In this episode, host Bilal Rehman interviews Dr. Robin Scheffler, historian of the modern biological and biomedical sciences at MIT and author of A Contagious Cause: The American Hunt for Cancer Viruses and the Rise of Molecular Medicine. Bilal explores Scheffler’s studies on the relationship and history between laboratory and legislature in bioscience, relating them to his own experiences with cancer in his family and his community. Particularly, Bilal uses Scheffler’s idea of the “biomedical settlement” to further understand his mother’s lymphoma diagnosis, his current academic interests, and the implications of his career as a physician in the future.
I-30 through Grand Prairie, TX
BILAL REHMAN: This is Meta-stasis. I'm your host, Bilal Rehman.
In this episode, I reflect on my own relationship to cancer and medicine, and explore the complex history of cancer research as told by MIT Professor Robin Scheffler in his 2019 book Contagious Cause.
First, a little bit about me.
My hometown — Grand Prairie, Texas — sits right in the middle of the Dallas-Fort Worth metroplex, and partly runs along I-30, the highway that connects the two cities.
[music/sound of trucks]
In the spring of 2014, I was a sophomore when my high school ran out of money. The school had to shut down and my friends and I were displaced to another school in Dallas. It was only 15 minutes away, but it was a completely different environment.
Late that summer, my mother was diagnosed with lymphoma. It was a scary couple of weeks before we learned that the cancer was treatable. She would have to go through over two dozen painful rounds of radiation.
When I settled into my new academic environment in the fall, my mom was already in remission.
BR: My new classmates met me with concerned support after hearing about my mom. But when I discussed the situation with my Grand Prairie friends who moved with me, I came across a perplexing trend: almost all of my friends from the Grand Prairie school had parents who also struggled with cancer. Among our parents, there was lymphoma, lung and throat cancer, and breast cancer. That shared experience extended to others in our community too - both of my neighbors had been diagnosed with skin cancer in recent years.
The evidence was anecdotal, but I couldn’t help but wonder: what specifically made us Grand Prairie folks more susceptible to cancer than my new classmates in Dallas? Was there something in the water? Were the fumes that hovered over I-30 making our parents sick? Or were we sick because we came from a lower income community?
I started thinking more about the social and environmental determinants of health. Now that I'm a few years away from medical school, I have an increasing concern for how our healthcare system is able to respond to those external factors.
Robin Scheffler's A Contagious Cause
BR: This brings us to A Contagious Cause: The American Hunt for Cancer Viruses and the Rise of Molecular Medicine.
The Metastasis team sat down with Professor Robin Scheffler, who spoke about cancer beyond the science, or more specifically, the history of cancer research in the United States after the second World War.
Scheffler told us that the American government has channeled overwhelming financial resources to cancer research, but at the expense of diminishing cancer as an epidemiological concern and as a public health issue.
ROBIN SCHEFFLER: There is a historian of technology who has coined a phrase known as “the shock of the old,” and he uses it to talk about the idea that we think about medical progress or scientific progress or technological progress, we think about the cutting edge.
But what often makes people's lives better, is the really easy, simple stuff. And in the case of thinking about cancer as a problem, we have a lot of that — there's a lot of really exciting research being done to understand cancer. There's lots of therapies for cancer that are, granted, immuno-therapy or gene editing, that I hope will work.
In the meantime, stuff like stopping smoking, making sure that people have safe workplaces, making sure that people can get cancer screening tests that have been around for half a century, making sure that people can afford medical care — they're technologically or scientifically very simple things, but they're very meaningful.
BR: This makes sense. There was—and is—so much more to treating cancer. It's not only a scientific problem, but a political one.
I saw this first hand when I was an intern at the Oral History Project at the MD Anderson Cancer Center. I learned that, for the most part, MD Anderson's focus in terms of research and care was dictated by corporate administrators, lobbyists, and the financial bottom line, rather than by physicians and researchers. In fact, it seemed like physicians rarely had any agency in improving the structure of healthcare outside of treating patients.
Over many decades, MD Anderson adopted corporate values and subtly oriented itself towards research, often at the expense of patient care. By framing a research-heavy agenda as the only way to win the "battle" against cancer, MD Anderson gained lots of public buy-in.
And it doesn't stop there.
RS: After the Second World War, pretty much every industrialized country that can adopts a system of national healthcare in some form or another, with the exception the United States. And a lot of people will explain this in the history of healthcare as, “Oh, well, that was American exceptionalism, American individualism, resistance to big government,” and those are all threads in American political history.
But the really odd thing to me when I was looking at that, is that most other nations did not invest nearly as much in biomedical research on the scientific side, and the United States at the same time that it's unwilling to get involved in health care, the federal government becomes the single largest player in science research, very rapidly over the course of a decade.
BR: It turns out that MD Anderson's history is a microcosm of the United States' general approach to cancer care in the postwar era. According to Scheffler, the United States bought into research as a solution to the cancer problem, investing heavily in science instead of public health and access to care.
There is a name for this lopsided investment, and Scheffer calls it the “biomedical settlement.”
