The Emperor of All Maladies: A Biography of Cancer (22 page)

The death of a man
is like the fall of a mighty nation

That had valiant armies, captains, and prophets,

And wealthy ports and ships all over the seas

But now it will not relieve any besieged city

It will not enter into an alliance

—Czeslaw Milosz, “The Fall”

I had recently begun to notice
that events outside science, such as Mary Lasker’s cocktail parties or Sidney Farber’s Jimmy Fund, had something to do with the setting of science policy.

—Robert Morison

In 1951, as Farber and Lasker were communicating with “telepathic” intensity about a campaign against cancer, a seminal event drastically altered the tone and urgency of their efforts. Albert Lasker was diagnosed with colon cancer. Surgeons in New York heroically tried to remove the tumor, but the lymph nodes around the intestines were widely involved, and there was little that could be done surgically.
By February 1952, Albert was confined
to the hospital, numb with the shock of diagnosis and awaiting death.

The sardonic twist of this event could not have escaped the Laskerites. In their advertisements in the late 1940s to raise awareness of cancer, the Laskerites had often pointed out that one in four Americans would succumb to cancer. Albert was now the “one in four”—struck by the very disease that he had once sought to conquer. “
It seems a little unfair
,” one of his close friends from Chicago wrote (with vast understatement), “for someone who has done as much as you have to forward the work in this field to have to suffer personally.”

In her voluminous collection of papers—in nearly eight hundred boxes filled with memoirs, letters, notes, and interviews—Mary Lasker left few
signs of her response to this terrifying tragedy. Although obsessed with illness, she was peculiarly silent about its corporality, about the vulgarity of dying. There are occasional glimpses of interiority and grief: her visits to the Harkness Pavilion in New York to watch Albert deteriorate into a coma, or letters to various oncologists—including Farber—inquiring about yet another last-ditch drug. In the months before Albert’s death, these letters acquired a manic, insistent tone. He had seeded metastasis into the liver, and she searched discreetly, but insistently, for any possible therapy, however far-fetched, that might stay his illness. But for the vast part, there was silence—impenetrable, dense, and impossibly lonely. Mary Lasker chose to descend into melancholy alone.

Albert Lasker died at eight o’clock
on the morning of May 30, 1952. A small private funeral was held in the Lasker residence in New York. In his obituary, the
Times
noted, “He was more than a philanthropist, for he gave not only of his substance, but of his experience, ability and strength.”

Mary Lasker gradually forged her way back to public life after her husband’s death. She returned to her routine of fund-raisers, balls, and benefits. Her social calendar filled up: dances for various medical foundations, a farewell party for Harry Truman, a fund-raiser for arthritis. She seemed self-composed, fiery, and energetic—blazing meteorically into the rarefied atmosphere of New York.

But the person who charged her way back into New York’s society in 1953 was fundamentally different from the woman who had left it a year before. Something had broken and annealed within her. In the shadow of Albert’s death, Mary Lasker’s cancer campaign took on a more urgent and insistent tone. She no longer sought a strategy to
publicize
a crusade against cancer; she sought a strategy to
run
it. “We are at war with an insidious, relentless foe,” as her friend Senator Lister Hill would later put it—and a war of this magnitude demanded a relentless, total, unflinching commitment. Expediency must not merely inspire science; it must invade science. To fight cancer, the Laskerites wanted a radically restructured cancer agency, an NCI rebuilt from the ground up, stripped of its bureaucratic excesses, intensely funded, closely supervised—a goal-driven institute that would decisively move toward finding a cancer cure. The national effort against cancer, Mary Lasker believed, had become ad hoc, diffuse, and abstract. To rejuvenate it, it needed the disembodied legacy of Albert Lasker: a targeted, directed strategy borrowed from the world of business and advertising.

Farber’s life also collided with cancer—a collision that he had perhaps presaged for a decade. In the late 1940s, he had developed a mysterious and chronic inflammatory disease of the intestines—likely ulcerative colitis, a debilitating precancerous illness that predisposes the colon and bile duct to cancer. In the mid-1950s (we do not know the precise date), Farber underwent surgery to remove his inflamed colon at Mount Auburn Hospital in Boston, likely choosing the small and private Cambridge hospital across the Charles River to
keep his diagnosis
and surgery hidden from his colleagues and friends on the Longwood campus. It is also likely that more than just “precancer” was discovered upon surgery—for in later years, Mary Lasker would refer to Farber as a “cancer survivor,” without ever divulging the nature of his cancer. Proud, guarded, and secretive—reluctant to conflate his battle against cancer with
the
battle—Farber also pointedly refused to discuss his personal case publicly. (Thomas Farber, his son, would also not discuss it. “I will neither confirm nor deny it,” he said, although he admitted that his father lived “in the shadow of illness in his last years”—an ambiguity that I choose to respect.) The only remnant of the colon surgery was a colostomy bag; Farber hid it expertly under his white cuffed shirt and his four-button suit during his hospital rounds.

Although cloaked in secrecy and discretion, Farber’s personal confrontation with cancer also fundamentally altered the tone and urgency of his campaign. As with Lasker, cancer was no longer an abstraction for him; he had sensed its shadow flitting darkly over himself. “[It is not] necessary,” he wrote, “in order to make great progress in the cure of cancer, for us to have the full solution of all the problems of basic research . . . the history of Medicine is replete with examples of cures obtained years, decades, and even centuries before the mechanism of action was understood for these cures.”

