Polio Wars (83 page)

IN MAY
1948 Kenny went to Washington to speak as an expert witness before the House Committee on Interstate and Foreign Commerce investigating whether and how the government should fund medical research. Wearing a corsage, a circle pin, strands of pearls, and a plumed hat, the white haired nurse praised a proposed Medical Research Foundation that would study polio as well as cancer and other “degenerative diseases.” “Mobilization of forces and pooling of knowledge concerning this disease are imperative,” Kenny told the committee. As the cameras clicked in a room packed with Congressmen and their aides, Kenny admitted that friends had advised her “not to interfere in any way with American politics” but she was nonetheless certain that the federal government should support medical research and “should undertake to see that every avenue is explored to wipe out this disease.”
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Kenny was invited to testify as a healer and medical celebrity, but most of all she was welcomed as a medical populist. Her presence transformed the Washington hearings into a platform to attack organized medicine, especially the policies of the nation's largest polio philanthropy, the National Foundation for Infantile Paralysis (NFIP). The NFIP, Kenny complained, used its power as a polio monopoly to deny her scientific respect. NFIP officials were organizing an international conference on polio to be held in July, but Kenny had heard that “my appearance at this meeting would mean that they would have to close the door.”
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A new government research agency run by unbiased officials could, she was sure, challenge the NFIP's power and, in this era of global tensions, demonstrate to other nations America's commitment to providing children with the best polio care based on the most modern knowledge of the disease.

Many members of the House committee agreed that the NFIP was an elitist medical monopoly, “a sort of medical closed shop, run for the benefit of certain doctors and
certain politicians, perhaps more than for the benefit of the patients,” as a Republican Congressman from Missouri noted.
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Although Roosevelt's death in April 1945 had left the NFIP without a political patron in the White House, Basil O'Connor, Roosevelt's former friend and advisor, had strong ties to America's social and scientific elite, especially the conservative leadership of the American Medical Association (AMA) through his friendship with Morris Fishbein. Fishbein's antipathy to alternative medicine and any government incursion into traditional medicine was reflected in the NFIP as well. Over the previous decade the NFIP had come to play a significant if somewhat hidden role in shaping American medical politics. O'Connor had moved the professional weight of the NFIP behind some of the more conservative forces in medicine, including the provivisection National Society for Medical Research and Fishbein's campaign against government health insurance. The NFIP was growing away from its early Democratic affiliations and closer to the Republican Party, the political affiliation of most American physicians in the 1940s and 1950s.

Scientific research and health care were crucial elements of national politics between 1945 and 1950. The experience of World War II had reinforced the notion that a government agency could effectively direct research priorities and that such research, based on widely shared goals, would provide concrete solutions. The American public, already impressed with the scientific achievements made during the war—penicillin, radar, the atomic bomb—saw research as having the potential to improve the world and everyday lives. World War II, as historian Victoria Harden described it, “enhanced public belief that scientific research offered an endless frontier on which a happier, healthier life could be built.”
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Not surprisingly, many witnesses at congressional hearings framed the debate on research policy within a broader project by liberal Truman Democrats to centralize and restructure American health care.

The federal government was becoming a major player in shaping the confusing quilt of medical research programs in peacetime. The Cold War now provided a new urgency for Congress to take a more active role in funding research. Against this cultural attitude and opponents like Kenny the NFIP had to defend its control of polio research funding in terms of democratic, responsive, health care management and to convince Congress and the public that private philanthropies should retain a respected place in the unsettled world of health policy.

Kenny came to Washington in the midst of a raucous debate over the National Science Foundation (NSF). In August 1947, President Truman had vetoed an NSF bill giving scientists significant control, explaining he was not willing to “vest the determination of vital national policies … in a group of individuals who would essentially be private citizens … [and] would be divorced from control by the people to an extent that implies … the state's lack of faith in the democratic process.”
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Immersed in postwar politics, the NSF bill became a powerful symbol of the changing relationship between government and the research community. Scientists feared rigid government bureaucrats; federal officials distrusted ivory-tower researchers; politicians wanted research that would lead to innovative technologies as dramatic as penicillin and the atomic bomb; and the public sought a fair, democratic, and representative science research policy. Privately Truman told science advisor Vannevar Bush that a science foundation run by a board of scientists outside government would become “simply a log-rolling affair to make grants to things that its members were interested in.”
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The story of the battle between Kenny and the NFIP allows us a new, rather unexpected look at the ways medical populism shaped postwar science policy. Populism in medicine is difficult to analyze and even harder to categorize. The version of medical populism, spurred by Kenny and her allies, challenged orthodox medicine's claims to authority, yet demanded access to medical science so that the people's health could be protected through scientific research. What Kenny and her allies promoted was a vision of populist science that idealized science and its products but attacked representatives of professional authority. A focus on such critics of medical orthodoxy thus complicates the accepted picture of postwar America as the era of organized medicine's Golden Age, when public respect for medical science was unrivaled and doctors in film and radio were always the good guys.
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The stream of populism that Kenny drew on was composed of elements from both the left and the right. These dissidents were against the medical establishment; they feared elitism and corporate conspiracy but idealized the tools and products of science. The people's health was threatened, according to Kenny and her supporters, by narrow-minded medical professionals unwilling to consider ideas promoted by anyone outside elite medical institutions. Yet truth could be gained not only by the work of mainstream scientists but also when scientific tools became resources available to all.

