The Emperor of All Maladies. Siddhartha Mukherjee

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      Mary Lasker knew that the stakes of this effort were enormous: the Laskerites’ proposed strategy for cancer ran directly against the grain of the dominant model for biomedical research in the 1950s. The chief architect of the prevailing model was a tall, gaunt, MIT-trained engineer named Vannevar Bush, who had served as the director of the Office of Scientific Research and Development (OSRD). Created in 1941, the OSRD had played a crucial role during the war years, in large part by channeling American scientific ingenuity toward the invention of novel military technologies for the war. To achieve this, the agency had recruited scientists performing basic research into projects that emphasized “programmatic research.” Basic research—diffuse and open-ended inquiry on fundamental questions—was a luxury of peacetime. The war demanded something more urgent and goal-directed. New weapons needed to be manufactured, and new technologies invented to aid soldiers in the battlefield. This was a battle progressively suffused with military technology—a “wizard’s war,” as newspapers called it—and a cadre of scientific wizards was needed to help America win it.

      The “wizards” had wrought astonishing technological magic. Physicists had created sonar, radar, radio-sensing bombs, and amphibious tanks. Chemists had produced intensely efficient and lethal chemical weapons, including the infamous war gases. Biologists had studied the effects of high-altitude survival and seawater ingestion. Even mathematicians, the archbishops of the arcane, had been packed off to crack secret codes for the military.

      The undisputed crown jewel of this targeted effort, of course, was the atomic bomb, the product of the OSRD-led Manhattan Project. On August 7, 1945, the morning after the Hiroshima bombing, the New York Times gushed about the extraordinary success of the project: “University professors who are opposed²⁹⁷ to organizing, planning and directing research after the manner of industrial laboratories . . . have something to think about now. A most important piece of research was conducted on behalf of the Army in precisely the means adopted in industrial laboratories. End result: an invention was given to the world in three years, which it would have taken perhaps half-a-century to develop if we had to rely on prima-donna research scientists who work alone. . . . A problem was stated, it was solved by teamwork, by planning, by competent direction, and not by the mere desire to satisfy curiosity.”

      The congratulatory tone of that editorial captured a general sentiment about science that had swept through the nation. The Manhattan Project had overturned the prevailing model of scientific discovery. The bomb had been designed, as the Times scoffingly put it, not by tweedy “prima-donna” university professors wandering about in search of obscure truths (driven by the “mere desire to satisfy curiosity”), but by a focused SWAT team of researchers sent off to accomplish a concrete mission. A new model of scientific governance emerged from the project—research driven by specific mandates, timelines, and goals (“frontal attack” science, to use one scientist’s description)—which had produced the remarkable technological boom during the war.

      But Vannevar Bush was not convinced. In a deeply influential report to President Truman entitled Science the Endless Frontier²⁹⁸, first published in 1945, Bush had laid out a view of postwar research that had turned his own model of wartime research on its head: “Basic research,” Bush wrote, “is performed without thought of practical ends. It results in general knowledge and an understanding of nature and its laws. This general knowledge provides the means of answering a large number of important practical problems, though it may not give a complete specific answer to any one of them. . . .

      “Basic research leads to new knowledge. It provides scientific capital. It creates the fund from which the practical applications of knowledge must be drawn. . . . Basic research is the pacemaker of technological progress. In the nineteenth century, Yankee mechanical ingenuity, building largely upon the basic discoveries of European scientists, could greatly advance the technical arts. Now the situation is different. A nation which depends upon others for its new basic scientific knowledge will be slow in its industrial progress and weak in its competitive position in world trade, regardless of its mechanical skill.”

      Directed, targeted research—“programmatic” science—the cause célèbre during the war years, Bush argued, was not a sustainable model for the future of American science. As Bush perceived it, even the widely lauded Manhattan Project epitomized the virtues of basic inquiry. True, the bomb was the product of Yankee “mechanical ingenuity.” But that mechanical ingenuity stood on the shoulders of scientific discoveries about the fundamental nature of the atom and the energy locked inside it—research performed, notably, with no driving mandate to produce anything resembling the atomic bomb. While the bomb might have come to life physically in Los Alamos, intellectually speaking it was the product of prewar physics and chemistry rooted deeply in Europe. The iconic homegrown product of wartime American science was, at least philosophically speaking, an import.

      A lesson Bush had learned from all of this was that goal-directed strategies, so useful in wartime, would be of limited use during periods of peace. “Frontal attacks” were useful on the war front, but postwar science could not be produced by fiat. So Bush had pushed for a radically inverted model of scientific development, in which researchers were allowed full autonomy over their explorations and open-ended inquiry was prioritized.

      The plan had a deep and lasting influence in Washington. The National Science Foundation (NSF), founded in 1950,²⁹⁹ was explicitly created to encourage scientific autonomy, turning in time, as one historian put it, into a veritable “embodiment [of Bush’s] grand design for reconciling government money and scientific independence.” A new culture of research—“long-term, basic scientific research³⁰⁰ rather than sharply focused quests for treatment and disease prevention”—rapidly proliferated at the NSF and subsequently at the NIH.