The Emperor of All Maladies: A Biography of Cancer (35 page)

The panel’s final report
, entitled the
National Program for the Conquest of Cancer
, was issued in the winter of 1970, and its conclusions were predictable: “In the past, when the Federal Government has desired to give top priority to a major scientific project of the magnitude of that involved in the conquest of cancer, it has, on occasion, with considerable success, given the responsibility for the project to an independent agency.” While tiptoeing around the idea, the panel was proposing the creation of an independent cancer agency—a NASA for cancer.

The agency would start with a budget of $400 million, then its allocations would increase by $100 million to $150 million per year, until, by the mid-1970s, it would stand at $1 billion. When Schmidt was asked if he thought that the country could “afford such a program,” he was unhesi
tant in his reply: “
Not only can we afford the effort
, we cannot afford
not
to do it.”

On March 9, 1971, acting on the panel’s recommendations
, Ted Kennedy and Jacob Javits floated a Senate Bill—S 1828, the Conquest of Cancer Act—to create a National Cancer Authority, an independent, self-governing agency for cancer research. The director of the authority would be appointed by the president and confirmed by the Senate—again underscoring an extraordinary level of autonomy. (Usually, disease-specific institutes, such as the National Heart Institute, were overseen by the NIH.) An advisory board of eighteen members would report back to Congress about progress on cancer. That panel would comprise scientists, administrators, politicians, physicians—and, most controversially, “lay individuals,” such as Lasker, Foote, and Bobst, whose sole task would be to keep the public eye trained sharply on the war. The level of funding, public scrutiny, and autonomy would be unprecedented in the history of the NIH—and arguably in the history of American science.

Mary Lasker was busy maneuvering behind the scenes to whip up support for the Kennedy/Javits bill. In January 1971, she fired off a cavalcade of letters to her various friends seeking support for the independent cancer agency. In February, she hit upon another tactical gem:
she persuaded her close friend Ann Landers
(her real name was Eppie Lederer), the widely read advice columnist from Chicago, to publish a column about cancer and the Kennedy bill, positioning it exactly at the time that the vote was fermenting in the Senate.

Landers’s column appeared on April 20, 1971
. It began solemnly, “Dear Readers: If you are looking for a laugh today, you’d better skip Ann Landers. If you want to be part of an effort that might save millions of lives—maybe your own—please stay with me. . . . How many of us have asked the question, ‘If this great country of ours can put a man on the moon why can’t we find a cure for cancer?’”

Landers’s answer to that question—echoing the Laskerites—was that cancer was missing not merely a medical cure but a political cure. “If enough citizens let their senators know they want Bill S-34 passed, it will pass. . . . Vote for S-34,” she pleaded. “And sign your name please.”

Even Landers and Lasker were shocked by the ensuing “blizzard” of mail. “
I saw trucks arriving at the Senate
,” the journalist Barbara Walters
recalled. Letters poured in by the bagful—about a million in all—pushing the Senate mailroom to its breaking point. One senator wrote that he received sixty thousand letters.
An exasperated secretary charged with sorting
the mail hung up the sign
IMPEACH ANN LANDERS
on her desk.
Stuart Symington, the senator from Missouri
, wrote to Landers begging her to post another column advising people to stop writing. “Please Eppie,” he begged, “I got the message.”

The Senate was also getting the message. In June 1971, a modified version of the Kennedy/Javits bill appeared on the floor. On Wednesday afternoon, July 7, after dozens of testimonies by scientists and physicians, the motion was finally put to a vote. At five thirty that evening, the votes were counted: 79 in favor and 1 against.

The swift and decisive victory in the Senate was precisely as the Laskerites had planned it. The cancer bill was now destined for the House, but its passage there promised to be a much tougher hurdle. The Laskerites had few allies and little influence in the lower chamber. The House wanted more testimony—and not just testimony from the Laskerites’ carefully curated panel. It solicited opinions from physicians, scientists, administrators and policymakers—and those opinions, it found, diverged sharply from the ones presented to the Senate. Philip Lee, the former assistant secretary of health complained, “
Cancer is not simply an island
waiting in isolation for a crash program to wipe it out. It is in no way comparable to a moon shot—to a Gemini or an Apollo program—which requires mainly the mobilization of money, men, and facilities to put together in one imposing package the scientific knowledge we already possess.” The Apollo mission and the Manhattan Project, the two models driving this War on Cancer were both
technological
achievements that stood on the shoulders of long and deep scientific discoveries (atomic physics, fluid mechanics, and thermodynamics). In contrast, even a cursory understanding of the process that made cells become malignant was missing. Seizing on the Laskerites’ favorite metaphor, Sol Spiegelman, the Columbia University cancer scientist, argued, “
An all-out effort at this time
would be like trying to land a man on the moon without knowing Newton’s laws of gravity.”
James Watson, who had discovered the structure of DNA
, unloosed a verbal rampage against the Senate bill. “
Doing ‘relevant’ research
is not necessarily doing ‘good’ research,” Watson would
later write. “In particular we must reject the notion that we will be lucky. . . . Instead we will be witnessing a massive expansion of well-intentioned mediocrity.”

