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| Califoshia’ Jivision 5 F (3) Gero 54

American Cancer Society 3

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FREEDOM TO TRY

What do we all agree on? At once the most satisfying and the most com
prehensive statement of what we agree on has been long since familiar to you.
Christ gave it as the reason for His coming: ‘I am come that they might have life
and that they might have it more abundantly." Each of us here tonight would agree
that we have become associated to help to do away with cancer. Each of us would
gladly do his share - and at times more than his share - to remove the threat of
cancer, abolish its pain, prevent its sufferings, repair its ravages, and put an
end to its deaths.

I have had the privilege and the duty over the last 0 years of coming
to know and work with persons singly or in associations in many countries, They
have worked alone or banded together to work that man may have life and have it
more abundantly. How does my experience appear in retrospect? Well, in the first
Place, much of the last 0 years has been spent in circumstances unfavorable to
success: war, postwar disillusionment and poverty, the depression, inflation,
another war, and then still more inflation. Indeed, when I review what I have
witnessed I could reasonably conclude that there must be something wonderfully
strong and vital in human associations for the health and welfare of man. It has
heartened me that such associations have even survived. Not only have they sur
vived, but they have grown in numbers, in variety of purpose, and in effective
power. Why? Or ~- perhaps a more practical question - how?

Thinking back over the last 0 years, if you will admit that frequency,
promptness, and ease of contact play an essential role in aiding human associations
of any kind to flourish, then think of the gains in the speed, the distance, and
the cheapness of travel and canmunication over these last hO years - automobiles
and their roads, airplane travel, the easy use of long distance telephones, the
reach of the radio, and now TV, electrically adding sight to hearing. Each of these
technical gains already stands more than equal to the human demand that can be
placed upon it. And,as one more gain in our resources in favor of health, a gain
that outweighs all the drag and obstacles of yesteryear - the discovery of the
proven value of medical research. Research not only makes discoveries, but the
over-all policy of backing research amounts to the discovery of the means to make
more discoveries, unpredictable and so perhaps unlimited. And so we begin to realize
that the limiting factor is probably less a technical question, and more a question
of our ability to get along with each other. That possibility provides ample reason
for maintaining a lay society like this one, because getting along with each other
requires no highly technical scientific training; it is a layman's job - certainly.
Thirty-seven years ago tonight I was learning the Portuguese language in
Brasil. Jantar - dimer - was at 5:30, and conversation set in then and lasted till
midnight. In that sense I was learning the Portuguese language. Now in Portuguese
when you want to say that you get along well with someone, you express that idea in
a phrase that literally translated had for me a world of meaning. The phrase in
Portuguese to describe getting on well with someone is "Eu me dou muito bem com elle."
Literally translated that means "I give myself very well with hime" This phrase has
not quite the meaning of "He lets me do as I please" or "He makes me do as he wants."
It does not mean "I can get along or walk in step with him." It is nearer correct
to translate that phrase as meaning "With him I am at my best." And on reflection
that phrase means that you will get along well with people when they feel that they
are at their best with you,and that you give them the appreciation, the encouragement,
the credit they want - or if you don't do this, you will see to it that they get it
from others. Most voluntary organizations of human beings need a generous measure
of such friendly appreciation and team play, and a constant awareness of how valuable
such an atmosphere can be to all its members. You can, of course, express the same

idea in various ways. An association of human beings can, for example, profit from
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reminding its members of the church whose worshippers were described as “worshipping
the Lord with a cross on one shoulder and a chip on the other." Or perhaps you
would enjoy with me the definition of a zealot as "one who redoubles his effort when
he has lost sight of his aim." Or the mellow Chinese proverb that observes, "Great
men never feel great; small men never feel small."

Indeed, thinking about attitudes and atmospheres in a voluntary health
agency might be much more helpful than spending the same amount of time in discussing
the outline of the best organizational structure. The spirit in an organization is
often given, and given rightly, as the reason for its success. I remember a neat
opening sentence in a memorandum by a sagacious American welfare worker in the
Europe of 1946. The memorandum began: "Once upon a time there was a successful
organization without any." Now, I do not advocate no organization at all as an ideal
circumstances but I have, through these years, read enough about Leadership and seen
enough examples of sane kind of Leadership to be ready for a treatise on Follower-
ship, or Membership.

