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OCR for page 248
· 10.
The Politics of Compromise
"Don't Be Taken In By Them Scientists Leave
Everything To Old Doc Politics"
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Copyright 1971 by Herblock in the Washington Post
It had been widely assumed that the House hearings would end in
the first week of October and that the subcommittee would go di-
rectly into executive session to write a clean bill. While the Octo-
ber it visit to Buffalo had come as something of a surprise to
many, it did little to alter the basic schedule of activity. And since
Mr. Rogers had used the hearings to effectively buttress his case,
the partisans of S . l 828 shifted their efforts to influencing the suc-
cessive stages of the legislative process. Cancer legislation would
have to be considered by the health subcommittee, the full com
OCR for page 249
The Politics of Compromise 249
mittee, the entire House, and, if a bill different from S. 1828 re-
sulted, there would have to be a joint House-Senate conference to
resolve the differences. Proponents of the Senate-passed legisla-
tion thought that their chances of prevailing increased at each suc-
cessive stage. "When the 9th inning comes, we'll win," Luke
Quinn insisted.
The Citizens Committee for the Conquest of Cancer became ac-
tive again. Solomon Garb personally traveled to Mr. Rogers'
home district and sought to organize people to bring pressure on
the Florida congressman.) He wrote various papers seeking their
editorial support, contacted a number of doctors, and, sought to
mobilize the substantial Jewish population in Rogers' constitu-
ency in support of the Senate bill.
Howard Metzenbaum, throughout August, tried to secure the
endorsement of Ohio's House delegation for the Conquest of
Cancer Act. A press release issued just before the House hearings
began listed 19 co-sponsors out of the 24-member delegation. On
October 8, owing to Metzenbaum's efforts, the Cuyahoga County
unit of the American Cancer Society held a luncheon to honor
seven northern-Ohio congressmen who were co-sponsors, and to
hear Charles Ebersol, vice-chairman of the ACS board of di-
rectors, talk about recent legislative developments.2
The American Cancer Society initiated a letter-writing cam-
paign to influence members of Congress.3 Dr. H. Marvin Pollard
wrote more than one hundred congressmen on October 4. Luke
Quinn, from his hospital bed in the Clinical Center at NIH, sent a
similar number of letters to individual representatives on October
5 and 6, many of whom were old personal friends. Dr. A.
Hamblin Letton, president-elect of the ACS, followed up with let-
ters to many in the House on October 12. The message was the
same in every case, vote for S. 1828. Congressional responses to
Pollard, Quinn, and Letton generally indicated strong support for
cancer legislation, substantial concern for the National Institutes
of Health, a clear recognition of differences between the House
subcommittee's bill and the Senate bill, and a legislator's recogni-
tion that judicious withholding of judgment was necessary.
The Citizens Committee and the ACS, though supporting the
same objective, took independent action in efforts to promote S.
OCR for page 250
250 The Politics of Compromise
1828. On Saturday and Sunday, October 9 and 10, full-page ad-
vertisements were run in the 21 daily newspapers published in the
congressional districts of the ten members of the House health
subcommittee.4 These advertisements were sponsored by the Citi-
zens Committee for the Conquest of Cancer. Readers were invited
to "let your Congressman . . . know that you want [S. 1828]
passed." The ailing Luke Quinn, though adamantly opposed to
these advertisements, was unable to persuade Mary Lasker not to
take this action. Quinn thought that such heavy-handed tactics
would only backfire.
The Cancer Society, believing that they had been unable to get
fair treatment in the press, took out full-page advertisements in
the New York Times, Washington Post, and Washington Evening
Star on October 12. "An open letter to the 435 members of the
House of Representatives from the president of the American
Cancer Society," was an effort to go over the heads of the sub-
committee and bring pressure on them through the opinions of
their fellow legislators.
"We are for the Conquest of Cancer Act-S. 1828-
unequivocally," the letter began, because it provided for "an un-
precedented mobilization of brains, science, technology and
money to smash the barriers that have stalled us" in the fight
against cancer. The bill preserved the "essential scientific rela-
tionships" between NCI and NIH, but by cutting red tape repre-
sented "an advance in the mechanics of administration." The
president, the Senate, the people, and the cancer experts on the
Panel of Consultants favored this legislation. Those who favored
the status quo did "not fully understand the situation," did "not
have expert cancer knowledge," and had "never made a parallel
study" to that of the Panel of Consultants. Without mention of
Mr. Rogers' bill, the ad concluded by saying, "The people are
desperate for action against cancer.... They are counting on
you, their representatives. And so are we. Vote for S. 1828."
