforcement of ethnic division of the indigenous population."

Until 1948, according to Derek Penslar, antisemitism in Palestine "grew directly out of the conflict with the Zionist movement and its gradual yet purposeful settlement of the country", rather than the European model vision of Jews as the cause of all the ills of mankind. According to Anthony Julius, anti-Zionism, a highly heterogeneous phenomenon, and Palestinian nationalism, are separate ideologies; one need not have an opinion on the Israeli–Palestinian conflict to be an anti-Zionist.

One Arab criticism of Zionism is that Islamic–Jewish relations were entirely peaceful until Zionism conquered Arab lands. Arab delegates to the United Nations also claimed that Zionists had unethically enticed Arab Jews to come to Israel. According to Gil Troy, neither claim is historically accurate, as Jews did not have the same rights as Muslims in these lands and had periodically experienced violent riots.

Perception of Zionism as racism

During the Cold War

In the 1960s and 1970s, Soviets and Americans interpreted the Arab–Israeli conflict as a proxy war between the totalitarianism of the Soviet–Arab alliance and the democracies of the Western world. Israel's victory in the Six-Day War of 1967 necessitated a diplomatic response by the Soviet–Arab alliance. The result was resolutions in the Organization for African Unity and the Non-Aligned Movement condemning Zionism and equating it with racism and apartheid during the early 1970s.

This culminated in November 1975 in the United Nations General Assembly's passage of Resolution 3379 by a vote of 72 to 35 (with 32 abstentions), which declared, "Zionism is a form of racism, and racial discrimination". The passage evoked, in the words of American U.N. Ambassador Daniel Patrick Moynihan, "a long mocking applause." U.N. representatives from Libya, Syria, and the PLO made speeches claiming that this resolution negated previous resolutions calling for land-for-peace agreements between Israel and its Arab neighbors. Israel's U.N. representative, Chaim Herzog, interpreted the resolution as an attack on Israel's legitimacy. African U.N. delegates from non-Arab countries also resented the resolution as a distraction from the fight against racism in places like South Africa and Rhodesia.

The decision was revoked on 16 December 1991, when the General Assembly passed Resolution 4686, repealing resolution 3379, by a vote of 111 to 25, with 13 abstentions and 17 delegations absent. Thirteen of the 19 Arab countries, including those engaged in negotiations with Israel, voted against the repeal, and another six were absent. All the ex-communist countries and most of the African countries who had supported Resolution 3379 voted to repeal it.

After the Cold War

In 1993, philosopher Cornel West wrote: "Jews will not comprehend what the symbolic predicament and literal plight of Palestinians in Israel means to blacks.... Blacks often perceive the Jewish defense of the state of Israel as a second instance of naked group interest, and, again, an abandonment of substantive moral deliberation." African-American support of Palestinians is frequently due to the consideration of Palestinians as people of color; political scientist Andrew Hacker writes: "The presence of Israel in the Middle East is perceived as thwarting the rightful status of people of color. Some blacks view Israel as essentially a white and European power, supported from the outside, and occupying space that rightfully belongs to the original inhabitants of Palestine."

In January 2015, the Lausanne movement published an article in its official journal comparing Christian Zionism, the crusades, and the Spanish Inquisition, and calling Zionism "apartheid on steroids". The Simon Wiesenthal Center called this last claim "the big lie", and rebutted the "dismissal of the validity of Israel's right to exist as the Jewish State".

Islamic perspectives

Quds Day demonstration in Qom, Iran

Muslims have made several arguments to oppose the state of Israel. Some Muslims view the State of Israel as an intrusion into what shari'a law defines as Dar al-Islam, a domain they believe should be ruled by Muslims, reflecting its historical conquest in the name of Islam. In addition, Quran 22:39–40 gives Muslims permission to fight those who "drove them from their homes", so some Muslims believe jihad against Israel was justified due to the 1948 Palestinian expulsions. Likewise, Iranian Islamists have cited the expulsion of Palestinians in their opposition to Israel. The founder of Hamas, Ahmad Yassin, said "we are not fighting Jews because they are Jews! We are fighting them because they assaulted us, they killed us, they took our land, our homes." Yusuf al-Qaradawi cited the expulsion of Palestinians. A fatwa from the European Council for Fatwa and Research condemned "Zionists who usurped Palestinian lands and forcibly expelled the Palestinians from their own homes."

Palestinian-American philosopher and scholar Ismail Raji al-Faruqi was a notable critic of Zionism, asserting that its nationalist ideology was incompatible with Judaism. In his book Islam and the Problem of Israel, first published in 1980, he examines the state of Israel from an Islamic perspective. Al-Faruqi argued that rather than providing security and dignity for Jews, Zionism had led to a precarious existence for Jews in Israel, where life was defined by conflict and dependence on international powers:

Zionism has not only contributed to this sad state of affairs. It is directly responsible for it. How, then, can it be said that it had succeeded in providing security for the Jew? Even in the very heartland of Zionism, in Israel, the Jew sits in the midst of an armory, surrounding himself with barbed wire, minefields, and all kinds of weaponry to prevent an onslaught which he knows for certain is coming, sooner or later. His very existence is a regimented spartanism, due in greatest measure to the bounty of international imperialism and colonialism. Thus, Israel, the so-called greatest achievement of Zionism, is really its greatest failure. For the very being of the Zionist state rests, in final analysis, on the passing whim of international politics.

Al-Faruqi argues that the injustices he attributes to Zionism require its dismantling, suggesting that Israeli Jews who renounce Zionism can live as an "ummatic community" within the Muslim world, following Jewish law as interpreted by rabbinic courts within an Islamic framework.

Left-wing politics

According to New York University social and cultural theorist Susie Linfield, one of the most pressing questions facing the New Left after World War II was "How can we maintain our traditional universalist values in light of the nationalist movements sweeping the formerly colonized world?"

During the late 1960s, anti-Zionism became a part of a collection of sentiments within the far-left politics, including anti-colonialism, anti-capitalism, and anti-Americanism. In this environment, Zionism became a representation of Western power. Indeed, philosopher Jean Améry argued that this "Zionism" was merely a straw man redefinition of the term, used to mean world Jewry. The far-left Israeli politician Simha Flapan lamented in 1968, "The socialist world approved the 'Holy War' of the Arabs against Israel in the disguise of a struggle against imperialism. ... Having agreed to the devaluation of its own ideals, [it] was ready to enter an alliance with reactionary and chauvinist appeals to genocide."

East German chairman Walter Ulbricht, 1960

East Germany's government was passionately anti-Zionist. From the 1950s through the 1970s, East Germany supplied Israel's neighboring Arab states with weapons. Immediately after the Six-Day War in 1967, East German Communist Party chairman Walter Ulbricht claimed that Israel had not been threatened by its neighboring Arab states before the war. He continually compared Israel to Nazi Germany. In 1969, West German left-wing anti-Zionists placed a bomb in a Jewish Community Center.

