Читать книгу The Emperor of All Maladies - Siddhartha Mukherjee, Siddhartha Mukherjee - Страница 24

“They form a society”

All of this demonstrates why²⁵⁸ few research scientists are in policy-making positions of public trust. Their training for detail produces tunnel vision, and men of broader perspective are required for useful application of scientific progress.

—Michael Shimkin

I am aware of some alarm²⁵⁹ in the scientific community that singling out cancer for . . . a direct presidential initiative will somehow lead to the eventual dismantling of the National Institutes of Health. I do not share these feelings. . . . We are at war with an insidious, relentless foe. [We] rightly demand clear decisive action—not endless committee meetings, interminable reviews and tired justifications of the status quo.

—Lister Hill

In 1831, Alexis de Tocqueville, the French aristocrat, toured the United States and was astonished by the obsessive organizational energy of its citizens. “Americans of all ages,²⁶⁰ all conditions, and all dispositions constantly form associations . . . of a thousand other kinds—religious, moral, serious, futile, general or restricted, enormous or diminutive,” Tocqueville wrote. “Americans make associations to give entertainments, to found seminaries, to build inns, to construct churches, to diffuse books, to send missionaries to the antipodes. . . . If it is proposed to inculcate some truth or to foster some feeling by the encouragement of a great example, they form a society.”

More than a century after Tocqueville toured the States, as Farber sought to transform the landscape of cancer, he instinctively grasped the truth behind Tocqueville’s observation. If visionary changes were best forged by groups of private citizens forming societies, then Farber needed such a coalition to launch a national attack on cancer. This was a journey that he could not begin or finish alone. He needed a colossal force behind him—a force that would far exceed the Jimmy Fund in influence, organization, and money. Real money, and the real power to transform, still lay under congressional control. But prying open vast federal coffers meant deploying the enormous force of a society of private citizens. And Farber knew that this scale of lobbying was beyond him.

There was, he knew, one person who possessed the energy, resources, and passion for this project: a pugnacious New Yorker who had declared it her personal mission to transform the geography of American health through group-building, lobbying, and political action. Wealthy, politically savvy, and well connected, she lunched with the Rockefellers, danced with the Trumans, dined with the Kennedys, and called Lady Bird Johnson by her first name. Farber had heard of her from his friends and donors in Boston. He had run into her during his early political forays in Washington. Her disarming smile and frozen bouffant were as recognizable in the political circles in Washington as in the salons of New York. Just as recognizable was her name: Mary Woodard Lasker.

Mary Woodard was born in Watertown, Wisconsin, in 1900. Her father, Frank Woodard, was a successful small-town banker. Her mother, Sara Johnson, had emigrated from Ireland in the 1880s, worked as a saleswoman at the Carson’s department store in Chicago, and ascended briskly through professional ranks to become one of the highest-paid saleswomen at the store. Salesmanship, as Lasker would later write, was “a natural talent” for Johnson. Johnson had later turned from her work at the department store to lobbying for philanthropic ventures and public projects—selling ideas instead of clothes. She was, as Lasker once put it, a woman who “could sell²⁶¹ . . . anything that she wanted to.”

Mary Lasker’s own instruction in sales began in the early 1920s, when, having graduated from Radcliffe College, she found her first job selling European paintings on commission for a gallery in New York—a cutthroat profession that involved as much social maneuvering as canny business sense. In the mid-1930s, Lasker left the gallery to start an entrepreneurial venture called Hollywood Patterns, which sold simple prefab dress designs to chain stores. Once again, good instincts crisscrossed with good timing. As women joined the workforce in increasing numbers in the 1940s, Lasker’s mass-produced professional clothes found a wide market. Lasker emerged from the Depression and the war financially rejuvenated. By the late 1940s, she had grown into an extraordinarily powerful businesswoman, a permanent fixture in the firmament of New York society, a rising social star.

In 1939, Mary Woodard met Albert Lasker²⁶², the sixty-year-old president of Lord and Thomas, an advertising firm based in Chicago. Albert Lasker, like Mary Woodard, was considered an intuitive genius in his profession. At Lord and Thomas, he had invented and perfected a new strategy of advertising that he called “salesmanship in print.” A successful advertisement, Lasker contended, was not merely a conglomeration of jingles and images designed to seduce consumers into buying an object; rather, it was a masterwork of copywriting that would tell a consumer why to buy a product. Advertising was merely a carrier for information and reason, and for the public to grasp its impact, information had to be distilled into its essential elemental form. Each of Lasker’s widely successful ad campaigns—for Sunkist oranges, Pepsodent toothpaste, and Lucky Strike cigarettes among many others—highlighted this strategy. In time, a variant of this idea, of advertising as a lubricant of information and of the need to distill information into elemental iconography would leave a deep and lasting impact on the cancer campaign.