The Rogers subcommittee met on Tuesday morning, October
12, for its first day of executive session. The members had not
been together since Thursday, with the exception of the three who
had traveled to Buffalo on Monday. When they met, they com-
pared notes on the weekend attack by the Citizens Committee and
OCR for page 251
The Politics of Compromise 251
that morning's message from the American Cancer Society. They
deeply resented the heavy-handed effort to stimulate constituent
pressure through the local district newspapers. They also resented
the implication of Dr. Pollard's letter that, after eleven days of
hearings, they did "not fully understand the situation." Nor did
Mr. Rogers appreciate the fact that neither group would even con-
cede that he had sponsored alternative legislation. They saw the
advertisements as a one-two punch by Mary Lasker and her as-
sociates designed to strong-arm the subcommittee into support for
the Senate bill. But the actual effect of the advertisements was
quite the opposite.
A "CLEAN BILL"
During the hearings, H.R. 10681 had been ignored by its oppo-
nents but had drawn support from the scientific community. Even
witnesses who found the Rogers' bill preferable to S. 1828, how-
ever, had made specific suggestions for its improvement. Though
the subcommittee had no intention of reporting S. 1828 to the full
committee, it was clear that H.R. 10681 would have to be im-
proved and rewritten. The task before the subcommittee was to
report out a "clean bill" that would contain the basis for accept-
ance by the House, compromise with the Senate, and agreement
with the Nixon administration.5
The immediate priority before Paul Rogers as he began four
days of executive session was to achieve unanimity within the
subcommittee. Five others Satterfield, Kyros, Preyer, Roy, and
Hasting~had co-sponsored H.R. 10681, so a long step had al-
ready been taken toward a united subcommittee. Symington, the
only Democrat who had not joined Rogers in mid-September,
strongly favored the chairman's approach and became an early
supporter of it in executive session. Rogers was then left with the
job of persuading the other three subcommittee Republicans-
Nelsen, Carter, and Schmitz-of the merits of the House bill.
The subcommittee worked through the text of the original H.R.
10681. They reduced its scope from "cancer and the major killer
diseases" to an exclusive concern for cancer. But they retained
those provisions of the bill that elevated the directors of the Na
OCR for page 252
252 The Politics of Compromise
tional Cancer Institute, the National Heart and Lung Institute, and
the National Institute of Neurological Disease and Stroke to be as-
sociate directors of NIH. These two steps were logically inconsis-
tent but legislatively logical. If Rogers could restrict the scope to
cancer, the Senate might wish to reserve new bureaucratic status
to the NCI director. The House subcommittee was signaling a po-
tential bargaining point to the Senate conferees. Paul Rogers had
always understood that the bill he finally reported out would be a
cancer bill.
New language was added which stressed that cancer research
was to be retained within the NIH.6 To provide for "the most ef-
fective attack on cancer," the subcommittee wrote into the new
bill, "it is important to use all of the biomedical resources of the
National Institutes of Health, rather than the resources of a single
Institute." The NCI director was authorized to implement this
general principle by taking whatever action was needed to insure
that "all channels for the dissemination and exchange of scientific
knowledge and information" were maintained between NCI and
all other medical and scientific organizations. The earlier bill had
granted this authority to the NIH director, so this reflected a gen-
eral upgrading of the NCI director.
The general principle of making full use of NIH resources was
incorporated through the provisions for "proper scientific review"
of all research grants. The NCI director was to use existing NIH
peer review groups to "the maximum extent possible." Where
appropriate, he might establish other peer review groups with the
approval of the NIH director and the National Advisory Cancer
Council. The maintenance of quality in research grant award deci-
sions was to be preserved.
The major concession of H.R. 10681 was retained in the new
bill. The NCI director was granted substantial budget autonomy
from NIH and HEW. He was to submit his annual budget request
directly to the president. While the NACC, the NIH director, and
the secretary of HEW could "comment" on the proposed budget,
they could not change it. In addition, Rogers added language to
insure that NCI received from the president and the Office of
Management and Budget "all funds appropriated by Congress for
obligation and expenditure." 'rhe NCI director was also author
OCR for page 253
The Politics of Compromise 253
ized to make research grants up to $35,000 after scientific review
but without NACC approval. So, while insisting that NCI remain
an organizational part of the National Institutes of Health, Rogers
and his subcommittee also provided it with a large degree of au
tonomy within the NIH.
The bill that the subcommittee was drafting amplified the pro-
visions of a national cancer program. The NCI director, for in-
stance, was directed to support "appropriate manpower programs
of training in fundamental sciences and clinical disciplines." In
this way, the subcommittee sought to reverse by statute the
Nixon-administration policy of reducing, if not eliminating, the
research training programs of NIH. The subcommittee judged
such programs essential to insuring an adequate supply of scien-
tists, physicians, and allied health professionals for the basic re-
search, clinical research, and treatment needs of an expanded
cancer effort.
The original Kennedy-Javits bill, and the compromise version
of S. 1828, had called for the cancer program to strengthen exist-
ing comprehensive cancer centers and to establish new ones. The
Rogers' bill had used this language but had defined centers to in-
clude the laboratory, research, and patient-care facilities required
to develop and demonstrate the best patient treatment methods,
but not to include the financing of extensive patient-care facilities.