A series of anti-Zionist aircraft hijackings took place in the 1970s with left-wing groups' support. The most famous of these was the 1976 Air France hijacking perpetrated by the Popular Front for the Liberation of Palestine in coordination with the Revolutionary Cells. The hijackers released all the non-Jewish hostages without Israeli citizenship, but kept all the Israeli citizens (including those with dual citizenship) and Jewish people for ransom. The separation of Jewish non-Israelis and Israelis from non-Israelis—which, in essence, meant separating out the Jewish passengers generally—shocked many on the German left. To Joschka Fischer, the way the hijackers treated Jews opened his eyes to the violent, Nazi-like implications of anti-Zionism. A few years later, the Revolutionary Cells and another anti-Zionist group attempted to firebomb two German movie theaters that were showing a movie based on the hijacking.

Pro-Palestinian protest with placards demanding the US to stop funding of "Israeli apartheid" in Washington, DC, 2017

Some Jewish organizations oppose Zionism as an integral part of their anti-imperialism. Today, some secular Jews, particularly socialists and Marxists, continue to oppose the State of Israel on anti-imperialist and human rights grounds. Many oppose it as a form of nationalism, which they argue is a product of capitalism. One secular anti-Zionist group, the International Jewish Anti-Zionist Network, a socialist, antiwar, anti-imperialist organization, calls for "the dismantling of Israeli apartheid, return of Palestinian refugees, and the ending of the Israeli colonization of historic Palestine."

In the 2000s, leaders of the Respect Party and the Socialist Workers Party of the United Kingdom met with leaders of Hamas and Hezbollah at the Cairo Anti-war Conference. The result of the 2003 conference was a call to oppose "normalization with the Zionist entity".

Christian anti-Zionism

Protestants

In April 2013 the Church of Scotland published "The Inheritance of Abraham: A Report on the Promised Land", which rejects the idea of a special right of Jewish people to the Holy Land through analysis of scripture and Jewish theological claims. The report draws on the writings of anti-Zionist Jews and Christians. According to Ira Glunts, it was revised after Scottish Jews harshly criticized it, replacing input from Mark Braverman with material from Marc H. Ellis, both Jewish. The revision says that criticism of Israel's policies toward the Palestinians "should not be misunderstood as questioning the right of the State of Israel to exist".

In 2014, a controversy arose when the United States Presbyterian Church (PCUSA) published a study guide, Zionism Unsettled, quickly withdrawn from sale on its website, that asserted that the Israeli-Palestinian conflict was fueled by a "pathology inherent in Zionism". Cary Nelson argued that the work and the Church's position were flawed, anti-Zionist, and antisemitic. In 2022, the same denomination's general assembly determined that Israel is an apartheid state.

Catholics

The Catholic Church rejects a theological basis for Zionism and has historically opposed it. The Vatican has nonetheless had diplomatic relations with Israel since 1993 (as a result of the Oslo Accords). It has also had diplomatic relations with the State of Palestine since 2015.

Haredi Judaism

Members of Neturei Karta holding Palestinian flags and placards saying that "Judaism condemns the state of Israel and its atrocities" in London, 2022

Most Orthodox religious groups have accepted and actively support the State of Israel, even if they have not adopted "Zionist" ideology. The World Agudath Israel party (founded in Poland) has at times participated in Israeli government coalitions. Most religious Zionists hold pro-Israel views from a right-wing viewpoint. The main exceptions are Hasidic groups such as Satmar Hasidim, which have about 100,000 adherents worldwide and numerous different, smaller Hasidic groups, unified in America in the Central Rabbinical Congress of the United States and Canada and Israel in the Edah HaChareidis. Many Hasidic rabbis oppose the creation of a Jewish state. In 1959, the Satmar Hasidic group's leader, Rabbi Joel Teitelbaum, published the book VaYoel Moshe, which expounds an Orthodox position for anti-Zionism based on a derivation of halacha from an aggadic passage in the Babylonian Talmud's tractate Ketubot 111a. Teitelbaum writes that God and the Jewish people exchanged three oaths at the time of the Jews' exile from ancient Israel, forbidding the Jewish people from massively immigrating to the Land of Israel and from rebelling against the nations of the world.

Allegations of antisemitism

A sign held at a protest in Edinburgh, Scotland on January 10, 2009

Anti-Zionism spans a range of political, social, and religious views. According to Rony Brauman, a French physician, former president of Médecins sans frontières (Doctors without Borders), and the director of the Humanitarian and Conflict Response Institute (HCRI) at the University of Manchester, there are three kinds of perspectives on Zionism, pro and contra: a non-antisemitic anti-Zionism, an antisemitic anti-Zionism, and an antisemitic Zionism. Shany Mor writes that before 1948 anti-Zionism was not antisemitic, but since 1948 some amount of antisemitism has been at work.

In the early 21st century, it was also claimed that a "new antisemitism" had emerged that was rooted in anti-Zionism. Advocates of this notion argue that much of what purports to be criticism of Israel and Zionism is demonization, and has led to an international resurgence of attacks on Jews and Jewish symbols and an increased acceptance of antisemitic beliefs in public discourse. Critics of the concept have suggested that the characterization of anti-Zionism as antisemitic is inaccurate, sometimes obscures legitimate criticism of Israel's policies and actions, and trivializes antisemitism. David Myers says that the equation should not be made without "careful contextualization and delineation".

Jewish right to a state

It is often argued that anti-Zionism is antisemitic because it supposedly denies only Jews the right to have a state when all other nations have one, a position argued by Dina Porat and Emanuele Ottolenghi. By contrast, Peter Beinart argues that "barely anyone suggests that opposing a Kurdish or Catalan state makes you an anti-Kurdish or anti-Catalan bigot". For example, the 1970 UN Friendly Relations Declaration upheld all people's right to self-determination, but cautioned that did not necessarily imply the creation of independent states.

Edward Said opposed Zionism, and instead proposed that a binational Israeli-Palestinian state would grant Jews (as well as the Palestinians) the right to self-determination. Jewish philosophers such as Martin Buber and Hannah Arendt conceived Jewish self-determination in the form of a binational state that would give Palestinians and Jews equal rights. In 2021, an Israeli philosopher also proposed to realize Jewish self-determination through "a binational federation with the Palestinians".

In 2021, more than 200 scholars of Jewish studies drafted the Jerusalem Declaration on Antisemitism, in which they argue that denying Jews the right to a state is not inherently antisemitic. The declaration says, "It is not antisemitic to support arrangements that accord full equality to all inhabitants 'between the river and the sea,' whether in two states, a binational state, unitary democratic state, federal state, or in whatever form."

The American Jewish Committee said that denying Jews the right to a state is antisemitic, but also that Palestinians who seek a single binational state are not antisemitic. Anti-Defamation League director Jonathan Greenblatt told The New Yorker that denying Jews a state is discriminatory and therefore antisemitic, but when asked whether it is antisemitic for Palestinians to want a one-state solution, he said he was "not talking about that".

Equating and correlating anti-Zionism with antisemitism

As early as 1966, Webster's Third New International Dictionary cited anti-Zionism as one of the core meanings of antisemitism, and a year later, Martin Luther King Jr. was falsely cited as having made the same equation in a letter. In 1972, Abba Eban said that the task of dialogue with gentiles is to prove that there is no distinction between antisemitism and anti-Zionism. In 1978, Fred Halliday, rebuffing the equation of anti-Zionism and antisemitism, wrote that disavowals were constantly required given the frequency of the accusation. In the early 2000s, it became increasingly commonplace for defenders of Israel to regard criticism of Zionism and Israel as tantamount to, interchangeable with, or closely related to antisemitism. In 2007, Tony Judt considered the merging of the two categories in polemics relatively new. A 2003–04 European Monitoring Centre on Racism and Xenophobia report aroused intense controversy over aspects of its provisory definition of antisemitism, which many regarded as ambiguous in blurring distinctions to the point that the two concepts became porous.

