The Emperor of All Maladies: A Biography of Cancer (21 page)

“
If a toothpaste
. . . deserved advertising at the rate of two or three or four million dollars a year,” Mary Lasker reasoned, “then research against diseases maiming and crippling people in the United States and in the rest of the world deserved hundreds of millions of dollars.” Within just a few years, she transformed, as
BusinessWeek
magazine once put it, into “
the fairy godmother of medical research
.”

The “fairy godmother” blew into the world of cancer research one morning with the force of an unexpected typhoon.
In April 1943, Mary Lasker visited
the office of Dr. Clarence Cook Little, the director of the American Society for the Control of Cancer in New York. Lasker was interested in finding out what exactly his society was doing to advance cancer research, and how her foundation could help.

The visit left her cold
. The society, a professional organization of doctors and a few scientists, was self-contained and moribund, an ossifying Manhattan social club.
Of its small annual budget of
about $250,000, it spent an even smaller smattering on research programs. Fund-raising was outsourced to an organization called the Women’s Field Army, whose volunteers were not represented on the ASCC board. To the Laskers, who were accustomed to massive advertising blitzes and saturated media attention—to “salesmanship in print”—the whole effort seemed haphazard, ineffectual, stodgy, and unprofessional. Lasker was bitingly critical: “
Doctors,” she wrote, “are not administrators
of large amounts of money. They’re usually really small businessmen . . . small professional men”—men who clearly lacked a systematic vision for cancer. She made a $5,000 donation to the ASCC and promised to be back.

Lasker quickly got to work on her own. Her first priority was to make a vast public issue out of cancer. Sidestepping major newspapers and promi
nent magazines, she began with the one outlet of the media that she knew would reach furthest into the trenches of the American psyche:
Reader’s Digest
.
In October 1943, Lasker persuaded a friend
at the
Digest
to run a series of articles on the screening and detection of cancer. Within weeks, the articles set off a deluge of postcards, telegrams, and handwritten notes to the magazine’s office, often accompanied by small amounts of pocket money, personal stories, and photographs. A soldier grieving the death of his mother sent in a small contribution: “
My mother died from cancer
a few years ago. . . . We are living in foxholes in the Pacific theater of war, but would like to help out.” A schoolgirl whose grandfather had died of cancer enclosed a dollar bill. Over the next months, the
Digest
received thousands of letters and $300,000 in donations, exceeding the ASCC’s entire annual budget.

Energized by the response, Lasker now set about thoroughly overhauling the flailing ASCC in the larger hopes of reviving the flailing effort against cancer. In 1949, a friend wrote to her, “
A two-pronged attack
on the nation’s ignorance of the facts of its health could well be undertaken: a long-range program of joint professional-lay cooperation . . . and a shorter-range pressure group.” The ASCC, then, had to be refashioned into this “shorter-range pressure group.” Albert Lasker, who joined the ASCC board,
recruited Emerson Foote
, an advertising executive, to join the society to streamline its organization. Foote, just as horrified by the mildewy workings of the agency as the Laskers, drafted an immediate action plan: he would transform the moribund social club into a highly organized lobbying group. The mandate demanded men of action: businessmen, movie producers, admen, pharmaceutical executives, lawyers—friends and contacts culled from the Laskers’ extensive network—rather than biologists, epidemiologists, medical researchers, and doctors. By 1945, the nonmedical representation in the ASCC governing board had vastly increased, edging out its former members.
The “Lay Group
,” as it was called, rechristened the organization the American Cancer Society, or the ACS.

Subtly, although discernibly, the tone of the society changed as well. Under Little, the ASCC had spent its energies drafting insufferably detailed memorandums on standards of cancer care for medical practitioners. (Since there was little treatment to offer, these memoranda were not particularly useful.) Under the Laskers, predictably, advertising and fund-raising efforts began to dominate its agenda.
In a single year, it printed 9 million
“educational” pieces, 50,000 posters, 1.5 million window stickers, 165,000
coin boxes, 12,000 car cards, and 3,000 window exhibits. The Women’s Field Army—the “
Ladies’ Garden Club
,” as one Lasker associate scathingly described it—was slowly edged out and replaced by an intense, well-oiled fund-raising machine. Donations shot through the roof: $832,000 in 1944, $4,292,000 in 1945, $12,045,000 in 1947.

Money, and the shift in public visibility, brought inevitable conflicts between the former members and the new ones. Clarence Little, the ASCC president who had once welcomed Lasker into the group, found himself increasingly marginalized by the Lay Group. He complained that the lobbyists and fund-raisers were “
unjustified, troublesome and aggressive
”—but it was too late. At the society’s annual meeting in 1945, after a bitter showdown with the “laymen,” he was forced to resign.

