Former National Cancer Institute Director Kenneth Endicott, interviewed by Devra Breslow (wife of principle investigator and Lasker crony Lester Breslow), Dec. 2, 1975. In: A History of Cancer Control in the United States 1946-1971. Funded by the National Cancer Institute.
DEVRA: That was during your tenure? What particular stimulation did you give to this or did your office?
DEVRA: And did you influence for example the mechanisms they developed for the studies that they did?
ENDICOTT: Yes. I took a very active role.
DEVRA: And the advisory committee set up and in the appointment of John Higginson?
ENDICOTT: Yes, I think I talked John into going. I played a very active role on the Board of Governors and so on. And tried to support him as best I could with NCI resources.
DEVRA: In fact, in the beginning was a large part of their U.S. money NCI money?
ENDICOTT: At the outset the basic contribution was the State Department. But we constantly supplemented that with contractual money and people.
DEVRA: Is that still the pattern?
ENDICOTT: I don't know.
[John Higginson (1922-2013) was the first director of the International Agency for Research on Cancer, from 1966-1981.]
DEVRA: Maybe we could talk about the promotive influences of some of these activities that you've referred to and some of the obstacles. For example, in addition to your own initiative, what really promoted the strengthening of the biometry/epidemiology, the whole etiologic approach to cancer control? What did you have going for you?
ENDICOTT: I think I was fortunate in picking a handful of key people.
DEVRA: So your judgment was obviously...
ENDICOTT: Well we always had substantial representation of basic scientists on the Council and I think really with the exception a virologist or two and Phil Shubik, we never really did succeed in getting people on the Council who were really strongly motivated in this other area. And I had to conclude at that time at any rate there was very little stomach anywhere in the scientific community for the kinds of things that needed to be done. It is just not an area where you are apt to get a two-way ticket to Stockholm.
DEVRA: There was a lot of that going on? Did you have a couple of Nobel laureates on the Council in those days?
ENDICOTT: Yes we did.
DEVRA: Wendell Stanley?
ENDICOTT: Wendell was one. He sure as heck supported me. He was very outspoken in getting the cancer virology program launched.
DEVRA: Helped to persuade some of the others that this was vital?
ENDICOTT: He did better than that. He had a number of inspirational talks with Lister Hill.
ENDICOTT: I think probably one of the promotive things we did was to finally convince Luther Terry that he had to do something about smoking and health. He certainly was a reluctant dragon, for a long time.
DEVRA: Let me ask you something. Lester saw Lee Burney yesterday, and said to him, "I have a question of you. I'd like to know why your statement of 1958, your Surgeon-General Statement, had so little impact?" I haven't seen his reply, but it is rather discouraging as we look at this history to realize that it just takes forever and forever for some things to sink in. Now you say Terry was a reluctant dragon, and the pressure was coming from where to push him to do something more than what obviously wasn't happening already?
ENDICOTT: Pressure was coming from the ACS, American Heart Association, American Public Health Association, and I remember at the meeting of the Board of Directors of the ACS, I just barely headed off a vote of censure, promising that if they lay off, I'd get back down to Washington and persuade them to do something.
DEVRA: They had been appealing through conventional routes -- lobbyists, friends, and so on -- and he wasn't responding?
ENDICOTT: No he wasn't.
DEVRA: Was he a member of the Board himself?
ENDICOTT: No, I was.
DEVRA: This was maybe in 1963, 62? So you brought the message back to him that things weren't good in the Cancer Society?
ENDICOTT: And convinced him that he ought to set up the committee or commission.
DEVRA: Did you staff that commission? People from your office?
ENDICOTT: Not entirely, but we supplied the bulk of the staff.
DEVRA: Now, that's a very interesting vignette as a matter of fact. He wasn't ready really to take a public position stronger than what had been taken say in 1958?
ENDICOTT: That's right.
DEVRA: That was a way to gain time. And during that time what else would happen? Deals with the tobacco companies?
ENDICOTT: No, not really. I don't really think that the commission came up with one iota of evidence that wasn't already at hand.
DEVRA: But the times were different.
ENDICOTT: A little. A blue ribbon commission, backing up the pronouncements I think was probably useful, but the British had already done that.
DEVRA: We have plenty of research here. Research paid for by the NCI, by the ACS.
ENDICOTT: But somewhere along the middle of that Terry became a convert, I think one has to remember, of course, that the Government itself was in an awkward position.
DEVRA: Why, because they were subsidizing the tobacco farmers?
ENDICOTT: Yeah. Tobacco is still a major industry, and there are some states that are practically dependent on it. We get a hell of a lot of revenue out of it.
DEVRA: State Governments, State Governments.
ENDICOTT: And [the] tobacco industry was well organized. It raised noticeable lumps on your head every time you...
DEVRA: Did they attempt to do that to you?
ENDICOTT: Oh yeah. They'd always be troublesome at the time of appropriations. There were two Congressmen on the appropriations subcommittee in the House who always came to the Hearings loaded with questions prepared by the tobacco industry. And we had plenty of trouble with interstate and foreign commerce committees. Quite hostile hearings.
DEVRA: There are several Southern Senators on that committee?
ENDICOTT: Oh sure. And it really was a drawn battle to get the first warning label on the cigarette pack.
DEVRA: Do you remember any specific events that really led to that decision finally? Any decisive events?
ENDICOTT: I don't really recall whose idea it was to do that. There were certainly some fascinating hearings on it though. On the cigarette smoking, lung cancer issue, I think one of the interesting things we got going during the 60's was the first time a program with the tobacco industry aimed at developing a less hazardous cigarette.