Scholars who equate anti-Zionism and antisemitism include Robert S. Wistrich, former head of the Vidal Sassoon International Center for the Study of Antisemitism at the Hebrew University of Jerusalem, who argues that since 1948, anti-Zionism and antisemitism have merged and that much contemporary anti-Zionism, particularly forms that compare Zionism and Jews with Hitler and Nazi Germany, has become a form of antisemitism.

Jean Améry became convinced that anti-Zionism was an updated version of the antisemitism he experienced as a Holocaust survivor. In a 1969 essay, he argues that the anti-Zionists of his time may not have ill intentions against all Jews, but their intentions are irrelevant. Their philosophy has a centuries-old pedigree beginning with the false charge of deicide and culminating in Nazi propaganda. Améry did not expect anti-Zionists of his time to take an unbending pro-Israel stance in the conflict between Israelis and Palestinians; he merely beseeched them to think critically, use common sense, and judge Israel fairly.

In 2016, the International Holocaust Remembrance Alliance adopted a Working Definition of Antisemitism, one that was subsequently officially recognized by various governments, foremost among them the U.S. and France, which endorsed the equation of certain manifestations of anti-Zionism with antisemitism. 127 Jewish intellectuals in the diaspora and Israel formally protested the French resolution equating anti-Zionism with antisemitism, arguing that the definition was injurious to numerous anti-Zionist Jews.

Contemporary examples of antisemitism in public life, the media, schools, the workplace, and in the religious sphere could, taking into account the overall context, include, but are not limited to... Denying the Jewish people their right to self-determination, e.g., by claiming that the existence of a State of Israel is a racist endeavor.

International Holocaust Remembrance Association

Deborah E. Lipstadt has documented several cases of people who made remarks that were clearly against Jews, and when criticized, defended themselves by saying that they were against "Zionists".

Kenneth L. Marcus, former staff director at the U.S. Commission on Civil Rights, identifies four main views on the relationship between anti-Zionism and antisemitism, at least in North America. Marcus also writes that a 2006 study of 5,000 people in Europe concluded that antisemitic views correlate among respondents with hostility to Israel, a result that nevertheless does not mean one cannot be critical of Israeli policies without being antisemitic.

In 2010, Oxford University Press published Anthony Julius's book Trials of the Diaspora: A History of Anti-Semitism in England. In it, Julius claims that the borders between anti-Zionism and antisemitism are porous. He concedes that it is possible to be in conflict with a Jewish ideology without discriminating against Jews, but argues that anti-Zionists cross the line so often as to make the distinction meaningless.

Professor Jeffrey Herf of the University of Maryland, College Park wrote: "One distinctive feature of the secular leftist antagonism to Israel ... was its indignant assertion that it had absolutely nothing to do with antisemitism. Yet the eagerness with which Israel's enemies spread lies about Zionism's racist nature and were willing to compare the Jewish state to Nazi Germany suggested that an element of antisemitism was indeed at work in the international Left as it responded to Israel's victory in June 1967." Anti-Zionists responded to the war's outcome by describing Israel in terms familiar from antisemitic stereotypes.

In December 2023, the U.S. House of Representatives passed a resolution equating antisemitism with anti-Zionism. Palestinian rights advocates called the resolution a "dangerous" move aimed at limiting freedom of expression and diverting attention from the war in Gaza.

View that the two are not interlinked

Several comparative surveys in Europe and the U.S. have failed to find a statistical correlation between criticism of Israeli policies and antisemitism:

  • Political scientist Peter Beattie, in an analytical overview of the specialist literature that used polling data in several countries to test the purported link between criticism of Israel and antisemitism, found no necessary empirical correlation, cautioning that assertions of such an inherent connection are calumnious. He concludes, "Most of those critical of Israeli policies are not anti-Semites. Only a fraction of the US population harbours anti-Semitic views, and while logically this fraction would be overrepresented among critics of Israel, the present and prior research indicate that they comprise only a small part. Inaccurate charges of anti-Semitism are not merely calumny, but threaten to debase the term itself and weaken its connection to a very real, and very dangerous, form of prejudice."
  • The German sociologist Werner Bergmann's analysis of empirical polling data from Germany concluded that whereas right-wing respondents critical of Israel tended to have views overlapping with classical antisemitism, left-wing interviewees' criticisms of Israel did not involve criticism of Jews.

Former director of the Institute for Jewish Policy Research Antony Lerman argues:

The anti-Zionism equals antisemitism argument drains the word antisemitism of any useful meaning. For it means that to count as an antisemite, it is sufficient to hold any view ranging from criticism of the policies of the current Israeli government to denial that Israel has the right to exist as a state, without having to subscribe to any of those things which historians have traditionally regarded as making up an antisemitic worldview: hatred of Jews per se, belief in a worldwide Jewish conspiracy, belief that Jews generated communism and control capitalism, belief that Jews are racially inferior and so on. Moreover, while theoretically allowing that criticism of Israeli governments is legitimate, in practice it virtually proscribes any such thing.

Shifting positions on the Zionist/Anti-Zionist spectrum

Before World War II and the creation of the State of Israel, the debate between Zionists and anti-Zionists was largely an internal Jewish affair; the questions it sought to answer involved Jewish self-definition and the proper use of political power in the Jewish diaspora. Once it became clear to most Jews that all of Zionism's alternatives failed to prevent the Holocaust, the debate largely subsided in the Jewish community. Most prewar Jewish anti-Zionists died in the Holocaust, emigrated to Israel, or became disillusioned by the Soviet Union.

Nevertheless, individual Jews have changed their position on the spectrum of pro- and anti-Zionist views:

  • Jacob Israël de Haan made aliyah to Palestine in 1919 as a convinced religious Zionist. Deeply troubled by Zionist attitudes toward Arabs, he began to champion Arab rights while also advocating on behalf of the Orthodox Ashkenazi Agudat Israel/Haredim communities, which maintained excellent relations with Arabs, and with which he felt more spiritually comfortable. His effectiveness with the Mandatory authorities in protesting Zionist claims to represent all Jews while they ignored dissent from Jerusalem's anti-Zionist orthodox communities was resented. He was ridiculed by Zionists, who assassinated him in 1924.
  • Isaac Deutscher decidedly opposed Zionism, then altered his judgment in the wake of the Holocaust, to support the foundation of Israel – the creation of a nation-state precisely when they were becoming anachronistic – even at the Palestinians' expense, then wavered at the end between contempt for Arab states' antisemitic demagoguery and odium for Israelis' fanatical triumphalism. In "Prussians of the Middle East", at the end of the Six-Day War, he prophesied that the victory would prove to be a disaster for Israel.
  • Noam Chomsky is often said to be an anti-Zionist. He has said that the word "Zionism" has changed connotations since his youth, with the boundaries of what are considered Zionist and anti-Zionist views shifting. The Zionist groups he led as a youth would now be called anti-Zionist because they mostly opposed the idea of a Jewish state. In 1947, in his youth, Chomsky's support for a socialist binational state, in conjunction with his opposition to any semblance of a theocratic system of governance in Israel, was considered well within the mainstream of secular Zionism; by 1987, it put him solidly in the anti-Zionist camp.
Photo of Hannah Arendt lecturing in Germany, 1955
Hannah Arendt lecturing in Germany, 1955