“Patients with cancer who are going to die this year cannot wait,” Farber insisted. Neither could he or Mary Lasker.

Mary Lasker knew that the stakes of this effort were enormous: the Laskerites’ proposed strategy for cancer ran directly against the grain of the dominant model for biomedical research in the 1950s. The chief architect of the prevailing model was a tall, gaunt, MIT-trained engineer named Vannevar Bush, who had served as the director of the Office of Scientific Research and Development (OSRD). Created in 1941, the OSRD had
played a crucial role during the war years, in large part by channeling American scientific ingenuity toward the invention of novel military technologies for the war. To achieve this, the agency had recruited scientists performing basic research into projects that emphasized “programmatic research.” Basic research—diffuse and open-ended inquiry on fundamental questions—was a luxury of peacetime. The war demanded something more urgent and goal-directed. New weapons needed to be manufactured, and new technologies invented to aid soldiers in the battlefield. This was a battle progressively suffused with military technology—a “wizard’s war,” as newspapers called it—and a cadre of scientific wizards was needed to help America win it.

The “wizards” had wrought astonishing technological magic. Physicists had created sonar, radar, radio-sensing bombs, and amphibious tanks. Chemists had produced intensely efficient and lethal chemical weapons, including the infamous war gases. Biologists had studied the effects of high-altitude survival and seawater ingestion. Even mathematicians, the archbishops of the arcane, had been packed off to crack secret codes for the military.

The undisputed crown jewel of this targeted effort, of course, was the atomic bomb, the product of the OSRD-led Manhattan Project. On August 7, 1945, the morning after the Hiroshima bombing, the
New York Times
gushed about the extraordinary success of the project: “
University professors who are opposed
to organizing, planning and directing research after the manner of industrial laboratories . . . have something to think about now. A most important piece of research was conducted on behalf of the Army in precisely the means adopted in industrial laboratories. End result: an invention was given to the world in three years, which it would have taken perhaps half-a-century to develop if we had to rely on prima-donna research scientists who work alone. . . . A problem was stated, it was solved by teamwork, by planning, by competent direction, and not by the mere desire to satisfy curiosity.”

The congratulatory tone of that editorial captured a general sentiment about science that had swept through the nation. The Manhattan Project had overturned the prevailing model of scientific discovery. The bomb had been designed, as the
Times
scoffingly put it, not by tweedy “prima-donna” university professors wandering about in search of obscure truths (driven by the “mere desire to satisfy curiosity”), but by a focused SWAT team of researchers sent off to accomplish a concrete mission. A
new model of scientific governance emerged from the project—research driven by specific mandates, timelines, and goals (“frontal attack” science, to use one scientist’s description)—which had produced the remarkable technological boom during the war.

But Vannevar Bush was not convinced. In a deeply influential report to President Truman entitled
Science the Endless Frontier
, first published in 1945, Bush had laid out a view of postwar research that had turned his own model of wartime research on its head: “Basic research,” Bush wrote, “is performed without thought of practical ends. It results in general knowledge and an understanding of nature and its laws. This general knowledge provides the means of answering a large number of important practical problems, though it may not give a complete specific answer to any one of them. . . .

“Basic research leads to new knowledge. It provides scientific capital. It creates the fund from which the practical applications of knowledge must be drawn. . . . Basic research is the pacemaker of technological progress. In the nineteenth century, Yankee mechanical ingenuity, building largely upon the basic discoveries of European scientists, could greatly advance the technical arts. Now the situation is different. A nation which depends upon others for its new basic scientific knowledge will be slow in its industrial progress and weak in its competitive position in world trade, regardless of its mechanical skill.”

Directed, targeted research—“programmatic” science—the cause célèbre during the war years, Bush argued, was not a sustainable model for the future of American science. As Bush perceived it, even the widely lauded Manhattan Project epitomized the virtues of basic inquiry. True, the bomb was the product of Yankee “mechanical ingenuity.” But that mechanical ingenuity stood on the shoulders of scientific discoveries about the fundamental nature of the atom and the energy locked inside it—research performed, notably, with no driving mandate to produce anything resembling the atomic bomb. While the bomb might have come to life physically in Los Alamos, intellectually speaking it was the product of prewar physics and chemistry rooted deeply in Europe. The iconic homegrown product of wartime American science was, at least philosophically speaking, an import.

A lesson Bush had learned from all of this was that goal-directed strategies, so useful in wartime, would be of limited use during periods of peace. “Frontal attacks” were useful on the war front, but postwar science could not be produced by fiat. So Bush had pushed for a radically inverted
model of scientific development, in which researchers were allowed full autonomy over their explorations and open-ended inquiry was prioritized.

The plan had a deep and lasting influence in Washington.
The National Science Foundation
(NSF), founded in 1950, was explicitly created to encourage scientific autonomy, turning in time, as one historian put it, into a veritable “embodiment [of Bush’s] grand design for reconciling government money and scientific independence.” A new culture of research—“long-term, basic scientific research rather than sharply focused quests for treatment and disease prevention”—rapidly proliferated at the NSF and subsequently at the NIH.