The clean bill specified that 15 new centers be established for
"clinical research, training, and demonstration of advanced
diagnostic and treatment methods" related to cancer. The new
legislation authorized the director of NCI to enter "cooperative
agreements" with public or private nonprofit agencies to pay for
planning, development, and basic operating expenses of new or
existing centers. Federal funds could be used for construction of
facilities, patient-care costs associated with research, training of
personnel, and the demonstration of treatment methods. Authority
was provided to give $5 million support to a center for each of
three years, with successive three-year renewals possible after
scientific review. Core support for cancer centers, clearly, had
been one outcome of the visit to Roswell Park Memorial Institute.
Rogers, in executive session, also insisted upon language that
provided statutory authority to NCI for "the prevention, control,
OCR for page 254
254 The Politics of Compromise
and eradication of cancer." Cancer control was further authorized
$20 million, $30 million, and $40 million for fiscal years 1972,
1973, and 1974, respectively. The subcommittee was attempting
to reinstate a program that the Nixon administration had termi-
nated a year earlier.
Representative Nelsen had a legislative reputation as a
compromise-seeker. "When I saw the storm clouds brewing," he
said, "I started to search for ways to make the House version ac-
ceptable to both the White House, which had already endorsed the
Senate bill, and to Senator Kennedy, the chief sponsor in the Sen-
ate."7 His search began on the first day of the hearings when he
suggested to Elliot Richardson that close liaison between HEW
and the subcommittee might be the best way to work out differ-
ences. He had also expressed to Senator Nelson the hope that dif-
ferences could be resolved "by sitting down together and working
it out."8
On October 7, Nelsen questioned Representative Brock Adams
(D., Wash.), an advocate of the Senate-passed legislation, on
prospects for a compromise.
In the Rogers bill you have your National Cancer Advisory
Council and they sort of sit in an overview position and I was
wondering if there is some way that we can find a sort of middle
road in this proposition.
There are those of us who time after time have seen some
new thing come along so we lay another layer on top of an
existing layer; nevertheless, I think there is merit in having
somebody with a little muscle in here to see to it that this activ-
ity is stimulated properly.
Now, if there was a little review group of two or three, ap-
pointed by the President and with authority of umpiring this ac-
tivity, maybe we could accommodate the wishes of the so-
called Senate bill. At the same time many of us don't want
to fragment past activity but still wish to earmark funds, and
a small group could sit in and watch and see the job is properly
done.9
Nelsen's embryonic idea had developed sufficiently by the fol-
lowing week for him to propose that the House legislation incor
OCR for page 255
The Politics of Compromise 255
porate a provision establishing the President's Cancer Attack
Panel. The panel would consist of three citizens, of whom at least
two would be distinguished scientists or physicians. These three
individuals would monitor the cancer program. Most importantly
to a Republican seeking a way to gain White House acceptance of
the bill, this proposed panel would report directly to the president,
thus meeting his oftstated desire to have direct responsibility for
the cancer program.
No sooner had Ancher Nelsen proposed the idea of the presi-
dent's panel than Paul Rogers accepted it. The idea had some
problems but also a certain logic. For Rogers, accepting the panel
idea, gained him the support of the ranking minority member for
the subcommittee's bill. Only two Republicans now were outside
the fold.
Representative Tim Lee Carter had been the only supporter of
the administration's position on the subcommittee. Throughout
the hearings the Kentucky M.D. referred to the time when the
Veterans Administration, in 1945, had brought in Dr. Paul Mag-
nuson, an eminent Chicago physician, to run their medical pro-
gram. Magnuson, Carter would point out, had infused new blood
into the program. The physician-congressman was also very
critical of PHS personnel who became administrators and who
were not "deeply, scientifically knowledgeable." In fact, this was
Carter's veiled way of expressing his intense dislike for Carl
Baker, the NCI director. Though a decision on who would run the
cancer program could not be made until legislation was passed,
Baker's own future prospects waxed and waned throughout this
time and Carter may have had reason to think a new program
would require new leadership.
But Carter had also been softened up by the extensive hearings.
One of the last witnesses to appear before the subcommittee had
been Francis Moore, M.D., professor of surgery at Harvard Med-
ical School and surgeon-in-chief at Boston's Peter Bent Brigham
Hospital. Moore's testimony against S. 1828 was impressive to
Carter because the surgeon referred to example after example
from l9th- and 20th-century medical history to reinforce his ar-
guments. Had there been a diabetes institute in the late 19th cen-
tury, Moore argued, it would not have supported the work of
OCR for page 256
256 The Politics of Compromise
Langerhans on the pancreas, work which led to the discovery of
insulin as a means of controlling diabetes. The relation between
insulin and diabetes was simply not recognized at the time. Had
there been a heart institute in 1915, he doubted whether it would
have put its money behind two people attempting to extract a fluid
from the liver, a fluid now known as "heparin," which prevents
blood clotting and which is essential for open heart surgery.
Would a government institute on poliomyelitis have supported the
work of Dr. John Enders in the early l950s, work that had at the
time more apparent relationship to kidney disease? Moore asked.
He thought not.