Zionists have on occasion interpreted criticism by pro-Zionists in the fold as evidence that the critics are anti-Zionist. One could oppose Zionism's central goal, the formation of a Jewish national state, and yet not be anti-Zionist. This was the case with some pre-state groups, political heirs of the cultural Zionism tradition founded by Ahad Ha'am, such as Brit Shalom and, later, Ihud. Hannah Arendt, who worked for the Jewish Agency for Palestine in the 1930s and was active in facilitating Jewish migration to Palestine from France, devoted much of her thinking in the 1940s to a critique of political Zionism. The Zionism she advocated had a broader definition: Jewish political agency anywhere. When partition was imminent, she came out strongly against the concept of a Jewish, as opposed to binational, state. While writing Eichmann in Jerusalem, she clarified her views: "I am not against Israel on principle, I am against certain important Israeli policies." Arendt took Israel's side in the Arab–Israeli conflict and rejoiced at its victory in the Six-Day War.

In 2024, Yossi Klein Halevi described three ways in which anti-Zionism threatens the Jewish people: the dismantling of the Jewish state would be extremely dangerous for Israeli Jews, leaving them defenseless; the criminalization of Jewish survival undermines Jewish identity; and anti-Zionism marginalizes diaspora Jews in their societies.

Far-right politics

Anti-Zionism has a long history of being supported by individuals and groups associated with Third Position, right-wing, and fascist (or "neo-fascist") political views. A number of militantly racist groups and their leaders are anti-Zionist, such as David Duke, the Ku Klux Klan, and various other Aryan/White-supremacist groups. In these instances, anti-Zionism is usually also deeply antisemitic, and often revolves around conspiracy theories discussed below.

Conspiracy theories

First edition of The Protocols of the Elders of Zion

The Protocols of the Elders of Zion came to be exploited by Arab anti-Zionists, although some have tried to discourage its usage. The Protocols itself makes no reference to Zionism, but after World War I, claims that the book is a record of the Zionist Congress became routine. The first Arabic translation of The Protocols was published in 1925, contemporaneous with a major wave of Jewish immigration to Palestine. A similar conspiracy theory is the belief in a powerful, well-financed "Zionist lobby" that clamps down on criticism of Israel and conceals its crimes. Zionists are able to do this in the United Kingdom, according to Shelby Tucker and Tim Llewellyn, because they are in "control of our media" and "suborned Britain's civil structures, including government, parliament, and the press."

Anti-Zionism is a major component of Holocaust denial. According to one strain of Holocaust denial, Zionists cooperated with the Nazis and are guilty of the crimes committed during the Holocaust. Deniers see Israel as having somehow benefited from what they call "the big lie" that is the Holocaust. Some Holocaust deniers claim that their ideology is motivated by concern for Palestinian rights.

As an alternative to outright Holocaust denial, Holocaust inversion acknowledges the Holocaust happened and uses it to demonize Israel. Just after the October 7, 2023, Hamas-led attacks on Israel, many instances of Holocaust inversion were reported on social media, "with the memory of the Holocaust weaponized".

Woozle effect

From Wikipedia, the free encyclopedia
https://en.wikipedia.org/wiki/Woozle_effect
Piglet and Pooh go in circles hunting a Woozle—but the tracks they follow are merely their own.

The Woozle effect, also known as evidence by citation, occurs when a source is widely cited for a claim that the source does not adequately support, giving said claim undeserved credibility. If results are not replicated and no one notices that a key claim was never well-supported in its original publication, faulty assumptions may affect further research.

The Woozle effect is somewhat similar to circular reporting in journalism, where someone makes a questionable claim, and a journalist unthinkingly accepts the claim and republishes it without realizing its dubious and unreliable origins. In turn, other journalists and the public then continue to repeat and duplicate the unsupported claim.

Origin and definition

A Woozle is an imaginary character in the A. A. Milne book Winnie-the-Pooh, published in 1926. In chapter three, "In which Pooh and Piglet Go Hunting and Nearly Catch a Woozle", Winnie-the-Pooh and Piglet start following tracks left in snow believing they are the tracks of an imaginary animal called a woozle. The tracks keep multiplying until Christopher Robin explains to them that they have been following their own tracks in circles around a spinney.

Prior to the introduction of the specific term "Woozle effect", the underlying concept dates back over 60 years. Bevan (1953), writing about scientific methodology and research errors in the field of psychology, uses the term "scientific woozle hunters". Wohlwill (1963) refers to a "hunt for the woozle" in social science research, and Stevens (1971) cautions readers about woozles in the study of a misquoted letter.

The term "woozle effect" was coined by Beverly D. Houghton in 1979 during a panel discussion, in order: "...to critique the burgeoning belief in a myth/archetype [of] the batterer emerging from the [then] virtually nonexistent literature and the popular press." More recently she described the effect as "reification-by-accretion". Other researchers have attributed the term to Richard Gelles (1980), and to Gelles and Murray A. Straus (1988). Gelles and Straus argue that the woozle effect describes a pattern of bias seen within social sciences and which is identified as leading to multiple errors in individual and public perception, academia, policy making, and government.

A woozle is also a claim, made about research, that is not supported by original findings. According to Donald G. Dutton, a woozle effect, or a woozle, occurs when frequent citation of previous publications that lack evidence misleads individuals, groups and the public into thinking or believing there is evidence, and non-facts become urban myths and factoids. The creation of woozles is often linked to the changing of language from qualified ("it may", "it might", "it could") to absolute form ("it is"), firming up language and introducing ideas and views not held by an original author or supported by evidence.

Dutton sees the woozle effect as an example of confirmation bias and links it to belief perseverance and groupthink. Because in the social sciences empirical evidence may be based on experiential reports rather than objective measurements, there may be a tendency for researchers to align evidence with expectation. According to Dutton, it is also possible that the social sciences may be likely to align with contemporary views and ideals of social justice, leading to bias in favor of those ideals. Gambrill (2012) links the woozle effect to the processes that create pseudoscience. Gambrill and Reiman (2011) also link it with more deliberate propaganda techniques; they also identify introductory phrases like "Every one knows ...", "It is clear that ...", "It is obvious that ...", "It is generally agreed that ..." as alarm bells that what follows might be a Woozle line of reasoning.

Examples

In 1980, Gelles illustrated the Woozle effect, showing how work by Gelles (1974) based on a small sample and published in The Violent Home by Straus, who had written the foreword for Gelles's book, was presented as if it applied to a large sample. Both of these were then cited by Langley & Levy in their 1977 book, Wife Beating: The Silent Crisis. In the 1998 book Intimate Violence, Gelles and Straus use the Winnie-the-Pooh woozle to illustrate how poor practice in research and self-referential research causes older research to be taken as fresh evidence causing error and bias.

