Richard A. Rettig, the author of an authoritative history of the writing of the National Cancer Act of 1971, died on Aug. 7.
Rettig, 87, died of complications from Parkinson’s.
His book, “Cancer Crusade: The Story of the National Cancer Act of 1971,” an acclaimed history of the landmark legislation that shaped America’s cancer policy, is available at no cost from the Cancer History Project’s website.
As a writer, Rettig was often hot on the heels of events. His “Cancer Crusade,” for example, was first published in 1977, just six years after the National Cancer Act was signed into law.
His second, equally remarkable, cancer history book, “False Hope; Bone Marrow Transplantation for Breast Cancer,” was published just eight years behind the finding that high-dose chemotherapy with autologous bone marrow transplantation was ineffective as a strategy for treatment of breast cancer (The Cancer Letter, May 28, 1999).
It’s important to note what Rettig was not. He was not a journalist. And he was not a historian. A political scientist, he showed up a few years after journalists left the scene and years ahead of historians.
Armed with more perspective than a journalist, he was able to make sense of the chaotic runup to the signing of the National Cancer Act. Who were the key players? What were their entrenched positions? What was the significance of the compromises they made?
If Rettig had a question, he could simply make a phone call and show up in someone’s office, place his tape recorder on his subject’s desk and get the answers. I am proud to say that “False Hope,” a book on which Retting is the lead author, made use of The Cancer Letter’s real-time coverage, and that he spent several days in the office here, photocopying back issue publications and looking through piles of papers I plopped down in front of him.
Turning back the clock and armed with perspective, “False Hope” shows how the unproven procedure was sold to patients and payers, ultimately leading to creation of Response Technology, a company that set out to build a nationwide chain of labs supporting high-dose chemotherapy with bone marrow transplantation (The Cancer Letter, Aug. 13, 1999). The story is all the richer because some of the data on which the sales pitches for BMT were based would later be proven to be falsified.
Rettig was born and raised in Bothell, WA. He graduated from Bothell High School in 1953, received a B.A. from the University of Washington in 1958, and a Ph.D. in political science from the Massachusetts Institute of Technology in 1968.
He held several faculty positions, became a staff member of the Institute of Medicine, and later became a social scientist at the RAND Corporation.
After Otis Brawley and I started the Cancer History Project, “Cancer Crusade” had become a hard-to-find classic. So, we asked Retting to allow us to bring this book back into print and make it freely available on the Cancer History Project website.
Rettig generously agreed. Parts of this story incorporate segments of the new introduction Otis and I wrote for “Cancer Crusade” (The Cancer Letter, Aug. 6, 2021).
Also, Rettig agreed to do an oral history.
“When I was a graduate student at MIT, in political science, I encountered NIH and its role in the American healthcare system. The encounter was in analysis of [NIH] in political terms,” Rettig said in a Q&A with us.
As we spoke, he was struggling cognitively, but he was still the same Dick Rettig, a guy full of insight. He sat in front of a massive four-drawer filing cabinet that prompted me to imagine the dusty pages—and even reel-to-reel cassettes, perhaps—that need to be digitized and made available to scholars.
“Cancer Crusade” is built around two subplots. The first is the complex interplay between the long-time NIH Director James Shannon and the philanthropist Mary Lasker. The second subplot is the years-long slugfest between Richard Nixon and the Kennedys.
Like a journalist, Rettig was able to observe these subplots as they developed.
Rettig was particularly intrigued by the NIH Director James Shannon, his deputies, and their relationships to the key members of Congress, especially on appropriations.
Shannon, a gigantic presence in “Cancer Crusade,” had served as NIH director from 1955 to 1968, presiding over a rapid expansion of biomedical research. That period is known interchangeably as “the Shannon years” and “the Golden Age.”
The pressure on Congress to dramatically increase appropriations for NIH came largely from outside the medical establishment, from a group of wealthy socialites who were galvanized into action by the philanthropist Mary Lasker, the widow of Albert Lasker, the founder of modern American public relations and creator of a variety of national brands of consumer products, including—problematically—Lucky Strike cigarettes.
The group also included the cancer pioneer Sidney Farber and the heart surgeon Michael DeBakey.
Lasker et al. sought to inspire the academic establishment to set its sights higher, to go for the cures, and they insisted that the cure for cancer could be easily accomplished if there was money to fuel research.
In the 1950s, cancer research was usually funded by philanthropy and clinical revenues. Federal funding of medical research was rare, and what little government-funded research existed followed the rules and regulations that applied to purchases of bombers and warships.
Someone in government specified what was needed and negotiated getting it done. The idea of an investigator-initiated grant—i.e. a situation where a scientist in a university has an idea for research and applies to get it funded—was neither widely used nor accepted in many parts of the NIH.
The National Cancer Act would change that.
It has been said, albeit with scant documentation, that the Lasker’s American Cancer Society funded more research grants than the government in the 1950’s. Lasker used her PR acumen to build a field army of advocates in communities across the U.S. Theirs was a movement to get the government into funding cancer research. The feeling was that the government had deep pockets and only the government could launch a sustained research effort.
Rettig became interested in the Shannon-Lasker interplay while he was still at MIT, he said.
“The hook got set early, independent of cancer, and early recognition of the role of Mary Lasker and her allies. Those were the antecedents to this,” Rettig said. With the buildup to the National Cancer Act, “cancer became the dominant motivating enemy to be vanquished,” Rettig said.
