The following excerpt is from “Crusade to Heal America: The Remarkable Life of Mary Lasker” by Judith L. Pearson, best-selling author and founder of A 2nd Act. A conversation and podcast recording with Pearson is available on the Cancer History Project.
Philanthropist and citizen lobbyist Mary Lasker was at the height of her influence in increasing federal medical research funding. With her friend Lyndon Johnson in the White House, an enormous step appeared imminent. But a greater obstacle lurked on the horizon.
Excerpt from chapter 8: “We Thought We’d Have More Time”
One night Mary received a phone call from the White House. “Listen,” President Johnson said, “I got something I need for you to do for me.”
“What is it?” she replied good-naturedly. “I’ll do it if I can.” Never in her wildest dreams could she have imagined what came next.
“I want to make you ambassador to Finland,” Johnson told her.
Mary was in shock. “Oh my God, I can’t move to Finland!”
Johnson insisted she’d be perfect for the job. “Right on the border of Russia,” he said. “I need someone who’s got some brains and some charm.”
It was a ridiculous notion. Give up her home, her friends, and New York City and move halfway around the world? Going to France every summer was one thing. This was quite another. “Lyndon, I wouldn’t be good!” Mary told him, frantically grasping for a reason he’d accept. The only thing that came to mind was the subject that was always on her mind. “I’ve got to get the answer to the different kinds of cancer,” she insisted. He told her not to be hasty, to think it over for twenty-four hours.
Mary really didn’t need the time, but she agreed to speak with him again the next day, when she politely repeated that the ambassadorship was out of the question. But she reminded him of the memo she had sent earlier. It contained all the ingredients for his upcoming announcement of the creation of the Com- mission on Heart Disease, Cancer, and Stroke. He had promised to make the announcement in his health message to Congress on February 10, which he did.
“Cancer, heart disease, and strokes stubbornly remain the leading causes of death in the United States,” the president said in that message. “I am establish- ing a Commission on Heart Disease, Cancer, and Strokes to recommend steps to reduce the incidence of these diseases through new knowledge and more complete utilization of the medical knowledge we already have.” His words were almost exactly what Mary had written for him.
She had also given Johnson her recommendations for commission members. Those included the many friends who had served in other capacities of the crusade. DeBakey would be chair, and commission members included Farber, former RCA president David Sarnoff, Emerson Foote, and Dr. Howard Rusk. Mary was back in Washington on Valentine’s Day to discuss it all further. “I think you should have the names of more women for the commission,” LBJ told her. “Get me more names of women!” So they added Bess Truman, Dr. Marion Fay (former president and dean of the Woman’s Medical College of Pennsylvania), Dr. Jane Wright (associate professor of surgical research at New York University School of Medicine, and the commission’s only African American), and Florence Mahoney.
Johnson wanted to know why Mary hadn’t suggested herself for the com- mission. There was no need: she had handpicked the members, most of whose thoughts about medical research mirrored hers. She would be advised of the final report before it was presented, at which time she could add anything she felt might be lacking. Plus, she and her staff would be heavy contributors of statistics for the report.
The president good-naturedly accused her of simply wanting others to do the heavy lifting. “You can make more work for more people than anybody I’ve ever heard of,” he teased. He still acknowledged her publicly, later saying that he appointed the commission “at the insistence of this lovely lady, Mary Lasker.” This would be the first time ever a president had ordered that direct aim be taken at solving the mysteries of America’s three major killers. It was a step closer to Mary’s dream of eradicating them forever.
Johnson was pleased with the suggestion of DeBakey as chair. The surgeon was a Texas Democrat and a heart specialist, two things that mattered to the president. DeBakey was genuinely honored and readily accepted, arriving at the White House on March 7 for the commission’s official introduction to the public. Speaking with DeBakey ahead of time, Johnson told him he felt the most important task before the commission was to make recommendations that would improve doctors’ ability to deal with heart disease, cancer, and strokes. How long would it take to complete the study? the president wanted to know. DeBakey, staggered by the enormousness of it all, suggested a year. That was not good enough for the president; Johnson wanted it completed before the 1965 State of the Union address. That was just nine months away, but the inspiring, off-the-cuff pep talk the president then gave the entire group of commission members made it seem possible. “Unless we do better,” Johnson said, “two- thirds of all Americans now living will suffer or die from cancer, heart disease or stroke. I expect you to do something about it.”
The commission divided itself into subcommittees for each of the conditions, plus five other committees to support the overall work. From the outset, the cancer subcommittee was in agreement on the direction they wanted to go. Chaired by Farber, it also included Dr. Lee Clark, director and surgeon-in-chief of M. D. Anderson Hospital and Tumor Institute, and Dr. Frank Horsfall, president and director of the Sloan Kettering Institute for Cancer Research. Among other things, they strongly favored the creation of regional cancer centers that would become the hubs of scientific and clinical work, with “the eradication of cancer [as] the accepted institutional goal.”