One notable example of the effect can be seen in citations of "Addiction Rare in Patients Treated with Narcotics", a letter to the editor by Jane Porter and Hershel Jick published by the New England Journal of Medicine in 1980. The letter, which was five sentences long and unlikely to have been peer reviewed according to a NEJM spokesperson, reported findings from analysis of medical records regarding the use of pain medication for hospital patients and concluded that "despite widespread use of narcotic drugs in hospitals, the development of addiction is rare in medical patients with no history of addiction". Although the study only concerned use of narcotics in hospital settings, over time it was increasingly cited to support claims that addiction to painkillers was similarly uncommon among patients prescribed narcotics to take at home. The authors of a 2017 letter published in the NEJM concerning the original 1980 letter found 608 citations of Porter and Jick, with a "sizable increase" after the release of OxyContin in 1995: Purdue Pharma, the manufacturers of OxyContin, cited the Porter and Jick study, as well as others, to argue that it carried a low risk of addiction. In 2007, Purdue and three of the company's senior executives pleaded guilty to federal criminal charges that they had misled regulators, physicians and patients about the addiction risk associated with taking OxyContin. The 1980 study was also misrepresented in both academic and non-academic publications: it was described as an "extensive study" by Scientific American, whilst Time said that it was a "landmark study" showing that "exaggerated fear that patients would become addicted" to opiates was "basically unwarranted", and an article in the journal Seminars in Oncology claimed that the Porter and Jick study examined cancer patients when the letter made no mention of what illnesses the patients were suffering from. The authors of the 2017 NEJM letter suggested that the inappropriate citations of the 1980 study played a role in the North American opioid epidemic by under-representing the risk of addiction: the page for the Porter and Jick letter on the Journal's website now includes a note informing the reader that it "has been 'heavily and uncritically cited' as evidence that addiction is rare with opioid therapy".

In a study conducted by the Vera Institute of Justice, Weiner and Hala (2008) reported some of the research-related difficulties associated with measuring human trafficking. They describe and map the unfolding of the Woozle effect in connection with prevalence estimates of human trafficking. Searching the relevant literature between 1990 and 2006, Weiner and Hala found 114 prevalence estimates in 45 publications. Only one of the publications cited original research, and several prevalence estimates appeared unsourced. The authors concluded that the sources they reviewed lacked citations, adequate operational definition, and discussion of methodology. Stransky and Finkelhor (2008/2012) criticize the general methodology involved in human trafficking research. They cite the Woozle effect and post a prominent warning on the first page of their report cautioning against citing any specific estimates they present, as the close inspection of the figures "...reveals that none are based on a strong scientific foundation."

Gambrill and Reiman (2011) analyze scientific papers and mass-market communications about social anxiety and conclude that many of them engage in disease mongering by presenting the disease model of social anxiety as an incontrovertible fact by resorting to unchallenged repetition techniques and by leaving out of the discourse any competing theories. Gambrill and Reiman further note that even after educating their subjects about the tell-tale signs of such techniques, many of them still failed to pick up the signs in a practical test.

Geraldine Hoff Doyle claimed to have been the inspiration for the "We Can Do It!" poster, achieving fame and honors when her statement – likely false – was repeated without confirmation.
James J. Kimble gives as an example the 1994–2015 historiography of the 1943 American "We Can Do It!" wartime poster. After Michigan resident Geraldine Hoff Doyle said in 1994 that she was the real-life model for the poster, many sources repeated her assertion without checking the two foundational assumptions: that Doyle was the young factory worker pictured in a 1942 wartime photograph, and that the photograph had inspired commercial artist J. Howard Miller to create the poster. Though some media representations described the connection as unconfirmed, many more enthusiastically endorsed it. The weight of these multiple endorsements gave Doyle's story a "convincing" authority, despite the lack of authority in establishing the connection. In 2015, Kimble found the original photographic print of the factory worker, its caption identifying the young woman as Naomi Parker, working in California in March 1942, when Doyle was still in high school.

Leukemia

From Wikipedia, the free encyclopedia
Leukemia
Other namesLeukaemia
A Wright's stained bone marrow aspirate smears from individuals with B-cell acute lymphoblastic leukemia(left) and acute myeloid leukemia (right). Myeloid leukemia cells are usually larger, contain prominent nucleoli, and specific, but not mandatory, cytoplasmic inclusions – Auer rods (purple needles).
Pronunciation
SpecialtyHematology and oncology
SymptomsBleeding, bruising, fatigue, fever, increased risk of infections
Usual onsetAll ages, most common in 60s and 70s. It is the most common malignant cancer in children, but the cure rates are also higher for them.
CausesInherited and environmental factors
Risk factorsSmoking, family history, ionizing radiation, some chemicals such as trichloroethylene, prior chemotherapy, Down syndrome.
Diagnostic methodBlood tests, bone marrow biopsy
TreatmentChemotherapy, radiation therapy, targeted therapy, bone marrow transplant, supportive care
PrognosisFive-year survival rate 67% (U.S.)
Frequency2.3 million (2015)
Deaths353,500 (2015)

Leukemia (also spelled leukaemia; pronounced /lˈkmə/ loo-KEE-mee-ə) is a group of blood cancers that usually begin in the bone marrow and produce high numbers of abnormal blood cells. These blood cells are not fully developed and are called blasts or leukemia cells. Symptoms may include bleeding and bruising, bone pain, fatigue, fever, and an increased risk of infections. These symptoms occur due to a lack of normal blood cells. Diagnosis is typically made by blood tests or bone marrow biopsy.

The exact cause of leukemia is unknown. A combination of genetic factors and environmental (non-inherited) factors are believed to play a role. Risk factors include smoking, ionizing radiation, petrochemicals (such as benzene), prior chemotherapy, and Down syndrome. People with a family history of leukemia are also at higher risk. There are four main types of leukemia—acute lymphoblastic leukemia (ALL), acute myeloid leukemia (AML), chronic lymphocytic leukemia (CLL) and chronic myeloid leukemia (CML)—and a number of less common types. Leukemias and lymphomas both belong to a broader group of tumors that affect the blood, bone marrow, and lymphoid system, known as tumors of the hematopoietic and lymphoid tissues.

Treatment may involve some combination of chemotherapy, radiation therapy, targeted therapy, and bone marrow transplant, with supportive and palliative care provided as needed. Certain types of leukemia may be managed with watchful waiting. The success of treatment depends on the type of leukemia and the age of the person. Outcomes have improved in the developed world. Five-year survival rate was 67% in the United States in the period from 2014 to 2020. In children under 15 in first-world countries, the five-year survival rate is greater than 60% or even 90%, depending on the type of leukemia. For infants (those diagnosed under the age of 1), the survival rate is around 40%. In children who are cancer-free five years after diagnosis of acute leukemia, the cancer is unlikely to return.

In 2015, leukemia was present in 2.3 million people worldwide and caused 353,500 deaths. In 2012, it had newly developed in 352,000 people. It is the most common type of cancer in children, with three-quarters of leukemia cases in children being the acute lymphoblastic type. However, over 90% of all leukemias are diagnosed in adults, CLL and AML being most common. It occurs more commonly in the developed world.

