The Emperor of All Maladies

Energized by the response, Lasker now set about thoroughly overhauling the flailing ASCC in the larger hopes of reviving the flailing effort against cancer. In 1949, a friend wrote to her, “A two-pronged attack

(#litres_trial_promo) on the nation’s ignorance of the facts of its health could well be undertaken: a long-range program of joint professional-lay cooperation . . . and a shorter-range pressure group.” The ASCC, then, had to be refashioned into this “shorter-range pressure group.” Albert Lasker, who joined the ASCC board, recruited Emerson Foote,

(#litres_trial_promo) an advertising executive, to join the society to streamline its organization. Foote, just as horrified by the mildewy workings of the agency as the Laskers, drafted an immediate action plan: he would transform the moribund social club into a highly organized lobbying group. The mandate demanded men of action: businessmen, movie producers, admen, pharmaceutical executives, lawyers—friends and contacts culled from the Laskers’ extensive network—rather than biologists, epidemiologists, medical researchers, and doctors. By 1945, the nonmedical representation in the ASCC governing board had vastly increased, edging out its former members. The “Lay Group,”

(#litres_trial_promo) as it was called, rechristened the organization the American Cancer Society, or the ACS.

Subtly, although discernibly, the tone of the society changed as well. Under Little, the ASCC had spent its energies drafting insufferably detailed memorandums on standards of cancer care for medical practitioners. (Since there was little treatment to offer, these memoranda were not particularly useful.) Under the Laskers, predictably, advertising and fund-raising efforts began to dominate its agenda. In a single year, it printed 9 million

(#litres_trial_promo) “educational” pieces, 50,000 posters, 1.5 million window stickers, 165,000 coin boxes, 12,000 car cards, and 3,000 window exhibits. The Women’s Field Army—the “Ladies’ Garden Club,”

(#litres_trial_promo) as one Lasker associate scathingly described it—was slowly edged out and replaced by an intense, well-oiled fund-raising machine. Donations shot through the roof: $832,000 in 1944, $4,292,000 in 1945, $12,045,000 in 1947.

Money, and the shift in public visibility, brought inevitable conflicts between the former members and the new ones. Clarence Little, the ASCC president who had once welcomed Lasker into the group, found himself increasingly marginalized by the Lay Group. He complained that the lobbyists and fund-raisers were “unjustified, troublesome and aggressive”

(#litres_trial_promo)—but it was too late. At the society’s annual meeting in 1945, after a bitter showdown with the “laymen,” he was forced to resign.

With Little deposed and the board replaced, Foote and Lasker were unstoppable. The society’s bylaws and constitution were rewritten

(#litres_trial_promo) with nearly vengeful swiftness to accommodate the takeover, once again emphasizing its lobbying and fund-raising activities. In a telegram to Mary Lasker, Jim Adams, the president of the Standard Corporation (and one of the chief instigators of the Lay Group), laid out the new rules, arguably among the more unusual set of stipulations to be adopted by a scientific organization: “The Committee should not include

(#litres_trial_promo) more than four professional and scientific members. The Chief Executive should be a layman.”

In those two sentences, Adams epitomized the extraordinary change that had swept through the ACS. The society was now a high-stakes juggernaut spearheaded by a band of fiery “laymen” activists to raise money and publicity for a medical campaign. Lasker was the center of this collective, its nucleating force, its queen bee. Collectively, the activists began to be known as the “Laskerites” in the media. It was a name that they embraced with pride.

In five years, Mary Lasker had raised the cancer society from the dead. Her “shorter-range pressure group” was working in full force. The Laskerites now had their long-range target: Congress. If they could obtain federal backing for a War on Cancer, then the scale and scope of their campaign would be astronomically multiplied.

“You were probably the first person

(#litres_trial_promo) to realize that the War against Cancer has to be fought first on the floor of Congress—in order to continue the fight in laboratories and hospitals,” the breast cancer patient and activist Rose Kushner once wrote admiringly to Mary Lasker. But cannily, Lasker grasped an even more essential truth: that the fight had to begin in the lab before being brought to Congress. She needed yet another ally—someone from the world of science to initiate a fight for science funding. The War on Cancer needed a bona fide scientific sponsor among all the advertisers and lobbyists—a real doctor to legitimize the spin doctors. The person in question would need to understand the Laskerites’ political priorities almost instinctually, then back them up with unquestionable and unimpeachable scientific authority. Ideally, he or she would be immersed in cancer research, yet willing to emerge out of that immersion to occupy a much larger national arena. The one man—and perhaps the only man—who could possibly fit the role was Sidney Farber.

