The Emperor of All Maladies. Siddhartha Mukherjee
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This stagnation of research funds stood in stark contrast to the swift rise to prominence of the disease itself. Cancer had certainly been present and noticeable in nineteenth-century America, but it had largely lurked in the shadow of vastly more common illnesses. In 1899, when Roswell Park46, a well-known Buffalo surgeon, had argued that cancer would someday overtake smallpox, typhoid fever, and tuberculosis to become the leading cause of death in the nation, his remarks had been perceived as a rather “startling prophecy,” the hyperbolic speculations of a man who, after all, spent his days and nights operating on cancer. But by the end of the decade, Park’s remarks were becoming less and less startling, and more and more prophetic by the day. Typhoid, aside from a few scattered outbreaks, was becoming increasingly rare. Smallpox was on the decline47; by 1949, it would disappear from America altogether. Meanwhile cancer was already outgrowing other diseases, ratcheting its way up the ladder of killers. Between 1900 and 191648, cancer-related mortality grew by 29.8 percent, edging out tuberculosis as a cause of death. By 1926, cancer49 had become the nation’s second most common killer, just behind heart disease.
“Cancer: The Great Darkness” wasn’t alone in building a case for a coordinated national response to cancer. In May that year,50 Life carried its own dispatch on cancer research, which conveyed the same sense of urgency. The New York Times published two reports on rising cancer rates, in April and June. When cancer appeared51 in the pages of Time in July 1937, interest in what was called the “cancer problem” was like a fierce contagion in the media.
Proposals to mount a systematic national response against cancer had risen and ebbed rhythmically in America since the early 1900s. In 1907, a group of cancer surgeons had congregated at the New Willard Hotel in Washington to create an organization to lobby Congress for more funds for cancer research. By 1910, this organization, the American Association for Cancer Research52, had convinced President Taft to propose to Congress a national laboratory dedicated to cancer research. But despite initial interest in the plan, the efforts had stalled in Washington after a few fitful attempts, largely because of a lack of political support.
In the late 1920s, a decade after Taft’s proposal had been tabled, cancer research found a new and unexpected champion—Matthew Neely, a dogged and ebullient former lawyer from Fairmont, West Virginia, serving his first term in the Senate. Although Neely had relatively little experience in the politics of science, he had noted the marked increase in cancer mortality in the previous decade—from 70,000 men and women in 191153 to 115,000 in 1927. Neely asked Congress54 to advertise a reward of $5 million for any “information leading to the arrest of human cancer.”
It was a lowbrow strategy—the scientific equivalent of hanging a mug shot in a sheriff’s office—and it generated a reflexively lowbrow response. Within a few weeks55, Neely’s office in Washington was flooded with thousands of letters from quacks and faith healers purporting every conceivable remedy for cancer: rubs, tonics, ointments, anointed handkerchiefs, salves, and blessed water. Congress, exasperated with the response, finally authorized $50,000 for Neely’s Cancer Control Bill, almost comically cutting its budget back to just 1 percent of the requested amount.
In 1937, the indefatigable Neely, reelected to the Senate, launched yet another effort to launch a national attack on cancer, this time jointly with Senator Homer Bone and Representative Warren Magnuson. By now, cancer had considerably magnified in the public eye. The Fortune and Time articles had fanned anxiety and discontent, and politicians were eager to demonstrate a concrete response. In June, a joint Senate-House conference56 was held to craft legislation to address the issue. After initial hearings, the bill raced through Congress and was passed unanimously by a joint session on July 23, 1937. Two weeks later, on August 5, President Roosevelt signed the National Cancer Institute Act.
The act created a new scientific unit called the National Cancer Institute (NCI), designed to coordinate cancer research and education.* An advisory council of scientists57 for the institute was assembled from universities and hospitals. A state-of-the-art laboratory space, with gleaming halls and conference rooms, was built among leafy arcades and gardens in suburban Bethesda, a few miles from the nation’s capital. “The nation is marshaling its forces58 to conquer cancer, the greatest scourge that has ever assailed the human race,” Senator Bone announced reassuringly while breaking ground for the building on October 3, 1938. After nearly two decades of largely fruitless efforts, a coordinated national response to cancer seemed to be on its way at last.
All of this was a bold, brave step in the right direction—except for its timing. By the early winter of 1938, just months after the inauguration of the NCI campus in Bethesda, the battle against cancer was overshadowed by the tremors of a different kind of war. In November, Nazi troops embarked on a nationwide pogrom against Jews in Germany, forcing thousands into concentration camps. By late winter, military conflicts had broken out all over Asia and Europe, setting the stage for World War II. By 1939, those skirmishes had fully ignited, and in December 1941, America was drawn inextricably into the global conflagration.
The war necessitated a dramatic reordering of priorities. The U.S. Marine Hospital59 in Baltimore, which the NCI had once hoped to convert into a clinical cancer center, was now swiftly reconfigured into a war hospital. Scientific research funding stagnated and was shunted into projects directly relevant to the war. Scientists, lobbyists, physicians, and surgeons fell off the public radar screen—“mostly silent,”60 as one researcher recalled, “their contributions usually summarized in obituaries.”
An obituary might as well have been written for the National Cancer Institute. Congress’s promised funds for a “programmatic response to cancer”61 never materialized, and the NCI languished in neglect. Outfitted with every modern facility imaginable in the 1940s, the institute’s sparkling campus turned into a scientific ghost town. One scientist jokingly called it “a nice quiet place out here in the country.62 In those days,” the author continued, “it was pleasant to drowse under the large, sunny windows.”*
The social outcry about cancer also drifted into silence. After the brief flurry of attention in the press, cancer again became the great unmentionable, the whispered-about disease that no one spoke about publicly. In the early 1950s, Fanny Rosenow63, a breast cancer survivor and cancer advocate, called the New York Times to post an advertisement for a support group for women with breast cancer. Rosenow was put through, puzzlingly, to the society editor of the newspaper. When she asked about placing her announcement, a long pause followed. “I’m sorry, Ms. Rosenow, but the Times cannot publish the word breast or the word cancer in its pages.64
“Perhaps,”