DEVRA: Whose initiative was that?
ENDICOTT: That was mine.
DEVRA: That this was the way to go. The other things might work but
ENDICOTT: It could be a long, long time before tobacco smoking disappeared, and we shouldn't put all our chips on an exhortation. It would be a good idea to see what we could do to make it less hazardous.
DEVRA: How did your office relate to the American Cancer Society?
ENDICOTT: Very closely.
DEVRA: You were obviously on their Board? Some of them were on the Council?
ENDICOTT: We had a very good working relationship.
DEVRA: With the Washington staff.
ENDICOTT: Not the Washington staff. But we worked very closely with the headquarters people in New York.
DEVRA: Were there tradeoffs?
ENDICOTT: Oh yeah. There were many things we did jointly.
DEVRA: Not just conferences and funding of research activities?
ENDICOTT: No. Let's see, what would one be, there were so many. I think probably the most significant had to do with lobbying.
DEVRA: Of your budget?
ENDICOTT: Yes. Now, Rod Heller and I both took a very active role in the American Cancer Society, as best we could in helping them raise funds. An effective working relationship between NCI and ACS in advocating appropriations, I think, clearly was the most significant.
DEVRA: It helped you immeasurably.
ENDICOTT: The other principal area of extensive collaboration other than joint sponsorship of meetings, which we did constantly, was pretty effective blending of our staff resources in the general area of public education.
DEVRA: That's kind of interesting because NCI and NIH generally really never had much of a mandate and didn't really seem to have much of a budget to do public education. Some professional education obviously. Quite a bit of that.
ENDICOTT: Both NCI and ACS plowed that field pretty thoroughly but it struck me that the ACS because of its enormous volunteer organization really had tremendous power in this area and so my feeling was let them take "center stage" and put our resources behind them. One of the things which you have to understand to work effectively with a voluntary organization is that they have to have a lot of visibility if they are going to get money. And I think a secret of really effective working relationships between the Society and NCI is to let them take the lion's share of the credit and don't get uptight about it. Because they reciprocated by pushing for a big budget for NCI. Okay, let them get the headlines, what the hell. I used to have an awful time with that because they continually annoy our public relations people.
DEVRA: Because they were getting so much...
ENDICOTT: Yeah, we'd jointly sponsor something. ACS would be prominent, way down here, in tiny print would be the NCI. We'd be putting in 99% of the budget. I just laughed about it.
DEVRA: They have to go out and raise money, too. Do you think there were any people on the ACS Board who particularly thought the government, NCI, even in their public education mission was slow, on the cigarette issue, early detection, and so here they were in there doing all the work in a sense, or they were doing what they felt was the government's work.
ENDICOTT: No, I don't think so. Clearly the example I cited to you of the ACS's Board of Directors almost censuring the Surgeon General is a good example of their impatience. I think they really felt this was their bag. There were some pretty shrewd, level-headed people there. I think that the ACS was somewhat queasy about the giant that the NCI was in terms of the resources it had for research. Clearly, they were never going to raise that kind of money.
DEVRA: They say in a lot of the annual reports that of course when a cure for cancer is found, they'll go out of business. Do you think they really believe that? Either part of that statement? One, that there will be a cure for this whole battery of diseases, and two, that they'll go out of business. Or will they get like the T.B. Association?
ENDICOTT: ____________ Anyway, I don't think it's a cause for immediate concern because it's not imminent. I really think that the relationship between the NCI and the ACS is sort of a model.
DEVRA: There isn't anything like it that I've found. I don't know whether the Heart Institute behaves the same way with the American Heart Association.
ENDICOTT: I don't think so. The groundwork, I can't take credit for. The groundwork was really laid by Rod Heller. I just came along and played a very active role.
DEVRA: Did he give you some points on how he had done it and how to keep it up?
ENDICOTT: No, I don't think we ever really discussed it.
DEVRA: His predecessors really didn't pay much attention to the Cancer Society? Spencer, Scheele.
ENDICOTT: Rod was primarily a "public healther." He was thoroughly at home in public health, was sort of uneasy in a research environment. But in a public health arena he was thoroughly at home and a real pro. I doubt if I'd have had enough common sense to really stroke the relationship, if he hadn't gotten it started. It was really easy for me.Endicott / A History of Cancer Control in the United States 1946-1971 / UCSF (pdf, 42 pp)
Kenneth Milo Endicott was NCI Director from July 1960 to July
1969. John Roderick Heller was
NCI Director from May 1948 to July 1960.
Endicott dedicated the June, 1968 issue of the Journal of the National
Cancer Institute to Howard B.
Andervont, who was Chief of the Laboratory of Biology at the
Cancer Institute from 1947-60, Scientific Editor of the Journal of
Cancer Institute from 1961-67, and a member of the Scientific Advisory
Board of the Council for Tobacco Research from 1964 to 1966, and from
May 7, 1963 Hill & Knowlton memo concerning House hearings on NIH appropriations in March 1963. From NCI Director Kenneth Endicott's prepared statement: "To date no human cancer-causing virus has been found. However, we know for example of a group of human viruses that have not yet been linked with specific diseases, and some animal viruses that cause bizarre changes in human cells growing in tissue culture... Our interest has been aroused by recent evidence obtained independently by Dr. John J. Trentin, Baylor University, and Dr. Robert J. Huebner, National Institute of Allergy and Infectious Diseases, that some of the human adenoviruses, which cause acute respiratory illness, produce tumors in hamsters..."Hill & Knowlton Memo May 7, 1963 / UCSF (pdf, 4 pp)