Classification

Four major kinds of leukemia
Cell type Acute Chronic
Lymphocytic leukemia
(or "lymphoblastic")
Acute lymphoblastic leukemia
(ALL)
Chronic lymphocytic leukemia
(CLL)
Myelogenous leukemia
("myeloid" or "nonlymphocytic")
Acute myelogenous leukemia
(AML or myeloblastic)
Chronic myelogenous leukemia
(CML)

General classification

Clinically and pathologically, leukemia is subdivided into a variety of large groups. The first division is between its acute and chronic forms:

  • Acute leukemia is characterized by a rapid increase in the number of immature blood cells. The crowding that results from such cells makes the bone marrow unable to produce healthy blood cells resulting in low hemoglobin and low platelets. Immediate treatment is required in acute leukemia because of the rapid progression and accumulation of the malignant cells, which then spill over into the bloodstream and spread to other organs of the body. Acute forms of leukemia are the most common forms of leukemia in children.
  • Chronic leukemia is characterized by the excessive buildup of relatively mature, but still abnormal, white blood cells (or, more rarely, red blood cells). Typically taking months or years to progress, the cells are produced at a much higher rate than normal, resulting in many abnormal white blood cells. Whereas acute leukemia must be treated immediately, chronic forms are sometimes monitored for some time before treatment to ensure maximum effectiveness of therapy. Chronic leukemia mostly occurs in older people but can occur in any age group.

Additionally, the diseases are subdivided according to which kind of blood cell is affected. This divides leukemias into lymphoblastic or lymphocytic leukemias and myeloid or myelogenous leukemias:

Combining these two classifications provides a total of four main categories. Within each of these main categories, there are typically several subcategories. Finally, some rarer types are usually considered to be outside of this classification scheme.

Specific types

Pre-leukemia

Signs and symptoms

Common symptoms of chronic or acute leukemia

The most common symptoms in children are easy bruising, pale skin, fever, and an enlarged spleen or liver.

Damage to the bone marrow, by way of displacing the normal bone marrow cells with higher numbers of immature white blood cells, results in a lack of blood platelets, which are important in the blood clotting process. This means people with leukemia may easily become bruised, bleed excessively, or develop pinprick bleeds (petechiae).

White blood cells, which are involved in fighting pathogens, may be suppressed or dysfunctional. This could cause the person's immune system to be unable to fight off a simple infection or to start attacking other body cells. Because leukemia prevents the immune system from working normally, some people experience frequent infection, ranging from infected tonsils, sores in the mouth, or diarrhea to life-threatening pneumonia or opportunistic infections.

Finally, the red blood cell deficiency leads to anemia, which may cause dyspnea and pallor.

Some people experience other symptoms, such as fevers, chills, night sweats, weakness in the limbs, feeling fatigued and other common flu-like symptoms. Some people experience nausea or a feeling of fullness due to an enlarged liver and spleen; this can result in unintentional weight loss. Blasts affected by the disease may come together and become swollen in the liver or in the lymph nodes causing pain and leading to nausea.

If the leukemic cells invade the central nervous system, then neurological symptoms (notably headaches) can occur. Uncommon neurological symptoms like migraines, seizures, or coma can occur as a result of brain stem pressure. All symptoms associated with leukemia can be attributed to other diseases. Consequently, leukemia is always diagnosed through medical tests.

The word leukemia, which means 'white blood', is derived from the characteristic high white blood cell count that presents in most affected people before treatment. The high number of white blood cells is apparent when a blood sample is viewed under a microscope, with the extra white blood cells frequently being immature or dysfunctional. The excessive number of cells can also interfere with the level of other cells, causing further harmful imbalance in the blood count.

Some people diagnosed with leukemia do not have high white blood cell counts visible during a regular blood count. This less-common condition is called aleukemia. The bone marrow still contains cancerous white blood cells that disrupt the normal production of blood cells, but they remain in the marrow instead of entering the bloodstream, where they would be visible in a blood test. For a person with aleukemia, the white blood cell counts in the bloodstream can be normal or low. Aleukemia can occur in any of the four major types of leukemia, and is particularly common in hairy cell leukemia.

Causes

Studies in 2009 and 2010 have shown a positive correlation between exposure to formaldehyde and the development of leukemia, particularly myeloid leukemia. The different leukemias likely have different causes.

Leukemia, like other cancers, results from mutations in the DNA. Certain mutations can trigger leukemia by activating oncogenes or deactivating tumor suppressor genes, and thereby disrupting the regulation of cell death, differentiation or division. These mutations may occur spontaneously or as a result of exposure to radiation or carcinogenic substances.

Among adults, the known causes are natural and artificial ionizing radiation and petrochemicals, notably benzene and alkylating chemotherapy agents for previous malignancies. Use of tobacco is associated with a small increase in the risk of developing acute myeloid leukemia in adults. Cohort and case-control studies have linked exposure to some petrochemicals and hair dyes to the development of some forms of leukemia. Diet has very limited or no effect, although eating more vegetables may confer a small protective benefit.

Viruses have also been linked to some forms of leukemia. For example, human T-lymphotropic virus (HTLV-1) causes adult T-cell leukemia.

A few cases of maternal-fetal transmission (a baby acquires leukemia because its mother had leukemia during the pregnancy) have been reported. Children born to mothers who use fertility drugs to induce ovulation are more than twice as likely to develop leukemia during their childhoods than other children.

In a recent systematic review and meta-analysis of any type of leukemia in neonates using phototherapy, typically to treat neonatal jaundice, a statistically significant association was detected between using phototherapy and myeloid leukemia. However, it is still questionable whether phototherapy is genuinely the cause of cancer or simply a result of the same underlying factors that gave rise to cancer. 

Radiation

Large doses of Sr-90 (called a bone seeking radioisotope) from nuclear reactor accidents, increases the risk of bone cancer and leukemia in animals and is presumed to do so in people.

Genetic conditions

Some people have a genetic predisposition towards developing leukemia. This predisposition is demonstrated by family histories and twin studies. The affected people may have a single gene or multiple genes in common. In some cases, families tend to develop the same kinds of leukemia as other members; in other families, affected people may develop different forms of leukemia or related blood cancers.

In addition to these genetic issues, people with chromosomal abnormalities or certain other genetic conditions have a greater risk of leukemia. For example, people with Down syndrome have a significantly increased risk of developing forms of acute leukemia (especially acute myeloid leukemia), and Fanconi anemia is a risk factor for developing acute myeloid leukemia. Mutation in SPRED1 gene has been associated with a predisposition to childhood leukemia.

Inherited bone marrow failure syndromes represent a kind of premature aging of the bone marrow. In people with these syndromes and in older adults, mutations associated with clonal hematopoiesis may arise as an adaptive response to a progressively deteriorating hematopoietic niche, i.e., a depleting pool of Hematopoietic stem cells. The mutated stem cells then acquire a self-renewal advantage.

Chronic myelogenous leukemia is associated with a genetic abnormality called the Philadelphia translocation; 95% of people with CML carry the Philadelphia mutation, although this is not exclusive to CML and can be observed in people with other types of leukemia.