Moore listed five medical research advances of the past quar-
ter century tissue transplantation, open heart surgery, polio-
myelitis, oral contraceptives, and tuberculosis. In each instance,
he said, support had gone to people-"often young people, often
unheard of people" in universities.~° A recent informal discus-
sion among a group of clinicians and scientists, Moore said, had
not produced one example of a major advance that had come from
a targeted institute.
Carter asked Moore what might have happened if there had
been an NIH in 1870 and it had supported Langerhans. The Har-
vard surgeon responded that Langerhans might have done his
work a bit faster, but since he didn't understand the hormone-
creating function of the pancreas he probably would not have
come up with the Banting-Best discovery. His support could have
come, Moore added, only as bright young people were supported,
not through targeted, directed research efforts. Carter thanked
Moore for his testimony. It "has so many things that I re-
member," the Kentucky physician said.
When Ancher Nelsen joined Paul Rogers as a supporter of the
clean bill, Tim Lee Carter found himself under substantial pres-
sure within the subcommittee to throw in his support. Whatever
the reasons, whether an expectation that Carl Baker would not be
running the new program, or the persuasive effects of testimony,
or the internal pressure from within the subcommittee, Carter de-
cided to support the rewritten House legislation.
At the end of four days of executive session, Paul Rogers
emerged buoyantly to announce at a press conference that the
OCR for page 257
The Politics of Compromise 257
subcommittee was unanimously reporting out H.R. 1 1302, "The
National Cancer Attack Act of 1971."~2 Even Representative
Schmitz, Rogers noted with obvious pleasure, had joined in the
subcommittee decision to report this clean bill to the full commit-
tee. Nine members of the subcommittee, the chairman pointed
out, Schmitz being the single exception, were now co-sponsors of
the new bill.
Rogers had parlayed his considerable legislative skill into a
unanimous position within the subcommittee. He added that he
expected little or no opposition to the new legislation from within
the full committee. The New York Times commented that "It
would be unusual for the full committee to raise serious objections
to a bill that had the unanimous agreement of that subcommittee,
particularly after the subcommittee devoted four weeks of hear-
ings to the measure."~3 Paul Rogers had passed a critical
milepost.
REAR GUARD ACTION
Rogers had been deeply angered by the full-page advertisements
sponsored by the Citizens Committee for the Conquest of Cancer
and the American Cancer Society. On Monday evening, October
11, he accused the supporters of an independent cancer agency of
trying "to stampede the Congress."~4 He was still smarting from
these pressure tactics when he emerged on Friday to report on the
unanimous action of the subcommittee on the legislation. "It is
most unfortunate," he said with emphasis, "that some people are
attempting to bring the issue of finding a cure for cancer into a
political setting."~5 Despite these efforts, Rogers predicted that
his legislation would be supported by the full committee and the
entire House.
Senator Gaylord Nelson appeared with Rogers at the Friday
press conference and also blasted the Cancer Society and the Citi-
zens Committee. One was moved to ask, he said, why it was
necessary to pressure the House through "a massive advertising
campaign," alleged to have cost $53,000, when everyone knew a
major cancer bill would be passed and signed by the president.
The answer, Nelson said, was simple enough:
OCR for page 258
258 The Politics of Compromise
This group does not want the bill to be modified or changed in
any way to correct what the scientific community considers a
major organizational defect in the Conquest of Cancer pro-
posal as it passed the Senate. Because they cannot win the sci-
entific argument, they have launched a propaganda cam-
paign at the grassroots level aimed at stampeding Congress by
making a political issue of an important scientific matter.
The American Cancer Society, which had hoped for "some
positive impact" on the Congress with the advertisements in the
Times, Post, and Star, was thrown on the defensive by this coun-
terattack. Though it issued a press release on the fifteenth that was
critical of the bill that Rogers' subcommittee had just reported,
the ACS representatives were preoccupied with responding to
Rogers and Nelson. Rather lamely they denied any attempt to
pressure the House in favor of an independent cancer agency and
declared that they had nothing to do with the advertisements in the
21 local newspapers.~7
Ironically, the Op-Ed page of the New York Times for October
15, 1971, carried a piece by Dr. Emil Frei, Act, president of the
American Association for Cancer Research, entitled "The Con-
quest of Cancer." Frei, who was also an associate director of M.
D. Anderson, argued a straight S. 1828 line in the article, which
the ACS had worked hard to get printed. Coming when it did, the
article was simply lost in the shuffle.
