Introduction

THE FAILED CRUSADE 173
Rhoads was driven by two central beliefs. First, he saw cancer as primarily
a disease of cells. Instead of surgery or radiation, which eliminated
the tumor mass, he wanted to focus on finding chemotherapy agents that
would stop cancer cells from dividing. His second basic principle was
based on advice from the industrialists who sat on his board. They
wanted to model Sloan-Kettering after the leading industrial labs of the
day, like Bell Labs, which married efficiency and high throughput to scientific
inquiry. 17 Rhoads implemented their vision. Between 1946 and
1950, scientists at Memorial Sloan-Kettering synthesized and tested fifteen
hundred derivatives of nitrogen mustard gas for their cancer-fighting
properties. In 1949, the FDA made mechlorethamine (Mustargen) the first
government-approved cancer chemotherapy agent (in those days, one
only had to prove it was safe, not effective, to get FDA approval).
Though the treatment was hardly curative, Time hailed the discovery.
The magazine featured a confident, crew-cut Rhoads on its cover clad in
a white lab coat with the symbol of the American Cancer Society—a
sword smashing through a crab—in the background. “Some authorities
think that we cannot solve the cancer problem until we have made a
great, basic, unexpected discovery, perhaps in some apparently unrelated
field. I disagree,” Rhoads was quoted as saying. “I think we know enough
to go ahead now and make a frontal attack with all our forces.” 18
He wasn’t the only clinician-scientist pushing NCI to pay closer attention
to the treatment mandate in its authorizing legislation. Shortly after
the war ended, Sidney Farber, the scientific director of the Children’s
Cancer Research Foundation in Boston and a member of the faculty at
Harvard Medical School, began experimenting with chemical blockers of
folic acid, which is needed for DNA replication. His target was acute
leukemia in children. A prodigious fundraiser with good connections to
many leading politicians, Farber scored the first major success of the
chemotherapy era when he came up with the antimetabolite compound
methotrexate, which produced remissions in some leukemia patients.
Farber began pushing for government funds to expand his experiments.
Over the next two decades Farber would serve as the chief advocate for
more money to develop new cancer chemotherapies.
Responding to pressure from key opinion leaders like Rhoads and
Farber, NCI in 1955 launched the Cancer Chemotherapy National
Service Center, a formal effort to develop new drugs. Many top scientists
at the agency, including its director Kenneth Endicott, were appalled. “I
thought it was inopportune, that we really didn’t have the necessary
information to engineer a program, that it was premature, and well, it