The struggle between Kenny and the NFIP that played out publicly at the 1948 hearings was part of a wider battle over the direction of research policy, especially over whether Congress should mandate lay representatives on the boards of its new research agencies to provide alternative views to the scientific and medical establishment. Kenny's testimony in Washington blasting medical elitism and parochial, inaccurate science exemplified the debate among politicians, philanthropic officials, the public, and even a few scientists in postwar America over the relationship between research and democracy.

Leaders of organized medicine tended to lump all medical populists together as quacks and cultists, and fought them with the help of state legislatures, the courts, and the media. To fight back, populists spoke of medical freedom—sometimes as an antigovernmental ideology, and sometimes as a resource to battle elitist professionals. Across American history medical populists have simultaneously pushed away and reached for government resources in their efforts to challenge medical trusts. Discoverers of anticancer tonics and rejuvenating operations, naturopaths, chiropractors, and others on the margins of the medical profession developed a populist ideology that drew on the public sympathy for outsiders fighting elitism. When these struggles entered the political arena they tended to find allies among right-wing politicians. Kenny was a newcomer to American politics but her claim that as an outsider she deserved scientific respectability and needed to be defended against Big Medicine and Big Science (as represented by the AMA and the NFIP) had deep political resonance.

Despite a lingering faith in the Thomas Edison-type lone inventor, the prospect of massive government investment into medical research grabbed the public imagination. But there was no consensus on how the government would ensure that its resources would be provided to researchers who would make the most important medical breakthroughs.
At the time of the Congressional hearings, most medical research remained diffuse and unregulated, relying on donations from large and small private organizations, often known as foundations, which were frequently single-disease charities that also paid for patient care.
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After the war this patchwork system of research funding seemed old fashioned and inefficient, but what model should replace it was less clear.

Elite scientists argued that research funding should be based on a “best science” model, but politicians in postwar America recognized the competing popular appeal for a “geographic” model, a kind of science democracy in which government money was distributed state by state, available not just for privileged academic researchers but for ordinary investigators. In what historian Harry Marks has called the “highly pluralist postwar system of medical research” Congress divided over whether the development of such research should be left in the hands of universities, private research institutes, and philanthropies or should be overseen by a government agency.
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As the NSF bill was reintroduced in 1948 a provocative study in
Science
reinforced Truman's sense that scientists could not be relied on to put the public's interest ahead of loyalty to their own institution or discipline. The study, quoted during the NSF Congressional hearings, found that almost 75 percent of the research funds distributed by scientists on the advisory boards of 10 private philanthropies—including the NFIP—went to researchers based at elite, Northeastern universities. Thus, it concluded, “our top scientists are no more able to provide equitable distribution of funds at their disposal than are the politicians they have so castigated.”
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Although Fishbein pointed out to O'Connor privately that the NFIP “comes off very well in comparison with other similar agencies,” the
Science
study was a blow to the idea of objective peer review, and useful for those who argued that geographic distribution of research funds would be just as meritorious as any other system.
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An early test of whether the country was ready to apply populist-defined democratic principles to scientific research came in 1945 when Harry Hoxsey, accompanied by 3 Congressmen, traveled to Washington, D.C. to ask the National Cancer Institute for a federal investigation of his anticancer powder. Hoxsey was the founder of his own National Cancer Research Institute in Taylorsville, Illinois.
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The Institute turned down this request, but North Dakota Senator William Langer, a distinctive Plains populist who mistrusted big government, Communists, and Jews took up Hoxsey's cause. Langer championed Kenny's cause as well. In 1944 Langer had introduced a Senate resolution proposing $10,000,000 for an Infantile Paralysis Control Board to be chaired by the Surgeon General and composed of Kenny herself and a “leading medical man” from each of the 48 states and Washington, D.C. “to investigate and study the origin, causes, and means of control of infantile paralysis.”
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The resolution did not pass but Langer continued to try to have the government support Kenny's work. In 1945 he suggested that the federal government establish a national polio clinic run by a board made up not of physicians but of “persons who have had infantile paralysis and have been treated for such disease in accordance with the methods discovered and practiced by Sister Elizabeth Kenny.” He also proposed federal funding for a polio research program to foster the national adoption of Kenny's method.
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Hoxsey and others demanded a populist version of medical research, and hoped that the federal government would respond with respectful attention and perhaps funding. This nascent research populism fit awkwardly with a growing anticommunist,
antiintellectual populist movement that feared the liberal Eastern establishment and its decadent bureaucracy. Members of the public, enthusiastic about government-sponsored research as an antidote to elitism, hoped that federal oversight would temper the power of elite scientists and physicians.

In the postwar years many Americans saw the NFIP, a lay-run disease-oriented charity, as old-fashioned and out of touch with modern epidemiological and structural changes in American life. The NFIP's distinctive style—especially its extensive resources and access to celebrities—was under attack. During the late 1940s, reinforced by public attention to the shift from infectious to chronic diseases, Americans began to see disease philanthropies as often inefficient and led by directors who were “aristocratic, aloof, and egotistical.” Social scientists pointed out that without proper yardsticks to measure the organizations' effectiveness, many programs were duplicated.
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The solution seemed to be single, federated fund drives such as Community Chest and Red Feather campaigns that were seen as more efficient and more effective.
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In 1947 when Henry Ford II became the new head of the Ford Motor Company he began to organize a United Health and Welfare Fund with the cooperation of the AFL and the CIO.
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