The administration was also active. On October 14, the White
House announced to the press that President Nixon would travel
the following Monday to Fort Detrick, Maryland. On Monday,
the eighteenth, the president announced the conversion of Fort
Detrick to a cancer research center. He hoped that as the nation
moved from a wartime to a peacetime era it could convert many of
its military facilities "to meet pressing domestic challenges." The
Fort Detrick scientists, Nixon said, could now devote themselves
"toward saving life, rather than destroying life." The president
referred to the Senate bill, which provided "an independently
budgeted program with the director . . . responsible directly to the
President," as "an important step" in the campaign against
cancer. He urged the House "to act promptly on this matter, so
OCR for page 270
270 ~ The Politics of Compromise
Representative Hale Boggs (D., La.) was Speaker pro tempore
in the absence of Carl Albert. Soon after the opening prayer and
preliminary business, he recognized Mr. Staggers. The commerce
committee chairman rose and said: "Mr. Speaker, I move to sus-
pend the rules and pass the bill (H.R. 11302) . . . to strengthen the
National Cancer Institute and the National Institutes of Health in
order to conquer cancer as soon as possible." Boggs allotted
twenty minutes of debate to "each side," meaning the Democrats
and the Republicans, not the pros and the antis.53
Staggers noted that the bill had emerged from 11 days of hear-
ings, four days of consideration by the subcommittee, and two
days by the full committee. The two negative votes in committee
reflected disagreement over how to achieve the conquest of
cancer, not disagreement with the objective itself. Pointedly ad-
dressing the Republicans, and any others who would invoke the
president in support of their position, he said that the administra-
tion had taken four different positions on cancer legislation during
the debate: "At first they were opposed to any legislation; then
they proposed their own bill; then they appeared before our
Committee and supported the Senate bill; and the last of their po-
sitions is support of the Senate bill with a substantial number of
amendments adopted by the Subcommittee on Public Health and
Environment."54 The implication was that the president obviously
wanted a cancer bill but not a particular bill.
In his remarks, Mr. Rogers drew the attention of his House col-
leagues to the fact that the approach of H.R. 11302 had been "en-
dorsed by an overwhelmingly united scientific and medical com-
munity." Practically every significant scientific body in the U.S.
supported the concept of maintaining the federal cancer research
effort within the NIH. Several Nobel laureates in medicine, he
said, including one whose award was based upon treatment of
cancer patients, supported this concept. So did the heads of 72
departments of medicine in medical schools throughout the coun-
try, as did 13 faculty of Harvard Medical School long associated
with cancer research or patient treatment. The legislation, Rogers
concluded, was "a balanced innovative approach . . . conceived
after rational study and close scrutiny by the hard working mem-
bers serving on the Subcommittee."5s The implied contrast with
the Senate was clear.
OCR for page 271
The Politics of Compromise 271
Representative William L. Springer controlled the Republican
time in the "debate." It was his "sincere judgment," he said, that
H.R. 11302 was "the proper approach" to the cancer problem and
would "hasten the day when this dread disease can be con-
quered." Tiernan challenged him:
Mr. Tierrzan. Mr. Speaker, will the gentleman yield?
Mr. Springer. I yield only for a question.
Mr. Tiernan. Is it not true the President approved the Senate
bill as passed?
Mr. Springer. He approves this bill.
Mr. Tiernan. But the President also approves the Senate bill.
Mr. Springer. I said the President approves this bill.56
Springer had returned to Washington from Chicago in early No-
vember with President Nixon on Air Force 1, and the two had dis-
cussed the legislation on that occasion.57 His authority was unas-
sailable.
Representative Ancher Nelsen expressed his pride in H.R.
11302, and considered it "one of the most important single pieces
of legislation" dealt with by the Congress this session. Dr. Tim
Lee Carter described the bill as a compromise arrived at "after
much discussion and debate," which "by and large, twas1 an ef-
fective piece of legislation."58 Dr. Roy, Carter's fellow M.D. on
the subcommittee, associated himself with the Kentuckian's re-
marks.
A great deal of strength was being mustered in favor of H.R.
11302. Nevertheless, Representative Adams took the floor to ask
his colleagues to vote down the suspension of the rules motion
and call up S. 1828 later. The medical community, he said, con-
trary to what Mr. Rogers had suggested, "is split as how to best
approach this problem."59 Those engaged in treatment of cancer
and in clinical research favored S. 1828.
Representative Tiernan complained that Mr. Springer would
not acknowledge the fact that the president actually wanted S.
1828. Representative Hastings replied: "The President, unfortu-
nately, in consideration of the Senate bill, did not have the advan-
tage of knowing that this House would come up with this superior
piece of legislation."60 It was an interesting legislative situation.
OCR for page 272
272 ~ The Politics of Compromise
Liberal Democrats were making an appeal for support for the
Senate bill on the grounds that President Nixon wanted legislation
that was still identified with Ted Kennedy. Republicans, with a
bill that was now acceptable to the White House, were not in-
clined to vote against the Republican leadership on the committee
and subcommittee. Nor were they inclined to vote against Paul
Rogers, the respected, conservative Florida Democrat who had
crafted H.R. 11302.
When the allotted time was up, the Speaker pro tempore di-
rected the Clerk of the House to call the roll. The House, by a vote
of 350 in favor and 5 opposed, approved H.R. 11302. Paul
Rogers relished the victory.
CONFERENCE
The joint House-Senate conference committee met on Wednes-
day, December 1, to resolve the differences between H.R. 11302
and S. 1828.62 The speed at which the conferees were moving
meant that agreement was quite certain.