With Little deposed and the board replaced, Foote and Lasker were unstoppable.
The society’s bylaws and constitution were rewritten
with nearly vengeful swiftness to accommodate the takeover, once again emphasizing its lobbying and fund-raising activities. In a telegram to Mary Lasker, Jim Adams, the president of the Standard Corporation (and one of the chief instigators of the Lay Group), laid out the new rules, arguably among the more unusual set of stipulations to be adopted by a scientific organization: “
The Committee should not include
more than four professional and scientific members. The Chief Executive should be a layman.”

In those two sentences, Adams epitomized the extraordinary change that had swept through the ACS. The society was now a high-stakes juggernaut spearheaded by a band of fiery “laymen” activists to raise money and publicity for a medical campaign. Lasker was the center of this collective, its nucleating force, its queen bee. Collectively, the activists began to be known as the “Laskerites” in the media. It was a name that they embraced with pride.

In five years, Mary Lasker had raised the cancer society from the dead. Her “shorter-range pressure group” was working in full force. The Laskerites now had their long-range target: Congress. If they could obtain
federal
backing for a War on Cancer, then the scale and scope of their campaign would be astronomically multiplied.

“
You were probably the first person
to realize that the War against Cancer has to be fought first on the floor of Congress—in order to continue the fight in laboratories and hospitals,” the breast cancer patient and
activist Rose Kushner once wrote admiringly to Mary Lasker. But cannily, Lasker grasped an even more essential truth: that the fight had to
begin
in the lab before being brought to Congress. She needed yet another ally—someone from the world of science to initiate a fight for science funding. The War on Cancer needed a bona fide scientific sponsor among all the advertisers and lobbyists—a real doctor to legitimize the spin doctors. The person in question would need to understand the Laskerites’ political priorities almost instinctually, then back them up with unquestionable and unimpeachable scientific authority. Ideally, he or she would be immersed in cancer research, yet willing to emerge out of that immersion to occupy a much larger national arena. The one man—and perhaps the only man—who could possibly fit the role was Sidney Farber.

In fact, their needs were perfectly congruent: Farber needed a political lobbyist as urgently as the Laskerites needed a scientific strategist. It was like the meeting of two stranded travelers, each carrying one-half of a map.

Farber and Mary Lasker met in Washington in late 1940s, not long after Farber had shot to national fame with his antifolates. In the winter of 1948, barely a few months after Farber’s paper on antifolates had been published, John Heller, the director of the NCI, wrote to Lasker introducing her to the idea of chemotherapy and to the doctor who had dreamed up the notion in Boston. The idea of chemotherapy—a chemical that could cure cancer outright (“
a penicillin for cancer
,” as the oncologist Dusty Rhoads at Memorial Hospital liked to describe it)—fascinated Lasker.
By the early 1950s, she was regularly
corresponding with Farber about such drugs. Farber wrote back long, detailed, meandering letters—“
scientific treatises
,” he called them—educating her on his progress in Boston.

For Farber, the burgeoning relationship with Lasker had a cleansing, clarifying quality—“a catharsis,” as he called it. He unloaded his scientific knowledge on her, but more important, he also unloaded his scientific and political ambition, an ambition he found easily reflected, even magnified, in her eyes. By the mid-1950s, the scope of their letters had considerably broadened: Farber and Lasker openly broached the possibility of launching an all-out, coordinated attack on cancer. “
An organizational pattern
is devel
oping at a much more rapid rate than I could have hoped,” Farber wrote. He spoke about his visits to Washington to try to reorganize the National Cancer Institute into a more potent and directed force against cancer.

Lasker was already
a “regular on the Hill
,” as one doctor described her—her face, with its shellacked frieze of hair, and her hallmark gray suit and pearls omnipresent on every committee and focus group related to health care. Farber, too, was now becoming a “regular.” Dressed perfectly for his part in a crisp, dark suit, his egghead reading-glasses often perched at the edge of his nose, he was a congressman’s spitting image of a physician-scientist. He possessed an “evangelistic pizzazz” for medical science, an observer recalled. “
Put a tambourine in
[his] hands” and he would immediately “go to work.”

To Farber’s evangelistic tambourine, Lasker added her own drumbeats of enthusiasm. She spoke and wrote passionately and confidently about her cause, emphasizing her points with quotes and questions. Back in New York, she employed a retinue of assistants to scour newspapers and magazines and clip out articles containing even a passing reference to cancer—all of which she read, annotated on the margins with questions in small, precise script, and distributed to the other Laskerites every week.

“
I have written to you so many times
in what is becoming a favorite technique—mental telepathy,” Farber wrote affectionately to Lasker, “but such letters are never mailed.” As acquaintance bloomed into familiarity, and familiarity into friendship, Farber and Lasker struck up a synergistic partnership that would stretch over decades. In a letter written in 1954, Farber used the word
crusade
to describe their campaign against cancer. The word was deeply symbolic. For Sidney Farber, as for Mary Lasker, the cancer campaign was indeed turning into a “crusade,” a scientific battle imbued with such fanatical intensity that only a religious metaphor could capture its essence. It was as if they had stumbled upon an unshakable, fixed vision of a cure—and they would stop at nothing to drag even a reluctant nation toward it.