It seems to me that the important underlying fact is that each one of US,
indeed nearly every human being, wants deep down in his heart to share and to do his
share at least once in his life, in something quite beautiful » unselfish, and
excellent - to give himself well. Can we not see, then, how greatly we contribute
when we fashion a society that will help its members to give themselves well? This
means producing an atmosphere and an attitude held in common, with which our fellow
members will be encouraged to give themselves well. Twenty self-effacing workers
in any cancer society would form an unforgettable nucleus of power and significance,
of sincerity and friendly excellence, of tolerance and tenacity of purpose, and
above all, of equanimity of faith.

The great contribution of the lay members of a cancer society is in creat-
ing and maintaining an air of expectancy. It is an act of faith to trust in research.
I can think of more than one example of that priceless layman's question, "Why not?"
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It has stirred doctors and scientists more than once to efforts they had not made
before. Perhaps it is a professional weakness of doctors not to think of all that
could be donee I remember, and very vividly, how many compromises I had to learn
to make as a hospital intern with what would have been the ideal treatment or plan
of convalescence of a patient without money. It finally occurred to me that maybe
the letters M.D. stand for Make Do. Such quizzical dissatisfaction now takes another
form in my mind. I am filled with eager gratitude - gratitude to the layman - when
uncompromiYsingly he asks, "Why not?" That may be an expensive question, and yet it
is priceless as an attitude.

One difficult aspect of voluntary organizations such as cancer societies
will doubtless continue to badger you. It is the all-too-human passion among your
members for kudos. Or a similar avid desire for personal distinction. But another
aspect of voluntary health work is too rarely recognized for the handicap it may
contain. This handicap or danger is the common assumption that a large financial
donation will entitle the donor to proprietary rights in point of controlling the
policy to be followed by the society. There are no neat preventives that I know
for such mistakes. "To foresee is to govern." Yes, that might avoid some propri-
etary embitterments. But I would venture to mention my personal conviction that if
a gift from a cancer society is not a gift of true freedom as well as of money, then
such gifts will not for long be able to reach scientists or other workers of the
highest intelligence and integrity. If, for example, the effect of cigarette smoking
on the incidence of lung cancer cannot be studied on a cancer society grant because
the tobacco industry has made generous grants to the society, we shall have trouble,
of a wonderfully transparent sort, in the near future. This sort of a possibility
means that much indeed depends on the independence, as well as on the wisdom, imagi-
nation, and discerment, of your scientific advisors.

Moreover, the task placed upon your policy-makers does not cease with a

success; it increases. It increases because a conspicuously successful choice by
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them so enhances the value of a society grant that merely the society's approval
may come to be considered as important as the work to be done or the sum of money
asked for. In short, bestowing approval can indeed be serious business.

In point of publicity and public relations generally, the climate in
America today is so commonly that of exaggerated claims, shrill superlatives, and
reckless overselling, that caution in describing the work of a struggling cancer
society cam be regarded by some people as a mistake. Candor may seem drab; and
honesty may come to look like timidity, and lose the very support it seeks from not
seeming to possess self-confidence. It has often seemed to me that the West Coast,
has an unusually high proportion of the naturally credulous, congenitally optimistic,
uncritically energetic American frontiersmen. They have moved in the belief that
"there's gold in them thar hills," and now they are living beyond the Western rangese
They are, however, wonderfully generous and philosophical when they have taken a
chance and lost. They resemble the timber jack who spent a winter's wages in one
72-hour spree. His magnanimous comment was, "Well, easy come, easy go."

Now, perhaps there are special opportunities for a cancer society in such
@ magnanimous part of the country as Califormia. You will be, perhaps, more likely
to take the long chance; as the descendants of the adventurous, you will be more
willing and inclined to draw a bow at a venture. My personal preference is, I must
admit, on the cautious side. If I am going to make a bet, the Scotch in me whispers
to bet with the house if possible.