The House conferees were led by Harley Staggers, and in-
cluded Mr. Springer and the 10 members of the health subcom-
mittee. The Senate conferees, led by Senator Kennedy, included
all 14 members of his subcommittee. Attention, though, was fo-
cused on Paul Rogers and Senator Kennedy. Kennedy had been
impressive in pushing a cancer bill through the Senate that had
President Nixon's personal approval and that drew only a single
dissenting vote. Rogers, however, had been equally impressive in
maneuvering his bill through the House legislative maze.
If anything, Rogers was in a stronger position in the conference
than Kennedy. He had checked with all of the House conferees
the previous morning. No one had any problems with the House
position as they went to conference and they agreed to stand to-
gether in the negotiations. Kennedy, by contrast, had experienced
some erosion of support for S. 1828 among the Senate conferees.
Gaylord Nelson communicated rather openly with the House con-
ferees during the conference, advising them on tactics in light of
probable Senate moves. Senators Cranston and Schweiker had
both informed Rogers beforehand that they favored the House
OCR for page 273
The Politics of Compromise 273
bill. Finally, the administration took a hands off posture toward
the work of the conference. Though still formally committed to S.
1828, the White House had already communicated through
Springer to the House Republican leadership that H.R. 11302 was
acceptable.63
The principal element of controversy between the Senate and
the House had been the organization of the cancer effort. Where
the Senate bill would create a new cancer agency "as an inde-
pendent agency within the National Institutes of Health," the
House bill provided that the NCI director report to the NIH di-
rector except on the matter of budget submissions. Rogers and the
House conferees expected this issue to be the focus of argument
and discussion, though they were not prepared to negotiate on it.
To their complete surprise, the Senate barely gave a passing nod
to the matter.64 Kennedy did suggest changing the name of NCI to
the National Cancer Authority, and the House members indicated
a willingness to accept this if all other NIH institutes were
changed accordingly. The matter was dropped.
The composition of the House-proposed President's Cancer At-
tack Panel dominated two days of conference deliberations. The
Senate proposed to add an additional three members to the
panel-the NCI director, the chairman of the NACC, and the NIH
director. Their intent, which reflected Benno Schmidt's thinking,
was to give the NCI director immediate access to the president
and to establish organizational power for cancer outside the NIH.
It was the same purpose that had been central to Congressman
Pickle's efforts to amend H.R. 11302 in the full Commerce
Committee. Rebuffed on one formulation, the Senate conferees
responded with a new variation, all of which added the NCI di-
rector to the panel. The House was equally adamant in opposing
any arrangement that included the NCI director. The panel was to
be an oversight body, a watchdog, Rogers and Nelsen argued. If
problems arose, slowing the cancer program, the panel was re-
sponsible for bringing them to the attention of the president for his
resolution, but its role was not that of direct program manage-
ment. The most telling House argument was that putting the NCI
director on the panel was like having the fox guard the henhouse:
an impartial review of the program would be impossible if those
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274 The Politics of Compromise
responsible for running
it.
it were also asked to pass judgment upon
The conference was deadlocked.65 Senator Kennedy, at the end
of the second day, proposed a weekend visit to President Nixon to
resolve the difference of view. The House conferees rejected this
idea, but the Senate conferees were ambivalent. If Kennedy went
to the president, the House members feared, and if Benno
Schmidt had the president's ear, as they believed he did, a nod by
Nixon toward the Senate view would lock up the Senate position.
It would also mean that the administration would bring pressure
on the House Republicans to accept the Senate proposal. Presi-
dential intervention in the conference could substantially alter the
bargaining power of the two sides.
The conference adjourned on Thursday and agreed to meet
again the following Tuesday. Whether Kennedy would visit the
president was left in the air. He did not, but he and eight col-
leagues wrote the president on Friday, December 3, inviting his
"specific guidance" on "the principal function and requisite
membership" of the cancer attack panel. The House version, the
letter noted, saw the panel performing oversight functions and
consequently its membership was to consist of three non-
governmental experts responsible for advising the president on
the program. The Senate view was that the panel ought to be en-
larged to include three "key program experts" so they would have
"a suitable channel for direct access to you."66
Benno Schmidt, who had actively promoted the Senate view of
the panel, had been acting largely on his own in this matter. Over
the weekend, though, Dr. Lee Clark and Dr. Gerald Murphy, re-
flecting long-standing suspicion of NCI on the part of the cancer
research institutes, told Schmidt that they did not favor the addi-
tion of the NCI director to the panel. If the same official responsi-
ble for program management were in a position to review his own
program, the cancer research institutes would be left without an
appellate body. Clark and Murphy also passed their views along
to the White House staff who were preparing the response to the
Senate letter. Schmidt, who quickly saw the logic of this as it
applied to Memorial Sloan-Kettering, accepted their argument.
The president's letter of Monday, December 6, said, regarding
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The Politics of Compromiser 275
the cancer attack panel, "I could work effectively with either ver-
sion." In vintage Nixon prose, he wrote:
The Senate version would have the advantage of bringing those
who are directly responsible for the Government's cancer effort
into all discussions with the President concerning its progress.