Others argued that the notion of a targeted war on a particular disease inevitably distracted from natural synergies with other arenas of research, forcing cancer researchers to think “inside the box.” An NIH administrator complained, “
In a nutshell
, [the act] states that all NIH institutes are equal, but one [the NCI] is more equal than the others.” Yet others argued that the metaphor of war would inevitably become a distraction. It would whip up a froth of hype and hope, and the letdown would be catastrophic. “
I suspect there is trouble ahead
for research in cancer,” Irvine Page, the editor of a prominent scientific journal wrote. “People have become impatient with what they take to be lack of progress. Having seen what can be achieved by systems analysis, directed research, and great coordinated achievements such as the moon walk, they transfer the same thinking to the conquest of cancer all too readily.” This bubble would inevitably burst if the cancer project stalled or failed.

Nixon, meanwhile, had reached the edge of his patience. Elections were fast approaching in 1972. Earlier that year, commentators such as Bob Wiedrich from the
Chicago Tribune
had laid down the stakes: “
If Richard Milhous Nixon
. . . can achieve these two giant goals—an end to the war in Vietnam and defeat of the ravages of cancer—then he will have carved for himself in the history of this nation a niche of Lincolnesque proportions, for he will have done more than put a man on the moon.”

An end to the war in Vietnam was nowhere in sight, but a campaign against cancer seemed vastly more tractable, and Nixon was willing to force a cancer bill—
any
cancer bill—through Congress. When the ever-resourceful Schmidt went to visit him in the Oval Office that fall of 1971 (in part, to propose a compromise), Nixon reassured Schmidt that he would finagle—or strong-arm—a solution: “
Don’t worry about it
. I’ll take care of that.”

In November 1971, Paul Rogers
, a Democrat in the House from Florida, crafted a compromise cancer bill. In keeping with the Laskerites’ vision, Rogers’s bill proposed a vast increase in the budget for cancer research. But in contrast to the Kennedy/Javits bill, it proposed to sharply restrict the autonomy of the National Cancer Institute. There would be no “NASA
for cancer.” But given the vast increase in money, the focused federal directive, and the staggering rise in hope and energy, the rhetoric of a “war” on cancer would still be fully justified. The Laskerites, their critics, and Nixon would all go home happy.

In December 1971, the House finally
put a modified version of Rogers’s bill to a vote. The verdict was nearly unanimous: 350 votes for and 5 against. A week later, a House-Senate meeting resolved minor differences in their bills, and the final legislation was sent to the president to sign.

On December 23, 1971, on a cold, windswept afternoon
in Washington, Nixon signed the National Cancer Act at a small ceremony in the White House. The doors to the State Dining Room were thrown open, and the president seated himself at a small wooden desk. Photographers parried for positions on the floor around the desk. Nixon leaned over and signed the act with a quick flourish. He handed the pen as a gift to Benno Schmidt, the chair of the Panel of Consultants. Mary Lasker beamed forcefully from her chair. Farber chose not to attend.

For the Laskerites, the date marked a bittersweet vindication. The flood of money authorized for cancer research and control—$400
million for 1972
; $500 million for 1973; and $600 million for 1974 (a total of $1.5 billion over the next three years)—was a monumental achievement.
If money was “frozen energy
,” as Mary Lasker often described it, then this, at last, was a pot of energy to be brought to full boil.

But the passage of the bill had also been a reality check. The overwhelming opinion among scientists (outside those on the Panel of Consultants) was that this was a premature attack on cancer. Mary Lasker was bitingly critical of the final outcome.
The new bill, she told a reporter, “contained nothing
that was useful that gave any guts to the Senate bill.”

Humiliated by the defeat,
Lasker and Sidney Farber withdrew
soon after the House vote from the political world of cancer. Farber went back to Boston and nursed his wounds privately. Lasker retired to her museum-like apartment on Beekman Place in New York—a white box filled with white furniture—and switched the focus of her efforts from cancer to urban beautification projects. She would continue to actively campaign in Washington for health-related legislation and award the Lasker Prize,
an annual award given to
researchers for breakthroughs
in medicine and biological sciences. But the insistent, urgent vigor that she had summoned during the two-decade campaign for a War on Cancer, the near-molten energy capable of flowing into any federal agency and annihilating resistance in its course, dissipated slowly. In April 1974, a young journalist went to Lasker to ask her about one of her many tulip-planting proposals for New York. At the end of the interview, the reporter asked Lasker about her perception of her own power: was she not one of the most powerful women in the country? Lasker cut the journalist short: “
Powerful? I don’t know
. No. If I were really powerful, I’d have gotten more done.”