The Emperor of All Maladies. Siddhartha Mukherjee

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,”²⁹⁴ 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’clock²⁹⁵ 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,²⁹⁶ 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.

      Farber’s life also collided with cancer—a collision that he had perhaps presaged for a decade. In the late 1940s, he had developed a mysterious and chronic inflammatory disease of the intestines—likely ulcerative colitis, a debilitating precancerous illness that predisposes the colon and bile duct to cancer. In the mid-1950s (we do not know the precise date), Farber underwent surgery to remove his inflamed colon at Mount Auburn Hospital in Boston, likely choosing the small and private Cambridge hospital across the Charles River to keep his diagnosis and surgery hidden from his colleagues and friends on the Longwood campus. It is also likely that more than just “precancer” was discovered upon surgery—for in later years, Mary Lasker would refer to Farber as a “cancer survivor,” without ever divulging the nature of his cancer. Proud, guarded, and secretive—reluctant to conflate his battle against cancer with the battle—Farber also pointedly refused to discuss his personal case publicly. (Thomas Farber, his son, would also not discuss it. “I will neither confirm nor deny it,” he said, although he admitted that his father lived “in the shadow of illness in his last years”—an ambiguity that I choose to respect.) The only remnant of the colon surgery was a colostomy bag; Farber hid it expertly under his white cuffed shirt and his four-button suit during his hospital rounds.

      Although cloaked in secrecy and discretion, Farber’s personal confrontation with cancer also fundamentally altered the tone and urgency of his campaign. As with Lasker, cancer was no longer an abstraction for him; he had sensed its shadow flitting darkly over himself. “[It is not] necessary,” he wrote, “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.”

      “Patients with cancer who are going to die this year cannot wait,” Farber insisted. Neither could he or Mary Lasker.

      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,