Mary and Albert had a brisk romance and a whirlwind courtship, and they were married just fifteen months after²⁶⁴ they met—Mary for the second time, Albert for the third. Mary Lasker was now forty years old. Wealthy, gracious, and enterprising, she now launched a search for her own philanthropic cause—retracing her mother’s conversion from a businesswoman into a public activist.

For Mary Lasker, this search soon turned inward, into her personal life. Three memories from her childhood and adolescence haunted her. In one, she awakes from a terrifying illness—likely a near-fatal bout of bacterial dysentery or pneumonia—febrile and confused, and overhears a family friend say to her mother that she will likely not survive: “Sara, I don’t think that you will ever raise her.”

In another, she has accompanied her mother to visit her family’s laundress in Watertown, Wisconsin. The woman is recovering from surgery for breast cancer—radical mastectomies performed on both breasts. Lasker enters a dark shack with a low, small cot with seven children running around and she is struck by the desolation and misery of the scene. The notion of breasts being excised to stave cancer—“Cut off ?” Lasker asks her mother searchingly—puzzles and grips her. The laundress survives; “cancer,” Lasker realizes, “can be cruel but it does not need to be fatal.”

In the third, she is a teenager in college, and is confined to an influenza ward during the epidemic of 1918. The lethal Spanish flu rages outside, decimating towns and cities. Lasker survives—but the flu will kill six hundred thousand Americans that year, and take nearly fifty million lives worldwide, becoming the deadliest pandemic in history.

A common thread ran through these memories: the devastation of illness—so proximal and threatening at all times—and the occasional capacity, still unrealized, of medicine to transform lives. Lasker imagined unleashing the power of medical research to combat diseases—a power that, she felt, was still largely untapped. In 1939, the year that she met Albert, her life collided with illness again: in Wisconsin, her mother suffered a heart attack and then a stroke, leaving her paralyzed and incapacitated. Lasker wrote to the head of the American Medical Association to inquire about treatment. She was amazed—and infuriated, again—at the lack of knowledge and the unrealized potential of medicine: “I thought that was ridiculous. Other diseases could be treated . . . the sulfa drugs had come into existence. Vitamin deficiencies could be corrected, such as scurvy and pellagra. And I thought there was no good reason why you couldn’t do something about stroke, because people didn’t universally die of stroke . . . there must be some element that was influential.”

In 1940, after a prolonged and unsuccessful convalescence, Lasker’s mother died in Watertown. For Lasker, her mother’s death brought to a boil the fury and indignation that had been building within her for decades. She had found her mission. “I am opposed to heart attacks and cancer,”²⁶⁵ she would later tell a reporter, “the way one is opposed to sin.” Mary Lasker chose to eradicate diseases as some might eradicate sin—through evangelism. If people did not believe in the importance of a national strategy against diseases, she would convert them, using every means at her disposal.

Her first convert was her husband. Grasping Mary’s commitment to the idea, Albert Lasker became her partner, her adviser, her strategist, her coconspirator. “There are unlimited funds,” he told her. “I will show you how to get them.” This idea—of transforming the landscape of American medical research using political lobbying and fund-raising at an unprecedented scale—electrified her. The Laskers were professional socialites, in the same way that one can be a professional scientist or a professional athlete; they were extraordinary networkers, lobbyists, minglers, conversers, persuaders, letter writers, cocktail party–throwers, negotiators, name-droppers, deal makers. Fund-raising—and, more important, friend-raising—was instilled in their blood, and the depth and breadth of their social connections allowed them to reach deeply into the minds—and pockets—of private donors and of the government.

“If a toothpaste . . .²⁶⁶ 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.”²⁶⁷

The “fairy godmother” blew into the world of cancer research one morning with the force of an unexpected typhoon. In April 1943, Mary Lasker visited²⁶⁸ 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 cold²⁶⁹. 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 of²⁷⁰ 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”²⁶³—the whole effort seemed haphazard, ineffectual, stodgy, and unprofessional. Lasker was bitingly critical: “Doctors,” she wrote, “are not administrators²⁷¹ 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 prominent 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 friend²⁷² 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 cancer²⁷³ 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 months²⁷⁴, 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 attack²⁷⁵ 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,²⁷⁶ 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,”²⁷⁷ 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 million²⁷⁸ “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,”²⁷⁹ 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”²⁸⁰—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 rewritten²⁸¹ 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 include²⁸² 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 person²⁸³ 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,”²⁸⁴ as the oncologist Dusty Rhoads at Memorial Hospital liked to describe it)—fascinated Lasker. By the early 1950s, she was regularly²⁸⁵ corresponding with Farber about such drugs. Farber wrote back long, detailed, meandering letters—“scientific treatises,”²⁸⁶ 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 developing²⁸⁷ 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,”²⁸⁸ 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”²⁸⁹ 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 times²⁹⁰ 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.