RS: The idea of the “biomedical settlement” was my effort to capture and explain the agreement that "Okay, we will have a federal presence and that medicine is just going to be on the research side." And in turn, people doing that research are going to accept that federal funding and do a lot of science with it on the faith or hope that that research will be relevant to public health.
Of course, the tensions are when the settlement doesn't quite do what it's supposed to do, and then the question is: How does it stick together and continue to operate at a political level, even as it's funding all of this scientific research?
BR: One program that exemplified the biomedical settlement was the Special Virus Leukemia Program. Founded in the 1960s, the project emerged from a longer trend in cancer research proposing that cancers might be contagious and caused by viruses. The goal of the SVLP was to identify a leukemia “virus” and subsequently develop a vaccine.
This project won massive federal support. While physician-scientists conducted research through the program, it was the lobbyists and anti-cancer advocates who cultivated public support and funding.
However, over the course of a decade, the SVLP failed to identify any cancer viruses.
My experiences at MD Anderson, along with Scheffler's articulation of the biomedical settlement and the fate of the SVLP, completely upended my views on medical research. I used to think that science and medicine proceed in a linear fashion: scientists research diseases, develop treatments, and then doctors provide those treatments to patients. Instead, I learned that science and medicine are intertwined with a complex system of social, economic, and political forces.
RS: I happen to think that all of this stuff that goes into making a laboratory work does make the discoveries that we have contingent in a way — it's not to say they're arbitrary, or infinitely flexible, but there is a high amount of contingency and that is a very unsettling idea for the chemistry majors who think that things are just out there the world.
And not only are they contingent, but they're linked into this much bigger political and social story about how American society grappled with cancer.
BR: I spent the majority of my undergraduate years at Rice University wrestling with this tension, uncertain about my future plans. Though I continued to spend time in clinical settings, I also explored fields that could help me better understand the complex forces that shape our healthcare system - fields like ethics and the medical humanities.
I learned that although any one physician is limited in their power to affect structural change, some individuals do manage to influence popular movements.
In his book, Scheffler highlighted Mary Lasker, a wealthy businesswoman and activist who pushed for a national health service. Though the American Medical Association and the burgeoning red scare ultimately defeated Lasker's dream for a national healthcare system, she soon turned her attention to securing federal funding for scientific research.
RS: Mary Lasker recalls that one of her household staff, I think a maid, got sick with cancer and she was shocked that there was nothing that can be done for her by doctors. One doctor she met with in New York casually mentioned that about $500,000 should be enough to do all the research necessary to deal with cancer.
So, she and her husband Albert Lasker become very active in the American Cancer Society. And after Albert Lasker dies in 1952 of cancer, she continues to push that effort forward through both the American Cancer Society as a philanthropy, but also through her lobbying and campaigning on behalf of expanding the federal government in Washington, and that was something that reflected her own convictions as a New Dealer but also her discussion with Albert Lasker of his work during WWI and the power of what he called “government money” to solve problems.
That was where Mary Lasker really had a big impact was by understanding that government money could be brought to bear on the cancer problem.
BR: In her hope to win federal funding for the good of public health, Lasker became one of the early architects of the now deeply entrenched biomedical settlement, which reflects a flawed faith in the singular power of research.
Nevertheless, Lasker herself serves as an example for how individuals can affect change on a structural level.
BR: After graduating college, I found myself back at my parent's place in Grand Prairie. Just under a year ago, my mother was diagnosed with another mild lymphoma—one that hasn’t required treatment thus far.
It feels like a return to my past—a renewed curiosity about the environment around me, after speaking to Scheffler, and my mother's second diagnosis--all against the same old drone of I-30 in the background.
I’m still unable to answer my questions from high school, but my experiences and continued pursuits in healthcare have made me more aware of the complex vehicle of people and policies that drives cancer research, both in the past and in the present. And it’s thanks to the research of individuals like Scheffler that we have hope of steering it in a more just and truly beneficial direction in the future.
Metastasis is a part of the Medicine, Race, Democracy Lab at Rice University. It is produced by Bilal Rehman, Eddie Jackson, and Katherine Wu with story editor Juliann Bi, intern Aysel Rizvi, and executive producers Danyal Rizvi and Lan Li. This episode was hosted by Bilal Rehman and edited by Lan Li with editorial assistance from Juliann Bi. Our music is by Moiz. Special thanks to Robin Scheffler for talking to us in this episode. You can learn Scheffler’s book A Contagious Cause: The American Hunt for Cancer Viruses and the Rise of Molecular Medicine published with the University of Chicago Press wherever books are sold.
Scheffler, Robin Wolfe. A Contagious Cause: The American Hunt for Cancer Viruses and the Rise of Molecular Medicine. University of Chicago Press, 2019.
Mulligan, John, and Bilal Rehman. “Corporate Medical Cultures: MD Anderson as a Case Study in American Corporate Medical Values.” Medical Humanities 46, no. 1 (March 1, 2020): 84–92. https://doi.org/10.1136/medhum-2018-011556.