A Few Lessons About Twitter, Cancer And Publishing A recent debate over a woman's decision to chronicle her cancer treatment online raises a lot of complicated questions, including ones about the relationship between traditional publishing and platforms like Twitter.

A Few Lessons About Twitter, Cancer And Publishing

Hands typing on a keyboard

I think that Bill Keller probably meant well when he wrote an op-ed for The New York Times this week about Lisa Bonchek Adams, a woman with cancer who's been writing about it, along with a lot of other things, on Twitter and on a personal blog.

In fact, there's a lot of content in his piece that Adams probably wouldn't even disagree with — his argument against battle terminology for cancer patients ("Adams is the standard-bearer for an approach to cancer that honors the warrior, that may raise false hopes, and that, implicitly, seems to peg patients like my father-in-law as failures") sounds an awful lot like one of her own blog posts ("When I die don't say I 'fought a battle.' Or 'lost a battle.' Or 'succumbed.' Don't make it sound like I didn't try hard enough, or have the right attitude, or that I simply gave up.").

It's hard to believe — and a little unfair to suggest — that Adams or her readers have done anything, or believe anything, that conflicts with the piece's closing quote from the medical school dean who said that while her writing had its place, "equal praise is due to those who accept an inevitable fate with grace and courage."

And yet, the piece enraged a lot of Times readers, according to public editor Margaret Sullivan, who reported that she heard a great deal of negative feedback, and who herself said "there are issues here of tone and sensitivity."

Boy ... you can say that again. By closing the piece with a piece about a dean who "cringes" at Adams' alleged embrace of a "combat metaphor" (unsupported by any quotes from her own writing) and salutes those who show grace and courage, Keller implicitly suggests that to handle your disease as Adams has is one way to go. The other way to go is with grace and courage. And that's very unfortunate.

Adams herself says that Keller, along with his wife Emma Gilbey Keller, who also wrote a controversial column critiquing Adams' handling of her cancer (that was in The Guardian and has since been taken down), have misrepresented the basic facts of her medical status, and Keller has already admitted he got the number of kids she has wrong. These disputes have been pretty thoroughly inventoried in a piece at Medium. And writers at outlets including The Atlantic and The New Yorker have been sharply critical of the need to explain to a cancer patient how to handle (and discuss) having cancer.

But while the personal angles on this story — why would two married people in the same week devote entire columns to debating the same cancer patient's chronicle of her disease? — are the most compelling and important, there is a publishing and media story here, which is that Bill Keller's column, in particular, reflects a misunderstanding of what Twitter is.

Keller's writing about Adams is full of little code words that downplay the significance of her writing, her readers and her community, undoubtedly unconsciously. She has "blogged and tweeted," rather than "she has written." Her audience is "rapt," rather than appreciative or respectful. Her criticisms of elements of the breast-cancer lobby are "potshots."

She is not an advocate for Sloan-Kettering, where she's being treated, but a "proselytizer." She "insists she is not dying," a construct that implies she is dying, and he knows it, but she won't admit it. She is "bedridden," rather than hospitalized. She doesn't type but "pecks." She is living "onstage." The expert he consulted has "perused" Adams' blog, a wiggly term that could mean "read for a while," but given the bad information that made it into the piece, might also mean "skim with skepticism."

This continues in the statement Keller gave to Sullivan. He says he's received negative responses on Twitter, which "encourages reflexes rather than reflection." Those who come to the Times and comment are "thoughtful and valuable," because newspaper comment sections provide so much "space for nuance." (On behalf of everyone who reads newspaper comment sections, and in the language of my people, let me just say: OMG LOL!!!!!!!!!!) He makes it pretty clear that in his mind, he's been criticized by people who either didn't understand his point or didn't care to "reflect."

You can certainly interpret his piece as the reflections of a man uncomfortable with Adams' way of having cancer. Or you can interpret it as the reflections of a man uncomfortable with her way of talking about having cancer. But you can also see in it the deep skepticism so many people with long histories in traditional publishing have about social media, in part because they want to comment on it from outside, not inside. (Keller has a Twitter account but doesn't use it much; it dates to 2009 but contains only 325 tweets.)

Keller repeatedly implies that Lisa Bonchek Adams has brought upon herself any scrutiny he wants to bring to bear on how she's chosen to manage having cancer. Because she tweets about it, he concludes, she's made it a topic for everyone else to write op-eds about.

But that's a flawed analysis. That assumes that the only potential reason not to write an op-ed about whether someone else is having cancer correctly is privacy. In fact, the reason not to write an op-ed about whether someone else is having cancer correctly might be something else entirely: a recognition of the limited value of your own opinion about someone else's medical treatment when you aren't privy to the details, or a decision to exercise restraint, or an understanding of how personal two interlocking decisions might be — the decision to write about cancer, and the decision to read about it.

The relaxed nature of social media doesn't change the fact that if you are asking for comment on someone else's writing, "perusal" might not be adequate or fair, and pervasive claims that she applies a "combat metaphor" to cancer should, just as if you were talking about a person doing traditional writing, be accompanied by some examples of her actually applying one.

I wonder sometimes whether the self-disclosure and informality of Twitter leads journalists to conclude they have different obligations to those who write on Twitter than to those who write elsewhere, because once you step outside of traditional publishing, you're in a sort of free-for-all where whatever anybody says is your own fault, because you opened your mouth. Thus, Keller devotes an entire column to a Twitter account he doesn't seem to have spent all that much time with (or if he did, he doesn't seem to have drawn reliable detail from), when I suspect there's almost no chance he would have written an entire column about a book he hadn't read carefully.

Here's my theory: Traditional publishing applies a sort of Presumption Of Importance to personal writing. It presumes you would not write about your experiences unless you wanted to advocate for your way as the right way, because in traditional publishing, the ideal is that space is limited, so editorial judgment filters only the most important and most special experiences into personal essays. Thus, it's very difficult for traditional publishers to believe that you might tweet about your experience simply for the benefit of those who may find it useful without particularly believing in your own exceptionalism.

Contrary to Keller's characterization of Adams' tweets as "broadcasts," they are the opposite — they are narrowcasts, particular to those who want this kind of close-up view. They don't have that Presumption Of Importance, of correctness, of answering a broad societal need. They don't represent Adams claiming that her way is the one right way, and the support of her readers doesn't necessarily represent ideological loyalty as much as gratitude and respect and sympathy, person to person.

Twitter is sort of small-p publishing, but it's not large-P Publishing as Keller perhaps understands it. It's not meant to announce its own heft as appearing on an op-ed page does. No one at a meeting has signed off; no one has given Adams permission to write about her treatment; no one has affirmed that, yes, this is important enough to share. Twitter (like the Internet in general) is a "pull" medium, not a "push" medium; it is fed by specific and fluid choices, not longstanding trust in curation (not that I have anything against trust in curation; almost everyone I know consumes a combination of curated and not-so-curated content).

Anyone who finds this Not Their Bag will simply not read it; she is taking up no ink and no oxygen that rightly belongs to others. She didn't ask for endorsement, she didn't ask for sign-off, she didn't ask for agreement. She's just telling a story.