On the other hand, I can understand the feeling of the House
conferees that the activities of the National Cancer Institute
can be more effectively monitored if the heads of that program
are not monitoring their own performance. In any event, the
nonnal powers of the executive could still be used to include
the agency heads when desirable if the House view is adopted,
or to exclude them when appropriate if the Senate view pre-
vails.67
There was no reason the president found to take a position on this
matter when he could live with either outcome.
When the conference committee met on Tuesday, the Senate
immediately accepted the House version of the President's Cancer
Attack Panel.68 Confronted with unyielding resolve by the House
conferees, no support from the White House, and a negative opin-
ion from key cancer institute directors, there was no other course
of action open. The way was clear to resolve other less serious
differences.
The House bill would have retained the National Advisory
Cancer Council as established in the 1937 legislation. The Senate
bill, on the other hand, would establish a National Cancer Advi-
sory Board with 18 members, no more than 12 of whom would be
physicians and scientists and no more than 8 would be laymen. In
his letter, President Nixon expressed a preference for the Senate
version, which provided for "expanded outside assistance." The
House accepted the Senate's proposal with the addition of five ex
officio members.69
Where the Senate bill had focused exclusively on cancer, the
House legislation also gave attention to heart and lung diseases
and stroke. The Senate view prevailed and all references to dis-
eases other than cancer were deleted. The Senate also recom-
mended deletion of all references to the directors of the National
Heart and Lung Institute and the National Institute of Neurologi
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276 ~ The Politics of Compromise
cat Diseases and Stroke, and this was accepted by the House. This
left only the House proposal for elevating the NCI director to be
an associate director of NIH. Since this provision had not found
support among the scientific community, the House yielded to the
Senate and eliminated this provision.70
The final difference was on the manner of appointment of the
NCI director. The Senate bill provided for appointment of the
NCI director by the president with the advice and consent of
the Senate. The House bill would have both the NCI director and
the director of NIH appointed by the president. Representative
Staggers was blunt on this point: "The Senate has never had ad-
vise and consent power over health matters and it will not have it
now." The House view prevailed.7~ The remaining language of
the bill was that of the House. At the end of the third day, the
conference emerged to report agreement on "The National Cancer
Act of 1971."
When the House received the conference report on Thursday
afternoon, December 9, Mr. Staggers averred that the com-
promise bill was superior to the bills previously passed by either
body. Mr. Rogers, differing slightly from this view, saw the con-
ference result as "basically the bill which the House approved."
"Mr. Speaker," he said, "this report represents a substantial vic-
tory for the House of Representatives, the biomedical community,
and the American people." By insuring that the well-integrated
NIH research program would be involved in the cancer fight,
Rogers said, the American public were guaranteed that the attack
on cancer would involve a marshalling of all national resources.
"I can think of no better Christmas present for the American
people," he concluded, "than to have this bill passed by this body
and signed by the President without delay." The House of Repre-
sentatives agreed to the conference report moments later.72
The Senate had met that morning and Kennedy submitted the
conference report. The two pieces of legislation, he said, had
been similar with "one key exception": "Many of us had felt that
in order to develop a sufficient program to attack the problems of
cancer, we ought to create a type of program modeled on the
Space Agency. There were those in the scientific and biomedical
research field who felt it should remain within the National
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The Politics of Compromise · 277
Cancer Institute, and the House provided accordingly."73 In most
other respects, the senator said, the two bills were consistent.
The Senate met on the morning of December 10 and accepted
the conference report. The roll call vote was 85 in favor and none
opposed.74 The measure was sent to the president for his signa-
ture.
A CHRISTMAS GIFT TO THE AMERICAN PEOPLE
The National Cancer Act of 1971 was signed on December 23,
1971, in the State Dining Room of the White House. One invited
guest later described the scene this way:
Some hundred people . . . were escorted into a large room half
filled with television cameras.... The doors in the front of the
room were theatrically flung open and the President of the
United States was announced. The audience rose, the television
cameras whirred, still photographers ran around to vantage
points, and the President, obviously fresh from a television
makeup technician's chair, turned on a contrived smile. He
came to sign the Cancer Act of 1971. Cancer research had en-
tered the political arena. The Congressmen and Senators who
guided the law into being smiled broadly as the cameras fo-
cused on them. Most of the scientists in the audience did not
smile; many were worried. The hoopla surrounding the Cancer
Act implied the conquest on cancer in the near future because a
couple of hundred million dollars a year more were to be chan-
neled into cancer research. Those of us there who knew the
"state of the art" had cause to worry.75
Whatever the anxieties of the scientific community, however,
this day belonged to the politicians and especially to President
Nixon.76 "We are here today," he said, "for the purpose of sign-
ing the National Cancer Act of 1971. I hope that in the years
ahead that we look back on this day and this action is shown as
being the most significant action taken during this administration.
