The Emperor of All Maladies

Farber needed a means to stimulate and fund the effort to find even more powerful antileukemia drugs. “We are pushing ahead as fast as possible,” he wrote in another letter—but it was not quite fast enough for him. The money that he had raised

(#litres_trial_promo) in Boston “has dwindled to a disturbingly small amount,” he noted. He needed a larger drive, a larger platform, and perhaps a larger vision for cancer. He had outgrown the house that Jimmy had built.

Part Two An Impatient War (#ulink_5a1c9961-47eb-5efd-8811-c840372055f6)

Perhaps there is only one cardinal sin

(#litres_trial_promo): impatience. Because of impatience we were driven out of Paradise, because of impatience we cannot return.

—Franz Kafka

The 325,000 patients with cancer

(#litres_trial_promo) who are going to die this year cannot wait; nor is it necessary, 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.

—Sidney Farber

Why don’t we try to conquer cancer by America’s 200th birthday? What a holiday that would be!

—Advertisement published in the New York Times by the Laskerites, December 1969

“They form a society” (#ulink_5b833584-6020-5e72-ae7b-e91182a087ac)

All of this demonstrates why

(#litres_trial_promo) 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 alarm

(#litres_trial_promo) 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,

(#litres_trial_promo) 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 sell

(#litres_trial_promo) . . . 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 Lasker

(#litres_trial_promo), 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 after

(#litres_trial_promo) 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,”

(#litres_trial_promo) 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 . . .

(#litres_trial_promo) 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.”

(#litres_trial_promo)

The “fairy godmother” blew into the world of cancer research one morning with the force of an unexpected typhoon. In April 1943, Mary Lasker visited

(#litres_trial_promo) 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 cold

(#litres_trial_promo). 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 of

(#litres_trial_promo) 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”

(#litres_trial_promo)—the whole effort seemed haphazard, ineffectual, stodgy, and unprofessional. Lasker was bitingly critical: “Doctors,” she wrote, “are not administrators

(#litres_trial_promo) 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 friend

(#litres_trial_promo) 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 cancer

(#litres_trial_promo) 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 months

(#litres_trial_promo), the Digest received thousands of letters and $300,000 in donations, exceeding the ASCC’s entire annual budget.