Working from the Executive Office Building, the commission was sup- plied with space and a support staff provided by PHS and NIH. They collected testimonies from national organizations (like ACS and the American Heart Association) and interviewed dozens of other expert witnesses in science and medicine. They analyzed the information and distilled it down to a hundred- plus-page document. “Report to the President: A National Program to Conquer Heart Disease, Cancer and Stroke” was formally submitted to Johnson on December 9, 1964.
The original purpose of the commission was to bridge the gap between clinical research in the three diseases and the delivery of the results to actual patients. Of the thirty-five recommendations made in the report, the “national network for patient care [and] research teaching in heart disease, cancer and stroke” got the most attention. It recommended the creation of centers, spread across universities, hospitals, and research institutes. Within five years, there would be twenty- five heart centers, twenty cancer centers, and fifteen stroke centers, plus 150 diagnostic and treatment centers for heart conditions, 200 for cancer, and 100 for stroke. The whole thing became known as the Regional Medical Programs (RMP). The cost of implementing these recommendations would be $357 million in the first year and $739 million by the fifth year, for a total of $2.9 billion.
That amount, however, was put into perspective by the report’s opening letter from DeBakey: “Our stated goals are neither impartial nor visionary—they can be achieved if we so will it. They must be achieved if we are to check the heavy losses these three diseases inflict upon our economy—close to $40 billion each year in lost productivity and lost taxes due to premature disability and death.”
This had always been one of Mary’s greatest themes, of course. If medical research achieves its goals and lives are saved, society is better off in myriad ways, not the least of which comes in the form of cold, hard cash. But that point was missed by the newspaper headlines, which latched on to the overall cost: “$3 Billion War on Cancer, Heart Disease, Stroke Urged.” The commission’s report was quoted as saying that “emphasis should be placed locally for the pro- vision of care for medically indigent patients in a diagnostic and treatment unit. Patients other than the medically indigent should pay for services.” Readers, however, saw that as federally funded medical care. In other words, the com- mission seemed to be advocating two of the dirtiest words in the English language: socialized medicine. The public was aghast; so was the American Medical Association.
In a brilliant political move, Mary and the president had originally included on the commission Dr. Hugh Hussey, the AMA’s director of scientific activities. In September, however, midway through the commission’s work, Hussey had handed in his resignation, stating that the commission’s direction was in potential conflict with AMA policy. That conflict was made clearer in a statement the association released the day after the debut of the recommendations. It had not had time to study the report, the association said. But it wanted to make clear that it would continue to oppose all federal intervention in the field of medicine.
Johnson was able to include the commission’s report in his State of the Union address, as he’d hoped. It was the first evening speech to be carried live on all three television networks. Three days later, the president delivered a health message to Congress. How wonderful it would have been if the message had focused solely on the commission’s recommendations. The president did, indeed, ask Congress to approve them. But the sweeping message also dealt with “hospital insurance for the elderly,” commonly referred to as Medicare.
Sixteen days later, the legislative process to approve the commission’s recommendations began. Bills were presented in both the House and the Senate, with Fogarty and Hill rolling up their sleeves to get the funds appropriated. But in the background, the AMA simmered. They would not be usurped again in their war to prevent socialized medicine, and used the next two months to continue to chip away at the DeBakey commission’s recommendations.
When the October 6, 1965, signing of the Heart Disease, Cancer, and Stroke Amendments of 1965 took place (amendments to the 1944 Public Health Service Act), the final bill bore little resemblance to the original recommendations. An avalanche of revisions had been presented to appease special interest groups. Most disappointing for Mary and the citizen lobbyists was that the categorical research targets were blurred.
“The intention was to attack these major diseases,” she said a few months later. “[They were] cut of course by the National Institutes of Health leadership, in the form of Dr. Shannon and some others. They loathe having any specifics attached to anything that they’re doing.” She reiterated her assertion that “they’re fearful that nothing will result, and they don’t want to be put on the spot to do something that they’re not at all sure they can accomplish.”
Mary was one of the nearly 250 people who were at the bill’s East Room signing, many of whom had originally been opposed to the idea of the com- mission. But there they were, happily taking pens and shaking hands with the president. Still, working with LBJ from the commission’s conception to this legislation had only served to confirm Mary’s opinion of him. He was a man with a noble spirit. He had a sympathetic comprehension of human problems, realizing full well that if health crises were happening to him, they were happening to tens of millions of other people, too. This president had just done more for the welfare of his fellow Americans in two years than had any other president before him in the 189-year history of the nation. And that gave Mary great satisfaction.