Cancer Wars

Mary Lasker recalled that at the start of her lobbying career after World War II, "cancer was a word you simply could not say out loud." Although cancer took nearly 200,000 lives each year, the media did not discuss it, federal spending on cancer research was minimal, and scientists understood it much less well than infectious diseases. When Lasker's long-time housekeeper fell ill with the disease, she refused to specify the diagnosis. Lasker turned to the woman's doctor for confirmation, who said that he had sent her to a hospital "called something like the home for the incurable." Outraged by her housekeeper's silent fate, Lasker set out to raise cancer awareness and create an institutional base for cancer research unequaled anywhere in the world. She helped to elevate cancer research over other research fields and steered it into new directions, at times over the objection of scientists.

Her first objective was to reform the American Society for the Control of Cancer (ASCC), one of the nation's most prominent disease-oriented voluntary organizations, founded in 1914. Lasker was surprised by the small scale of its operation, with only 1,000 members and an annual budget of $102,000, none of it devoted to research. With the help of several of Albert Lasker's corporate allies, the Laskers reorganized the ASCC according to a business model, introducing modern advertising and publicity techniques to dramatically increase its fundraising, strengthen public faith in medical science, and promote the idea that research could produce a "cure" for cancer. The newcomers' wealth, connections, and salesmanship enabled them to take over the society's board of directors, until then dominated by physicians, and to redefine the mission of the society, which they renamed the American Cancer Society (ACS) in 1944. They boosted fundraising to $14 million in 1948, a quarter of which was devoted to research grants.

Lasker and her allies gave the ACS a new focus on lobbying for cancer research dollars. She helped ACS place articles on the need for regular screening and early detection of cancer in widely-read publications like Readers' Digest with the assistance of sympathetic writers. She commissioned ACS radio ads to appeal to philanthropists and corporations after she and her husband convinced David Sarnoff, the powerful head of the Radio Corporation of America, that the time had come to mention cancer on the airwaves. She and the other new ACS leaders lobbied Congress for increased research appropriations for the National Cancer Institute, which leapt from $1.75 million in fiscal 1946 to more than $14 million in 1947 and $110 million in 1961.

Throughout the 1950s and 1960s, theories about the origins of cancer abounded, ranging from the hypothesis that it was a "disease of civilization"--that it arose from the emotional stresses, neuroses, and chemical products of modern life--to investigations of cancer-causing viruses and environmental carcinogens, namely toxins and nuclear radiation. However, the basic biological mechanisms of this complex disease and its many forms remained unknown. Some scientists and public health officials complained that too much money was spent on cancer research, and not enough on measures that had been shown to help control cancer, such as epidemiological studies, efforts to eliminate environmental and occupational carcinogens, and anti-smoking campaigns.

Lasker believed that laboratory research, carried out with ample federal support, would uncover the secrets of cancer and produce means of prevention and cure. She employed her full repertoire of lobbying techniques, making campaign contributions, corresponding with lawmakers, presenting witnesses before Congress, and marshalling statistics showing how negligible federal expenditures on cancer research were compared to defense spending, even though the disease cost many more lives each year than were lost in war.

But even Lasker thought that cancer research should lead to therapies more quickly, especially after the death of her husband from cancer in 1952. Starting in the mid-1950s, she promoted applied cancer research and clinical testing of drugs she considered promising. She embraced chemotherapy, the newest form of cancer treatment since the development of cancer surgery and radiation therapy early in the twentieth century, after her close ally, Sidney Farber, had produced a remission of acute leukemia in children by administering anti-folic acid compounds. Congress, swayed by Farber's testimony, directed $3 million towards chemotherapy in 1954. Only three years later, almost half of NCI's budget was spent on testing thousands of chemical compounds for promising leads. Kenneth Endicott, the program's first director, predicted that "the next step--the complete cure--is almost sure to follow." By the 1980s, scientists had found about thirty drugs for treating human cancers, especially in children.

A "cure" proved elusive, but Lasker remained undaunted. Certain of the scientific prowess and superior resources of the United States, she called for an all-out "War on Cancer" by the late 1960s. In December 1969, the Citizens Committee for the Conquest of Cancer (which Lasker founded) placed a full-page ad in the New York Times and Washington Post declaring "MR. NIXON: YOU CAN CURE CANCER." The ad cited Farber's belief that "we are so close to a cure for cancer. We lack only the will and the kind of money and comprehensive planning that went into putting a man on the moon," the technological spectacle that had riveted the nation only five months earlier.

Lasker sought not only more funds for clinical cancer research, but also to create a cancer agency separate from NIH and similar to NASA and the Atomic Energy Commission in that it reported directly to the President. What Lasker and her allies regarded as the bureaucratic caution of NCI would thus be prevented from slowing scientific progress.

Such a comprehensive restructuring of cancer research was anathema to officials and scientists, who argued that research at NIH benefited from interaction among its researchers. NIH director James Shannon insisted that the increase in research funding go towards basic research and be distributed by NIH, not earmarked by Congress. He warned against the proposal to separate NCI from NIH, and deplored science policy making "by uncritical zealots, by experts in advertisement and public relations, and by rapacious empire builders." Lasker's proposal to restructure NIH was also opposed by academic researchers, who were receiving an ever greater share of their biomedical research funds from NIH grants.

The hard-fought controversy resulted in a compromise, the National Cancer Act of 1971. The act made the record sum of $1.59 billion available for cancer research over a three-year period. It stipulated that the NCI director (like the NIH director) was to be appointed by the President, and that NCI would submit budget requests directly to the White House, not as part of the NIH budget.

The act was widely supported by Congress, and marked the high point of Lasker's influence. Many scientists, however, spoke of "Mrs. Lasker's war" and criticized her for promising more than science at its present state could deliver. Turning the analogy of the moon landing on its head, the director of Columbia University's Institute of Cancer Research, Sol Spiegelman, averred that "an all-out effort at this time [to find a cure for cancer] would be like trying to land a man on the moon without knowing Newton's laws of gravity." Others complained that under the National Cancer Act, NCI continued to favor basic research over prevention and early detection, still the most effective means of fighting cancer.

The act substantially increased funding for cancer research, but its outlays were hardly lavish and barely kept up with rising inflation during the 1970s. Its framers sought to appeal to those who favored prevention over research by including a provision to establish seventeen comprehensive cancer centers, which screened and treated patients and disseminated information about the disease. The act provided unprecedented sums for testing chemicals for carcinogenic effect, an undertaking that, while at times derided for testing substances indiscriminately, was of practical use to scientists and regulators throughout the world.

Nevertheless, the rhetoric of the War on Cancer raised public expectations of impending breakthroughs in cancer research and treatment, expectations it could and did not meet. By suggesting that cancer could be "conquered" within a matter of years, Lasker diminished her own political clout, and contributed to rising skepticism of modern biomedical science among Americans who had long believed in its inevitable progress.