From Bench to Bedside: Mary Lasker and the Drive for "Payoff" from Medical Research
Over the course of her long career as a Congressional lobbyist for medical research and health causes, Lasker grew impatient with the lag between advances in biomedical science and the emergence of new therapies that would benefit patients. Researchers, Lasker believed, "should be paying more attention to helping human beings, who after all are the ones paying for research." To her, eradication of disease was the overarching goal, one that could be achieved if scientists dared to apply their laboratory findings to the development of medical treatments and technologies. Researchers, who lauded her success in securing federal funds for their work, often resisted her call for applied research as premature.
From the beginning of her lobbying activities, Lasker was concerned about the ability of clinical medicine in the United States to provide for the health of patients. In the aftermath of World War II, a shortage of doctors, psychologists, and other key medical personnel to care for a growing population loomed. Alarmed, Lasker lobbied Congress to provide financial assistance to medical schools to expand their enrollment. Her initiative was thwarted in the early 1950s by the American Medical Association, who feared that such aid would allow the federal government to interfere in medical education and, eventually, in the fee-for-service system of health care.
Instead, Lasker began to promote applied research targeted to finding treatments. In the mid-1950s, she precipitated the establishment of a research and testing program in cancer chemotherapy at the National Cancer Institute. In the 1960s, she championed the anti-tuberculosis drug isoniazid, and complained when the medical profession was too slow in accepting it: "people are dying while we are talking, people who don't need to die." Similarly, she charged that the National Institute of Mental Health was deliberately obstructing the testing of psychopharmacological drugs.
Emboldened by scientific breakthroughs which promised new ways of controlling disease--in particular the deciphering of the genetic code in the early 1960s--Lasker prevailed upon President Lyndon Johnson to establish the Commission on Heart Disease, Cancer, and Stroke, which assessed the steps required to bring the benefits of research to patients. The commission, chaired by Lasker ally Michael DeBakey, urged the creation of a federally-sponsored network of clinical centers that would combine research, training, and patient care. The so-called Regional Medical Centers became part of Johnson's Great Society legislation in 1965.
She constantly criticized scientists and physicians for moving too slowly, urging them to apply their laboratory findings to drug development when they were sixty percent certain of positive outcomes, not just when they were 100 percent certain. Investigators at the National Institutes of Health, she alleged in a moment of frustration, "are not people with a sense of mission to reduce the death rate directly."
Lasker regarded James Shannon, NIH director from 1955 to 1968, as "afraid of clinical research." A pioneer in the development of anti-malarial drugs, Shannon resented Lasker's tutoring on medical research and administration. He opposed her efforts to launch large-scale NIH programs to develop an artificial heart, body scanners, and surgical lasers, warning that these programs would divert research funds and that the current state of technology could not produce useful devices. Although he appreciated her role in increasing NIH's budget, their relationship was frosty.
Lasker's allies in Congress, in particular Senator Lister Hill, were more receptive to her call for applied research. At her urging, Hill added $5 million to the NIH budget for 1968 for a test of the cholesterol-lowering drug Atromid-S (clofibrate), in the hope that it would prevent heart attacks. NIH scientists, who had not asked for the money, considered the project premature and ill-conceived, warning, correctly, that a conclusive field trial would take ten years and more than $50 million to complete. By 1980, the drug was found to have serious side effects and to benefit only a small number of patients.
In her quest for "payoffs" from medical research, Lasker turned repeatedly to the White House. For instance, as a long-time party donor and a personal friend of Lady Bird Johnson, she was able to give President Lyndon Johnson a memorandum asking whether "too much energy [was] being spent on basic research and not enough on translating laboratory findings into tangible benefits for the American people." In the spring of 1967, Johnson forcefully questioned Shannon and NIH institute directors on the issue. Scientists were dismayed, fearing that the President was biased against basic research and misled by advice on research from lay people. To make amends, Johnson visited the NIH campus, where he declared NIH a "billion-dollar success story."
After her involvement in the War on Cancer in the early 1970s, Lasker turned to other, less contentious causes, in particular fighting hypertension and glaucoma. After a five-year, multi-center Veterans Administration study demonstrated that treating even mild hypertension could reduce the chance of heart disease and stroke, Lasker urged Elliot Richardson, Secretary of Health, Education and Welfare, to establish a national program for high blood pressure education, to alert physicians and the general public to "the silent killer." In 1972 the National High Blood Pressure Education Program was started, under the direction of the National Heart Institute at NIH. Meanwhile, she and Mike Gorman developed a parallel citizens' organization, Citizens for the Treatment of High Blood Pressure. The group launched an educational and preventive campaign against hypertension that produced $120 million in federal grants for state and local programs to monitor blood pressure and provide information on treatment with medication and changes in diet. Lasker and Gorman established a similar organization to address the problem of glaucoma, the leading cause of blindness in the U.S., by coordinating screening and education programs. During the 1980s, she lent her energy, diminished by several recent strokes but never faltering, to raising money for research on AIDS, arthritis, osteoporosis, diabetes, and growth disorders.
In acknowledging the paucity of therapeutic outcomes of biomedical research between the 1950s and the 1970s, Lasker concluded that "I did something wrong--or didn't do enough of the right things." By taking responsibility for shortcomings in the nation's biomedical research enterprise in this manner, she nonetheless put herself at its center.