It could be." The president remarked on the season and the occa-
sion:
Hope and comfort, the relief of suffering and the affirmation of
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278 The Politics of Compromise
life itself these are the qualities which have traditionally been
associated with the Christmas season. There could be no more
appropriate time than this to sign into law the National Cancer
Act of 1971. For this legislation-perhaps more than any legis-
lation I have signed as President of the United States-can
mean new hope and comfort in the years ahead for millions of
people in this country and around the world.
While biomedical research was "a notoriously uncertain enter-
prise," the president said, there would be no uncertainty about the
government's role in the cancer effort. "I am determined," Mr.
Nixon continued, "that the Federal will and Federal resources
will be committed as effectively as possible to the campaign
against cancer and that nothing will be allowed to compromise
that commitment."
The president had great confidence in that pledge, he said, be-
cause immediately prior to the ceremony he had asked Benno
Schmidt to serve on the President's Cancer Panel for the three-
year term and to be chairman in its first year. Schmidt, the presi-
dent announced, had accepted this invitation. Mr. Nixon de-
scribed Schmidt as "an effective leader of men and a dedicated
community servant," and expressed the view that the nation was
fortunate to have such an individual "heading this important panel
in its critical first year." The president then gave Benno Schmidt
the pen with which he signed his first name. It was a great mo-
ment of personal recognition for the chairman of the Panel of
Consultants.
Richard Nixon wrapped himself in the mantle of leadership in
the nation's new commitment to an attack on cancer. He reminded
his audience that he had asked for such a program in his January
State of the Union Message and his health message of February,
and that he had submitted very specific proposals for a cancer-
cure program in May. Beyond this, the Congress had appropriated
the additional $100 million for cancer research he had requested,
which brought the fiscal 1972 appropriations for NCI to $337.5
million. In addition, the president noted, he had announced the
conversion that October of the biological warfare activities of Fort
Detrick, Maryland, into a leading center for cancer research.
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The Politics of Compromise 279
The president noted that the new act allowed him to appoint the
director of NCI, and provided that the NCI budget be submitted
directly to him. It also provided the three-member President's
Cancer Panel and a new National Cancer Advisory Board, which
bodies, made up of presidential appointees, reported directly to
him. "The important result of all these provisions," Mr. Nixon
said, "is to place the full weight of the Presidency behind the Na-
tional Cancer Program" and to enable him "to take personal
command of the Federal effort to conquer cancer so its activities
need not be stymied by the familiar dangers of bureaucracy and
red tape." "Having asked for this authority and this responsibil-
ity," he said, impressing the presidential seal even more firmly on
the cancer program, "I now pledge to exercise it to the fullest."
President Nixon emphasized that a "total national commit-
ment" meant more than government. "It is essential," he said,
"that an organization such as the American Cancer Society
which has raised so much money for this cause and which has
done so much to promote research and education in this field
continue to play its full effective role." When he signed his last
name to the bill, he gave the pen to Dr. A. Hamblin Letton, the
new president of the American Cancer Society. Le.ton thanked
the president for "a wonderful Christmas present" on behalf of
the two and a quarter million volunteers of the ACS.
Senators Kennedy, Dominick, Williams, Schweiker, and Beall
were present, as were Representatives Staggers, Springer, Ro-
gers, Nelsen, Satterfield, Kyros, and Hastings. "I deeply ap-
preciate the months of hard and careful effort," the president said
to these legislators, "which so many of the Members of Congress
gave to this cause." He was pleased, he said, that the Congress
was "totally committed" to providing what funds were necessary
for the conquest of cancer. The president posed for pictures with
Senator Kennedy and Representative Rogers, which were trans-
mitted by the wire services to newspapers throughout the coun-
try.77 It was one of the most prominent displays of bipartisan
cooperation seen in Washington during the first Nixon administra-
tion.
Among the one hundred thirty-seven guests, representing the
Panel of Consultants were Lee Clark, Joseph Burchenal, Mathilde
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Krim, Jonathan Rhoads, Emerson Foote, Anna Rosenberg
Hoffman, and William McC. Blair. Mary Lasker, of course, was
present.78 The NIH was represented by Robert Marston, John
Sherman, and Kenneth Endicott, then director of the Bureau of
Health Manpower Education. The National Cancer Institute was
represented by Dr. Carl Baker, its director, and ten staff mem-
bers.
President Nixon sought to capture the significance of the occa-
sion in this way:
As this year comes to an end, cancer remains one of man-
kind's deadliest and most elusive enemies. Each year it takes
more lives in this country alone than we lost in battle in all of
World War II. Its long shadow of fear darkens every corner of
the earth. But just as cancer represents a grim threat to men and
women and children in all parts of the world, so the launching
of our great crusade against cancer should be a cause for new
hope among people everywhere.
With the enactment of the National Cancer Act, the major
components for our campaign against cancer are in place and
ready to move forward. I am particularly happy that the year
1971-at the beginning of which I issued my call for a new
campaign against cancer-can end with the signing of this
landmark legislation.79
Representative terms from entire chapter:
senate bill