Non-ionizing radiation

Whether or not non-ionizing radiation causes leukemia has been studied for several decades. The International Agency for Research on Cancer expert working group undertook a detailed review of all data on static and extremely low frequency electromagnetic energy, which occurs naturally and in association with the generation, transmission, and use of electrical power. They concluded that there is limited evidence that high levels of ELF magnetic (but not electric) fields might cause some cases of childhood leukemia. No evidence for a relationship to leukemia or another form of malignancy in adults has been demonstrated. Since exposure to such levels of ELFs is relatively uncommon, the World Health Organization concludes that ELF exposure, if later proven to be causative, would account for just 100 to 2400 cases worldwide each year, representing 0.2 to 4.9% of the total incidence of childhood leukemia for that year (about 0.03 to 0.9% of all leukemias).

Diagnosis

The increase in white blood cells in leukemia

Diagnosis is usually based on repeated complete blood counts and a bone marrow examination following observations of the symptoms. Sometimes, blood tests may not show that a person has leukemia, especially in the early stages of the disease or during remission. A lymph node biopsy can be performed to diagnose certain types of leukemia in certain situations.

Following diagnosis, blood chemistry tests can be used to determine the degree of liver and kidney damage or the effects of chemotherapy on the person. When concerns arise about other damages due to leukemia, doctors may use an X-ray, MRI, or ultrasound. These can potentially show leukemia's effects on such body parts as bones (X-ray), the brain (MRI), or the kidneys, spleen, and liver (ultrasound). CT scans can be used to check lymph nodes in the chest, though this is uncommon.

Despite the use of these methods to diagnose whether or not a person has leukemia, many people have not been diagnosed because many of the symptoms are vague, non-specific, and can refer to other diseases. For this reason, the American Cancer Society estimates that at least one-fifth of the people with leukemia have not yet been diagnosed.

Treatment

Most forms of leukemia are treated with pharmaceutical medication, typically combined into a multi-drug chemotherapy regimen. Some are also treated with radiation therapy. In some cases, a bone marrow transplant is effective.

Acute lymphoblastic

Management of ALL is directed towards control of bone marrow and systemic (whole-body) disease. Additionally, treatment must prevent leukemic cells from spreading to other sites, particularly the central nervous system (CNS); periodic lumbar punctures are used for diagnostic purposes and to administer intrathecal prophylactic methotrexate. In general, ALL treatment is divided into several phases:

  • Induction chemotherapy to bring about bone marrow remission. For adults, standard induction plans include prednisone, vincristine, and an anthracycline drug; other drug plans may include L-asparaginase or cyclophosphamide. For children with low-risk ALL, standard therapy usually consists of three drugs (prednisone, L-asparaginase, and vincristine) for the first month of treatment.
  • Consolidation therapy or intensification therapy to eliminate any remaining leukemia cells. There are many different approaches to consolidation, but it is typically a high-dose, multi-drug treatment that is undertaken for a few months. People with low- to average-risk ALL receive therapy with antimetabolite drugs such as methotrexate and 6-mercaptopurine (6-MP). People who are high-risk receive higher drug doses of these drugs, plus additional drugs.
  • CNS prophylaxis (preventive therapy) to stop cancer from spreading to the brain and nervous system in high-risk people. Standard prophylaxis may include radiation of the head and/or drugs delivered directly into the spine.
  • Maintenance treatments with chemotherapeutic drugs to prevent disease recurrence once remission has been achieved. Maintenance therapy usually involves lower drug doses and may continue for up to three years.
  • Alternatively, allogeneic bone marrow transplantation may be appropriate for high-risk or relapsed people.

Chronic lymphocytic

Decision to treat

Hematologists base CLL treatment on both the stage and symptoms of the individual person. A large group of people with CLL have low-grade disease, which does not benefit from treatment. Individuals with CLL-related complications or more advanced disease often benefit from treatment. In general, the indications for treatment are:

Treatment approach

Most CLL cases are incurable by present treatments, so treatment is directed towards suppressing the disease for many years, rather than curing it. The primary chemotherapeutic plan is combination chemotherapy with chlorambucil or cyclophosphamide, plus a corticosteroid such as prednisone or prednisolone. The use of a corticosteroid has the additional benefit of suppressing some related autoimmune diseases, such as immunohemolytic anemia or immune-mediated thrombocytopenia. In resistant cases, single-agent treatments with nucleoside drugs such as fludarabine, pentostatin, or cladribine may be successful. Younger and healthier people may choose allogeneic or autologous bone marrow transplantation in the hope of a permanent cure.

Acute myelogenous

Many different anti-cancer drugs are effective for the treatment of AML. Treatments vary somewhat according to the age of the person and according to the specific subtype of AML. Overall, the strategy is to control bone marrow and systemic (whole-body) disease, while offering specific treatment for the central nervous system (CNS), if involved.

In general, most oncologists rely on combinations of drugs for the initial, induction phase of chemotherapy. Such combination chemotherapy usually offers the benefits of early remission and a lower risk of disease resistance. Consolidation and maintenance treatments are intended to prevent disease recurrence. Consolidation treatment often entails a repetition of induction chemotherapy or the intensification of chemotherapy with additional drugs. By contrast, maintenance treatment involves drug doses that are lower than those administered during the induction phase.

Chronic myelogenous

There are many possible treatments for CML, but the standard of care for newly diagnosed people is imatinib (Gleevec) therapy. Compared to most anti-cancer drugs, it has relatively few side effects and can be taken orally at home. With this drug, more than 90% of people will be able to keep the disease in check for at least five years, so that CML becomes a chronic, manageable condition.

In a more advanced, uncontrolled state, when the person cannot tolerate imatinib, or if the person wishes to attempt a permanent cure, then an allogeneic bone marrow transplantation may be performed. This procedure involves high-dose chemotherapy and radiation followed by infusion of bone marrow from a compatible donor. Approximately 30% of people die from this procedure.

Hairy cell

Decision to treat
People with hairy cell leukemia who are symptom-free typically do not receive immediate treatment. Treatment is generally considered necessary when the person shows signs and symptoms such as low blood cell counts (e.g., infection-fighting neutrophil count below 1.0 K/μL), frequent infections, unexplained bruises, anemia, or fatigue that is significant enough to disrupt the person's everyday life.

Typical treatment approach
People who need treatment usually receive either one week of cladribine, given daily by intravenous infusion or a simple injection under the skin, or six months of pentostatin, given every four weeks by intravenous infusion. In most cases, one round of treatment will produce a prolonged remission.

Other treatments include rituximab infusion or self-injection with Interferon-alpha. In limited cases, the person may benefit from splenectomy (removal of the spleen). These treatments are not typically given as the first treatment because their success rates are lower than cladribine or pentostatin.

T-cell prolymphocytic

Most people with T-cell prolymphocytic leukemia, a rare and aggressive leukemia with a median survival of less than one year, require immediate treatment.

T-cell prolymphocytic leukemia is difficult to treat, and it does not respond to most available chemotherapeutic drugs. Many different treatments have been attempted, with limited success in certain people: purine analogues (pentostatin, fludarabine, cladribine), chlorambucil, and various forms of combination chemotherapy (cyclophosphamide, doxorubicin, vincristine, prednisone CHOP, cyclophosphamide, vincristine, prednisone [COP], vincristine, doxorubicin, prednisone, etoposide, cyclophosphamide, bleomycin VAPEC-B). Alemtuzumab (Campath), a monoclonal antibody that attacks white blood cells, has been used in treatment with greater success than previous options.