In fact, their needs were perfectly congruent: Farber needed a political lobbyist as urgently as the Laskerites needed a scientific strategist. It was like the meeting of two stranded travelers, each carrying one-half of a map.

Farber and Mary Lasker met in Washington in late 1940s, not long after Farber had shot to national fame with his antifolates. In the winter of 1948, barely a few months after Farber’s paper on antifolates had been published, John Heller, the director of the NCI, wrote to Lasker introducing her to the idea of chemotherapy and to the doctor who had dreamed up the notion in Boston. The idea of chemotherapy—a chemical that could cure cancer outright (“a penicillin for cancer,”

(#litres_trial_promo) as the oncologist Dusty Rhoads at Memorial Hospital liked to describe it)—fascinated Lasker. By the early 1950s, she was regularly

(#litres_trial_promo) corresponding with Farber about such drugs. Farber wrote back long, detailed, meandering letters—“scientific treatises,”

(#litres_trial_promo) he called them—educating her on his progress in Boston.

For Farber, the burgeoning relationship with Lasker had a cleansing, clarifying quality—“a catharsis,” as he called it. He unloaded his scientific knowledge on her, but more important, he also unloaded his scientific and political ambition, an ambition he found easily reflected, even magnified, in her eyes. By the mid-1950s, the scope of their letters had considerably broadened: Farber and Lasker openly broached the possibility of launching an all-out, coordinated attack on cancer. “An organizational pattern is developing

(#litres_trial_promo) at a much more rapid rate than I could have hoped,” Farber wrote. He spoke about his visits to Washington to try to reorganize the National Cancer Institute into a more potent and directed force against cancer.

Lasker was already a “regular on the Hill,”

(#litres_trial_promo) as one doctor described her—her face, with its shellacked frieze of hair, and her hallmark gray suit and pearls omnipresent on every committee and focus group related to health care. Farber, too, was now becoming a “regular.” Dressed perfectly for his part in a crisp, dark suit, his egghead reading-glasses often perched at the edge of his nose, he was a congressman’s spitting image of a physician-scientist. He possessed an “evangelistic pizzazz” for medical science, an observer recalled. “Put a tambourine in [his] hands”

(#litres_trial_promo) and he would immediately “go to work.”

To Farber’s evangelistic tambourine, Lasker added her own drumbeats of enthusiasm. She spoke and wrote passionately and confidently about her cause, emphasizing her points with quotes and questions. Back in New York, she employed a retinue of assistants to scour newspapers and magazines and clip out articles containing even a passing reference to cancer—all of which she read, annotated on the margins with questions in small, precise script, and distributed to the other Laskerites every week.

“I have written to you so many times

(#litres_trial_promo) in what is becoming a favorite technique—mental telepathy,” Farber wrote affectionately to Lasker, “but such letters are never mailed.” As acquaintance bloomed into familiarity, and familiarity into friendship, Farber and Lasker struck up a synergistic partnership that would stretch over decades. In a letter written in 1954, Farber used the word crusade to describe their campaign against cancer. The word was deeply symbolic. For Sidney Farber, as for Mary Lasker, the cancer campaign was indeed turning into a “crusade,” a scientific battle imbued with such fanatical intensity that only a religious metaphor could capture its essence. It was as if they had stumbled upon an unshakable, fixed vision of a cure—and they would stop at nothing to drag even a reluctant nation toward it.

“These new friends of chemotherapy” (#ulink_010be4bc-8d75-5ca1-859d-bb3711c7ded1)

The death of a man

(#litres_trial_promo) 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

(#litres_trial_promo) 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

(#litres_trial_promo) 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,”

(#litres_trial_promo) 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

(#litres_trial_promo) 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,

(#litres_trial_promo) 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.