Mary Lasker and the Growth of the National Institutes of Health

In the twenty-five years after World War II, the United States built the largest medical research enterprise in the world, with the National Institutes of Health (NIH) as its centerpiece. Notwithstanding a dominant political creed that questioned the role of the state in society, the country went further than any other nation in erecting a centralized, government-financed institutional framework for biomedical research. Mary Lasker was a key part of this enterprise: she developed a compelling political rationale for federal sponsorship of medical research, built a powerful lobby that won large research appropriations, and pushed NIH into new scientific directions, at times in opposition to the scientific establishment.

Until World War II, medical research in the United States was modest in scale. It was conducted at universities, non-profit institutes, or private companies, with only a few federal grants-in-aid. Scientists opposed federal financing of research as government infringement on the freedom of science and a violation of the principle that not money, but the individual ability of the investigator counted most in achieving scientific progress. Poor health was considered by many Depression-era Americans to be a matter of fate, and access to health care not a right, but a privilege.

The war changed such attitudes. The draft highlighted the poor health of the American people: one-third of prospective recruits were rejected for medical reasons. Furthermore, the atomic bomb program dramatized that government research could yield scientific breakthroughs. Mary Lasker concluded from these wartime experiences that public health had to be improved and that medical research could ensure such improvement, but only after it was reorganized and given a large infusion of federal funds. "Without money, nothing gets done," she asserted. Postwar prosperity, rising public expectations of good health and longevity, and a new faith in the potential of science provided economic and cultural impetus for Lasker's efforts to reshape the medical research enterprise.

She found a close ally in Florence Mahoney, whose husband was an heir to the Cox newspaper chain, the country's largest, and who shared Mary's early interest in birth control and mental health. After her divorce in 1950, Mahoney moved to Washington, where she became unofficial hostess to the health lobby, bringing together legislators, policymakers, and scientists at her Georgetown home.

After first pushing for research institutes independent of the National Institute of Health (then still singular), Lasker and Mahoney shifted their position in 1946 in favor of expanding its research capabilities. With their lobbying support, the NIH budget grew 150-fold, to $460 million, between 1945 and 1961, and reached $1 billion by the late 1960s. Several new research institutes were established by 1950, including the National Heart Institute, the National Institute of Mental Health, and the National Institute of Neurological Diseases and Blindness, each with the ability to award research grants to investigators throughout the country and the world, their main function. The modern, plural National Institutes of Health was born.

Mahoney and Mike Gorman, a journalist hired by Lasker to head her lobbying organization in Washington, the National Mental Health Committee, helped Lasker form enduring political relationships with key members of Congress. Of particular importance to Lasker were two Democrats with jurisdiction over medical research policy from the late 1940s to the late 1960s: Representative John Fogarty of Rhode Island, chairman of the House subcommittee on health appropriations, and Senator Lister Hill of Alabama, chairman of the Senate committee on labor and public welfare and the appropriations subcommittee for health. Lasker supplied their committees with figures on death, disability, and loss of income (and thus of taxes) from disease.

In a choreographed ritual that was repeated at annual budget hearings for many years, Fogarty started out by castigating administration officials for "cutting back" the NIH budget request. He then called on expert witnesses, recruited by Lasker, to describe the true financial needs of medical research institutions. These "citizen" witnesses included heart surgeon Michael DeBakey, cancer researcher Sidney Farber, and psychiatrist Karl Menninger, all winners of Lasker awards. Witnesses of lesser renown were coached by Gorman to use plain language in displaying their expertise while showing passion for their subject. "Doctors aren't used to selling anything," Lasker stated flatly; they had to be taught that Congress expected them to ask for large increases in research funds each year, lest they be seen as timid in the face of scientific challenges.

After hearing these witnesses, Fogarty, assisted by Gorman and NIH director James Shannon, wrote a report calling for a substantial increase in NIH funds beyond the administration's budget, an increase of as much as $155 million (for fiscal year 1962). Meanwhile, Lasker and Mahoney secured editorial endorsements of a funding increase in the Cox newspapers. Lister Hill then followed with a similar performance in the Senate, raising NIH appropriations still further.

Lasker's clout in Congress grew because she had access to Presidents, especially Democrats, supplying them with a steady flow of memos and drafts of speeches. As an aide to President Lyndon Johnson stated, Lasker and her associates "set a new fashion for lobbyists. The moving and shaking done by such womenfolk affects everybody including the most obdurate politician."

Lasker's lobbying success drew criticism as well as praise. NIH scientists, although buoyed by the unprecedented resources and prestige they enjoyed in the postwar years, were wary of research funding by disease category through separate NIH institutes. They preferred allocations by scientific disciplines based on the process of peer review of research proposals initiated by investigators, not appropriations to individual NIH institutes for research on specific diseases selected by Congress, which some of them derisively called "disease-of-the-month-club" legislation. Other critics argued that Lasker's lobbying on behalf of research for cancer and heart disease elevated efforts to extend life for the elderly over initiatives that would save more lives, such as preventive medicine, smoking cessation, and research on trauma and accidents. Advocates of Great Society and civil rights programs who sought to promote access to quality health care questioned whether citizens really benefited from medical research dollars. Such criticism notwithstanding, Lasker's efforts to drive up funding for research on "dread diseases" that alarmed the public remained politically popular.

One of Lasker's lobbying achievements was a statutory requirement that NIH establish advisory councils to oversee grant making and overall direction of research--councils that included laypeople as well as physicians and scientists. Beginning in 1950, Lasker served for twenty years, with only brief interruptions, on the National Heart Advisory Council and the National Cancer Advisory Council. Mahoney served equally long on several councils, as did Mary's sister, Alice Fordyce. For most of these years they were the only women on their councils, which added to the challenge of facing the initial prejudice towards laypersons displayed by the medical professionals on the councils. But Lasker and Mahoney soon learned to use their position on the councils to push NIH to support new scientific fields, such as cancer chemotherapy and research on aging.

John Fogarty died of a heart attack in January 1967; Lister Hill and James Shannon retired in 1968. The following year, without Fogarty and Hill's skillful intercession on behalf of NIH, Congress reduced its budget by $20 million, then the largest cut in the agency's history. "[T]he inexorable workings of tide and time have combined to diminish the [medical research] lobby's political power," wrote one of Lasker's critics, Joseph D. Cooper, in the Medical Tribune. "Laskerism flourished because the right people were in place at the right time." In the absence of national health insurance, medical research was to be the main safeguard of the health of the American people. Yet Lasker's faith in the power of science to stamp out disease surpassed the ability of researchers to develop new treatments.

Nevertheless, predictions of the research lobby's demise proved premature. Lasker's political argument that support of biomedical research would in the long run pay large dividends in longevity and productivity for all Americans remained compelling even during the economic and political troubles of the 1970s, and gained new currency with the decoding of the human genome in the 1990s.