Some people who successfully respond to treatment also undergo stem cell transplantation to consolidate the response.

Juvenile myelomonocytic

Treatment for juvenile myelomonocytic leukemia can include splenectomy, chemotherapy, and bone marrow transplantation.

Prognosis

The success of treatment depends on the type of leukemia and the age of the person. Outcomes have improved in the developed world. The average five-year survival rate is 65% in the United States. In children under 15, the five-year survival rate is greater (60 to 85%), depending on the type of leukemia. In children with acute leukemia who are cancer-free after five years, the cancer is unlikely to return.

Outcomes depend on whether it is acute or chronic, the specific abnormal white blood cell type, the presence and severity of anemia or thrombocytopenia, the degree of tissue abnormality, the presence of metastasis and lymph node and bone marrow infiltration, the availability of therapies and the skills of the health care team. Treatment outcomes may be better when people are treated at larger centers with greater experience.

Epidemiology

Deaths due to leukemia per million persons in 2012
  0–7
  8–13
  14–22
  23–29
  30–34
  35–39
  40–46
  47–64
  65–85
  86–132

In 2010, globally, approximately 281,500 people died of leukemia. In 2000, approximately 256,000 children and adults around the world developed a form of leukemia, and 209,000 died from it. This represents about 3% of the almost seven million deaths due to cancer that year, and about 0.35% of all deaths from any cause. Of the sixteen separate sites the body compared, leukemia was the 12th most common class of neoplastic disease and the 11th most common cause of cancer-related death. Leukemia occurs more commonly in the developed world.

United States

About 245,000 people in the United States are affected with some form of leukemia, including those that have achieved remission or cure. Rates from 1975 to 2011 have increased by 0.7% per year among children. Approximately 44,270 new cases of leukemia were diagnosed in the year 2008 in the US. This represents 2.9% of all cancers (excluding simple basal cell and squamous cell skin cancers) in the United States, and 30.4% of all blood cancers.

Among children with some form of cancer, about a third have a type of leukemia, most commonly acute lymphoblastic leukemia. A type of leukemia is the second most common form of cancer in infants (under the age of 12 months) and the most common form of cancer in older children. Boys are somewhat more likely to develop leukemia than girls, and white American children are almost twice as likely to develop leukemia than black American children. Only about 3% cancer diagnoses among adults are for leukemias, but because cancer is much more common among adults, more than 90% of all leukemias are diagnosed in adults.

Race is a risk factor in the United States. Hispanics, especially those under the age of 20, are at the highest risk for leukemia, while whites, Native Americans, Asian Americans, and Alaska Natives are at higher risk than African Americans.

More men than women are diagnosed with leukemia and die from the disease. Around 30 percent more men than women have leukemia.

Australia

In Australia, leukemia is the eleventh most common cancer. In 2014–2018, Australians diagnosed with leukemia had a 64% chance (65% for males and 64% for females) of surviving for five years compared to the rest of the Australian population–there was a 21% increase in survival rates between 1989–1993.

UK

Overall, leukemia is the eleventh most common cancer in the UK (around 8,600 people were diagnosed with the disease in 2011), and it is the ninth most common cause of cancer death (around 4,800 people died in 2012).

History

Photo of the upper body of a bespectacled man
Rudolf Virchow

Leukemia was first described by anatomist and surgeon Alfred-Armand-Louis-Marie Velpeau in 1827. A more complete description was given by pathologist Rudolf Virchow in 1845. Around ten years after Virchow's findings, pathologist Franz Ernst Christian Neumann found that the bone marrow of a deceased person with leukemia was colored "dirty green-yellow" as opposed to the normal red. This finding allowed Neumann to conclude that a bone marrow problem was responsible for the abnormal blood of people with leukemia.

By 1900, leukemia was viewed as a family of diseases as opposed to a single disease. By 1947, Boston pathologist Sidney Farber believed from past experiments that aminopterin, a folic acid mimic, could potentially cure leukemia in children. The majority of the children with ALL who were tested showed signs of improvement in their bone marrow, but none of them were actually cured. Nevertheless, this result did lead to further experiments.

In 1962, researchers Emil J. Freireich, Jr. and Emil Frei III used combination chemotherapy to attempt to cure leukemia. The tests were successful with some people surviving long after the tests.

Etymology

Observing an abnormally large number of white blood cells in a blood sample from a person, Virchow called the condition Leukämie in German, which he formed from the two Greek words leukos (λευκός), meaning 'white', and haima (αἷμα), meaning 'blood'. It was formerly also called leucemia.

Society and culture

According to Susan Sontag, leukemia was often romanticized in 20th-century fiction, portrayed as a joy-ending, clean disease whose fair, innocent and gentle victims die young or at the wrong time. As such, it was the cultural successor to tuberculosis, which held this cultural position until it was discovered to be an infectious disease. The 1970 romance novel Love Story is an example of this romanticization of leukemia.

In the United States, around $5.4 billion is spent on treatment a year.

Research directions

Significant research into the causes, prevalence, diagnosis, treatment, and prognosis of leukemia is being performed. Hundreds of clinical trials are being planned or conducted at any given time. Studies may focus on effective means of treatment, better ways of treating the disease, improving the quality of life for people, or appropriate care in remission or after cures.

In general, there are two types of leukemia research: clinical or translational research and basic research. Clinical/translational research focuses on studying the disease in a defined and generally immediately applicable way, such as testing a new drug in people. By contrast, basic science research studies the disease process at a distance, such as seeing whether a suspected carcinogen can cause leukemic changes in isolated cells in the laboratory or how the DNA changes inside leukemia cells as the disease progresses. The results from basic research studies are generally less immediately useful to people with the disease.

Treatment through gene therapy is currently being pursued. One such approach used genetically modified T cells, known as chimeric antigen receptor T cells (CAR-T cells), to attack cancer cells. In 2011, a year after treatment, two of the three people with advanced chronic lymphocytic leukemia were reported to be cancer-free and in 2013, three of five subjects who had acute lymphocytic leukemia were reported to be in remission for five months to two years. Subsequent studies with a variety of CAR-T types continue to be promising. As of 2018, two CAR-T therapies have been approved by the Food and Drug Administration. CAR-T treatment has significant side effects, and loss of the antigen targeted by the CAR-T cells is a common mechanism for relapse. The stem cells that cause different types of leukemia are also being researched.

Pregnancy

Leukemia is rarely associated with pregnancy, affecting only about 1 in 10,000 pregnant women. How it is handled depends primarily on the type of leukemia. Nearly all leukemias appearing in pregnant women are acute leukemias. Acute leukemias normally require prompt, aggressive treatment, despite significant risks of pregnancy loss and birth defects, especially if chemotherapy is given during the developmentally sensitive first trimester. Chronic myelogenous leukemia can be treated with relative safety at any time during pregnancy with Interferon-alpha hormones. Treatment for chronic lymphocytic leukemias, which are rare in pregnant women, can often be postponed until after the end of the pregnancy.

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