Indeed, I have often been struck by the analogy, in broadest terms, between
medical research and the operations of the bank at Monte Carlo. In any single medical
research project you may lose your bet; but as a policy, medical research will pay
off in the long run. There is my faith. There is so much we don't know yet; and
what may look like only a 50-50 chance of success or failure is actually weighted
in favor of success, just as the odds at Monte Carlo favor the bank's winning. For

example, all the expenses behind the development of the proof of the value of the
sulfa drugs came, probably, to not more than $200,000 outlay. In fact, I suspect
that $85,000 paid the bill. Now, when holders of life insurance do not die, the
life insurance companies save money. In the first year of the use of sulfa drugs
for pneumonia, among the insured of one life insurance company only, in the State of
California only, this single life insurance company saved $3,000,000 in policies

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that didn't have to be paid because the sulfa drugs staved off so many
deaths fran pneumonia. You can imagine what a winning that was for all life insur-
ance companies and all pneumonia patients throughout the worlds I am not implying
that sane wonder drug will be discovered that will cure cancer or prevent it, but
who as yet is in a position to declare that it will not? I cited the figures on
pneumonia to illustrate the stupefying magnitude of the gain inherent in medical
research and discovery.

If the facts stupefy, I want the lay public to be stupefied. In fact, I
want to increase if possible the intensity of the motivation behind cancer societies.
We need to draw upon such enthusiasm to stop the appalling drains of cancer on the
happiness of others - and perhaps some day our own.

The French have a phrase which conveniently expresses an idea that deserves
to be mentioned, even though in saying it I run a risk of getting myself misunderstoods
The phrase is "Je constate - je ne critique pas" - I make a statement but it is not
a criticism. It so happens that my work has made me witness of the extraordinary
emotional value of patients' notes to individual scientists or to donors of support
in the fight against disease. I would ask you to note particularly that the incom-
parable value of a patient's spontaneous and unexpected expression of gratitude
depends in fact more upon its spontaneity than anything else. Now almost by defi-
nition you cannot order spontaneity or organize gratitude. Indeed the delicacy of
making this suggestion to you, and controlling the inferences that could be made
from my speaking about it in public, made me wait until I was no longer an official

of a foundation before I mentioned it. The foundation trustees and officers are not
languishing for appreciation; they do not wait on being thanked. But when I learned
that one of our best-known private citizens and benefactors of medical research has
carried in his wallet a letter of spontaneous gratitude from an unknown but imagina-
tive patient, and carries that letter though it is falling to pieces, I began to

wish that a patient or two now and then could see the beauty and the refreshing power
that is within his command if he could write such a spontaneous letter occasionally.

Perhaps this museun-piece of a letter in the donor's purse, this letter
that approaches the end of its existence as a kind of keepsake, can serve to convey
another and more robust and workaday message to this audience. In such work as you
have long been doing or may be contemplating entering upon, the wiser attitude for
you may simply be not to look for gratitude, but simply to decide the fight against
cancer is what you want to take part in. All I want to record is that patients are
not powerless. Their spontaneous gratitude provides an enormously powerful reward
for many a donor - but only if the letter be spontaneous.

When the gift is freedom from pain and disfigurement and even the gift of
life itself, the relationships between donor and beneficiary become sometimes as
complicated as they are intense. We should remember that,if we want to take part
in the campaign against cancer; and if that's what we want to do, we can on our side
be grateful to all cancer patients for helping us do what we set out to do, and for
trusting us enough to give us the opportunity to work for them. I learned the value
of that attitude with the Brazilian backwoodsmen when they allowed me to examine
them and their families, and treat then for hookworm disease from which large numbers
suffered without knowing that they were afflicted and without knowing that they were
suffering from being more than chronically tired. When you think it over carefully,
you can well be grateful to people when they let you help then. That was your idea
in the first place, wasn't it? |

Doubtless, in the minds of many of you another question has been lurking:
Why not let all this cancer work be done by the goverment, with its apparently
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limitless resources? Why hold ourselves answerable for expenses that we are perhaps
already paying in the form of taxes or an inflation that makes the dollar saved in
1939 now worth 52¢? I think the answer is that to take that position shows ignorance
of the nature of the cancer campaign, which is essentially an attack on the unknown.
And a costly ignorance it is.

