Noble Conspirator: Florence S. Mahoney and the Rise of the National Institutes of Health (review)

In 1967, journalist Elizabeth Brenner Drew published an article in the Atlantic Monthly about Washington's "noble conspirators" who lobbied Congress for large appropriations for medical research.¹ One of those lobbyists was Florence S. Mahoney, who exploited her connections with presidents and members of Congress to advance the cause of medical research—which primarily translated into increased funding for the National Institutes of Health (NIH). This book examines Mahoney's contributions.

Born Florence Amelia Sheets, the daughter of affluent Midwestern landowners, Mahoney pursued a lifelong interest in both physical and mental health matters. After her marriage to Daniel Mahoney of the Cox newspaper chain, she entered a world of access to powerful people. From this position she became involved in lobbying for health crusades and joined forces with Mary Lasker, wife of advertising magnate Albert Lasker, who shared her interest in mental health. The creation of the National Institute of Mental Health in 1946 was one of the first national efforts for which the two lobbied successfully.

Mahoney and Lasker also supported President Harry Truman's crusade for national health insurance, and when it was defeated, they turned their efforts toward gaining additional funding for NIH. During the 1950s and 1960s—the so-called Golden Years at NIH—the women and their allies served as one leg of the powerful political triangle described by Stephen Strickland in his 1972 study of medical research policy.² The other two legs were Congressional support, and bureaucratic leadership at the NIH. While helping to increase NIH budgets, however, Mahoney and Lasker also pressured the NIH to fund efforts to apply knowledge quickly and were strong supporters of initiatives such as the Regional Medical Programs, which aimed to bring the newest medical expertise to centers around the nation. NIH director James Shannon and many of his colleagues resisted the pressure for quick results, believing that a commitment to basic research, an inquiry into how the human body works in health and disease with no immediate therapeutic goal, would pay richer medical dividends in the long run.

In 1968, two legs of the triangle shifted dramatically, with Shannon's retirement, the death of one Congressional champion, and the retirement of another. The third leg also began to splinter as Lasker began pushing for what became the 1971 National Cancer Act, while Mahoney chose to press for the creation of an institute to study human aging. After the National Institute on Aging (NIA) was created in 1974, Mahoney also played a key role in identifying Robert N. Butler as its first director. NIA became her best-known legacy.

Judith Robinson has based her account of these events largely on Mahoney's voluminous correspondence. The study clearly shows—sometimes to the point of tedium—that Mahoney entertained the rich and well-connected and capitalized on those connections to advance her political agenda. What is missing in this book is the richness of historical context and perceptive analysis. Errors of fact appear: For example, Robinson cites the 1943 Claude Pepper hearings as "the first congressional hearings ever held to review government-supported research" (p. 63)—but this simply is not true. Beginning with the 1878 creation of the National Board of Health to address research on yellow fever, Congress had reviewed federal support for research on numerous occasions. The activities of the other players in the medical research story are also sketched in only the roughest way. The reorganization of postwar federal medical research in the 1944 Public Health Service Act is noted only in passing as a backdrop for Mahoney's activities. A completely unfounded conclusion, that "as other causes of death were conquered . . . old age became its major perpetrator" (p. 251), would suggest that no...