The Emperor of All Maladies. Siddhartha Mukherjee

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СКАЧАТЬ the parents’ eyes look suspiciously bright with tears shed and unshed. Some of the children’s robust looks, I find, are owing to one of the antileukemia drugs that produces a swelling of the body. And there are children with scars, children with horrible swellings on different parts of their bodies, children missing a limb, children with shaven heads, looking pale and wan, clearly as a result of recent surgery, children limping or in wheelchairs, children coughing, and children emaciated.”

      Indeed, the closer one looked, the more sharply the reality hit. Ensconced in his new, airy building, with dozens of assistants swirling around him, Farber must have been haunted by that inescapable fact. He was trapped in his own waiting room, still looking for yet another drug to eke out a few more months of remission in his children. His patients—having walked up the fancy steamed stairs to his office, having pranced around on the musical carousel and immersed themselves in the cartoonish gleam of happiness—would die, just as inexorably, of the same kinds of cancer that had killed them in 1947.

      But for Farber, the lengthening, deepening remissions bore quite another message: he needed to expand his efforts even further to launch a concerted battle against leukemia. “Acute leukemia,” he wrote²⁵⁴ in 1953, has “responded to a more marked degree than any other form of cancer . . . to the new chemicals that have been developed within the last few years. Prolongation of life, amelioration of symptoms, and a return to a far happier and even a normal life for weeks and many months have been produced by their use.”

      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 raised²⁵⁵ 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

      Perhaps there is only one cardinal sin²⁵⁶: impatience. Because of impatience we were driven out of Paradise, because of impatience we cannot return.

      —Franz Kafka

      The 325,000 patients with cancer²⁵⁷ 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”

      All of this demonstrates why²⁵⁸ 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 alarm²⁵⁹ 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,²⁶⁰ 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 sell²⁶¹ . . . 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 СКАЧАТЬ