When our pioneer forebears wanted to find something - water or pasturage
or a pass over the mountains - they divided their full numbers into several scouting
parties. In so doing they were placing their confidence in the simple device of
inereasing their chances of success by dividing their total strength into several
separate ways of going at it, in short, into scouting parties. Parties, yes - but
they had to be parties large enough to be self-sufficient, and to go long distances
unaided and to bring to successful conclusion considerable explorations. I call your
attention to the fact that though variety was the best use of their total strength,
each of their constituent parties had to be large enough to carry out its purpose,
play its hunch, and give adequate trial to its own conviction. Now, team research
in cancer presents a comparable picture. Lone research workers would be more numerous
than teams, but the different skills involved in proving many an idea in cancer
research are not at the command of only one worker. We should be mindful of the
importance of backing several and different projects well enough and long enough to
have the evidence conclusive when the projects are finished. A cancer society is an
explicit declaration of the importance of variety in looking for anything that is
difficult to find -- let us not cut down our chances by turning over’ the gearch ,eF
reducing the number of scouting parties and their convictions or even their hunches.

I have not time to build up a convincing case for another impression I
have formed over the years. Yet I would not feel comfortable to leave it unmentioned.
I believe that when career posts, that is lifetime jobs, for research workers in any
medical field are in notably short supply, most young men cannot and do not plan such
careers for themselves. They might, if the loyalty and tenacity of support for
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research were a byword among junior research workers. The fact is near to being

the precise reverse - namely, the fickleness and wpredictability of grants in aid
has become a byword among young scientists. We seem to forget that if research is
exciting the unexpected termination of its support can be bitterly disappointing.
This is not a welcome thing to hear, but I have noticed that foundation officers or
society agents often fail to make adequate allowance for the extent to which their
power to give money may cut them off from hearing what would be salutary home truths,
It could be understood that sane recipients of grants in aid may fear that stark
statements might lead to a discontinuance of their grant. So we don't hear as much
as might be good for us.

Many a three- or five-year grant in aid starts off bravely and admirably
as an admitted risk. But as its junior personnel pass through and leave the thirties,
the scarcity of subsequent careers for them forces the more sober and dependable to
quit research. Furthermore, I venture to say that when a candid and honest investi-
gator discovers all by himself that the idea on which he has been spending the past
three years is wrong, untrue, and clearly vain and futile, he has a sense of frustra-
tion, disappointment, and failure for which the salary he has had out of the grant in
aid proves scant recompense. Nor would I have you infer that it is only the younger
workers who suffer from thelack of decent salaries and predictable careers. The
older chiefs of research projects become acutely consciousof the precariousness of
their junior colleagues' futures. So, in no very mysterious fashion, the impression
leaks to the younger generations that scientific careers are too precarious to bet
one's life on. Anyone who feels that $300 or $30 or $30,000 given to research on
cancer is something of a gamble, can reflect if he pleases upon the fact that young
men betting their whole futures on becoming research workers of maturity and value
are making a far greater gamble than a donation represents.

Apart from these considerations, I would offer the opinion that if and when

substantial advances are made in our knowledge of cancer, we shall have a peculiar
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and urgent need for plenty of older men who have acquired a background of experience
and wisdom. We shall need their services so as to be able to utilize the new
advances of the future.

When Solon, the Greek lawgiver, was asked if he had given the Greeks the
best laws he could, he replied, "I gave them the best laws they were capable of
receiving." There will be, I think, nothing to regret in having more experienced
workers available to help in using the advances we may reasonably expect to be made
in the next decade or two. We need to remember that our research workers, unusual
as we hope they will prove to be in many ways, are probably human beings who like a
measure of predictability in their careers. Your task, essentially, is to fashion a
type of career that will serve a great hope - the control of cancer. Imagination,
curlosity, modesty, tolerance, faith, and above all, variety of convictions, remain
the essential‘iin point of policy in a successful attack on the unlmown. That is the
policy that experience has shown to be the wisest course to follow. This is what I

tried to condense in the title I suggested for this talk: "Freedom to Try."