About half of “Cancer Crusade” chronicles the legislative history of the National Cancer Act and the interplay between two archenemies—Sen. Edward M. Kennedy (D-MA) and then-President Nixon.
Kennedy’s career had suffered a catastrophic setback in July 1969, when a car he was driving went off a bridge on Chappaquiddick Island, killing Mary Jo Kopoechne, a young woman who had been working on Robert Kennedy’s campaign. Ted Kennedy won reelection to his Senate seat, but lost his position as the Majority Whip.
Kennedy had previously not expressed great interest in cancer, and the disease would not affect his immediate family until 1973. In 1972, Kennedy needed an issue that could propel him to presidency, and, clearly, declaring a war on cancer was an opportunity.
Initially, Lasker and her allies had been relying on Sen. Ralph Yarborough to develop their cancer bill. Yarborough had convened a “panel of consultants,” which issued a report calling for bold action on cancer.
Alas, Yarborough lost his Senate seat, and under normal circumstances, the effort to develop a bill would have been stalled at the end of 1970. For Kennedy, this was an opportunity to jump in and lead.
“Nixon got deeply involved because of Kennedy,” Rettig said to us, recapping his book’s key argument. “He didn’t want yet another Kennedy to mar his political career. Nixon feared Kennedy, from his experience with late Jack Kennedy, and was not about to let another Kennedy influence and wreck his own political career. And so, that was a very important precipitating factor in the president’s involvement in this.”
In other words, tragic events in Chappaquiddick were a part of the chain of events that led to the signing of the National Cancer Act. Rettig stops short of hyping this point, but a careful reader of “Cancer Crusade” will be able to discern it.
The Kennedy bill, optimistically called the Conquest of Cancer Act, proposed giving the cancer program unprecedented autonomy, including pulling NCI out of NIH.
Shannon, by then a former NIH director, was strongly opposed to this idea. Lasker and her allies have gone too far, Shannon wrote:
The creation of an independent Cancer Authority, removing the NCI from the ambit of the NIH, would, in my opinion, not accomplish anything that could not be done within present NIH processes, or trivial and easily realized modifications thereof.
On the other hand, it would unleash forces of a divisive character which would quickly destroy the integrity of the NIH. I predict that in a very short time, orderly governance would be replaced by anarchy, and that instead of a judiciously balanced program of biomedical research, program emphasis would be entirely determined by uncritical zealots, by experts in advertising and public relations, and by rapacious “empire builders.”
These latter forces are not to be disdained and they have played an invaluable role in the past quarter century in making the lay public aware that, through research, there was a real possibility of realizing inchoate public hopes and aspirations to control disease.
As forces modulating the scientific judgment process, their contributions have been positive and important. As determinants, however, I would expect them to create chaos.
Ultimately, through compromise, the National Cancer Act was softened, leaving NCI within NIH, but giving it unique authorities that include the bypass budget and presidential appointment of NCI directors (no other NIH institute or center is run by a presidential appointee). Unique authorities also include the President’s Cancer Panel, which is designed to have direct access to the president.
Before he left Washington, Rettig stopped by The Cancer Letter office and gave me a stack of transcripts of meetings that chronicled the buildup to the National Cancer Act. The yellowed pages were annotated with Rettig’s tight handwriting. ‘You’ll write about this someday,’ he said, and, of course, he was right.
At the signing of the National Cancer Act, on Dec. 23, 1971, a sense of optimism could be felt in the room. Some congressmen seriously discussed cancer being cured by America’s bicentennial—by July 4, 1976.
Indeed, if the U.S. could build an atomic bomb, if the U.S. could put a man on the moon, the U.S. could cure cancer, they postulated.
Whether they realized it or not, the politicians and advocates who clashed over the legislative sausage-making Rettig describes in “Cancer Crusade” had, in fact, built the launching pad for the National Cancer Program’s ultimate takeoff.
Years later, after Kennedy was diagnosed with a brain tumor, Rettig reflected on the senator’s role in making the National Cancer Act happen.
“The American people have been fortunate indeed to have such an articulate and tireless advocate for medical research, and especially for cancer research. Kennedy’s understanding of the issues is broadly philosophical, brilliantly political, and deeply personal. One could not ask for more,” Rettig wrote in a guest editorial in this publication (The Cancer Letter, May 23, 2008).
Rettig’s academic interests also included the political battles and payment policies around kidney failure, dialysis, and kidney transplantation.
In 2005, Rettig retired to St. Augustine, FL.
Before he left Washington, Rettig stopped by The Cancer Letter office and gave me a stack of transcripts of meetings that chronicled the buildup to the National Cancer Act. The yellowed pages were annotated with Rettig’s tight handwriting.
“You’ll write about this someday,” he said, and, of course, he was right.
He is survived by his wife of 23 years, Marisella Veiga, his daughter Kirsten (Curtis Scott), his son Mark (Greta), and two grandchildren as well as brothers Jim (Jan), Jerry (Nancy) and Edward and many nieces and nephews. Surviving in-laws are Glenna Veiga, Luis (Suzi) Veiga, Juan (Marjorie) Veiga, and Carmen Rodes Veiga. Service was held at Bothell United Methodist Church in Bothell, Washington, on Aug. 26.
“Cancer Crusade” is available on the Cancer History Project as a free download, as a PDF or e-book. A print version is available for purchase.
