The US Congress has long been enamoured of the National Institutes of Health (NIH). From all sides of the House and Senate, in hard economic times and good, the fondness for the federal government's major biomedical research agency has been a constant. It is true that devotion has fluctuated at times, tested by the rival suitors of spending cuts and deficit reduction. However, the NIH has survived these challenges, and its marriage to Congress has endured though the contract has changed. Where once the marriage contract sought to distance NIH science from short-term political requirements, a new contract emerged demanding more attention to current political necessities, most recently exemplified by the Covid-19 pandemic.

The roots of this marriage go back to the 1940s, when – in the twenty-five years following World War II – the US built the largest biomedical research enterprise in the world, with the government-funded NIH as its flagship. The NIH argued that unlike wartime biomedical programs such as the development of antibiotics (including penicillin), DDT, improved malarials or plasma fractionation products, future research would generally only benefit the patient after years of basic research had laid the groundwork for new approaches to disease. What this meant was that NIH research should not be driven by short-term demands for cures. It should be free to undertake the long-term fundamental research it deemed necessary for biomedical progress, which alongside clinical research would be evaluated through what was at the time a novel process: peer review by other scientists, free from immediate government control. Within this framework the NIH played a key part in establishing the postwar infrastructure of biomedical research.

This chapter explores the origins of this contract between the NIH and Congress, and how since the 1970s the relationship was challenged by concerns about unethical biomedical practices, new technologies such as recombinant DNA (and later cloning, stem cells and human genetics), the pace and direction of research, the lack of public accountability, the growing role of pharmaceutical and biotech companies in research, and the ever-escalating costs of long-term biomedical research. These led to periodic efforts within Congress to cut funding, prompting recurrent warnings of delayed cures for deadly diseases, stymied scientific careers and the rise of rivals in Europe, Japan and most recently China. Yet NIH funding generally continued to grow, buttressed by supporters in Congress, powerful disease lobbies, and research institutions dependent on federal funding.

Writing in The Natural History of Cancer (1908), the British medical practitioner William Roger Williams adduced what he called ‘overwhelming evidence … that the incidence of cancer is largely conditioned by nutrition’. In his experience most of those affected with the disease in the early stages were ‘large, robust, well-nourished, florid persons, who appear[ed] to be overflowing with vitality’, whereas ‘the small, pale, [and] ill-nourished’ seldom fell victim to the disease. No factor, he claimed, was more likely to promote cancer than excessive feeding. Cancer was a rejuvenescence most likely to occur when there had been sudden or violent change in the environment, especially from poverty and want to riches and plenty. It was particularly associated with ‘the gluttonous consumption of proteids – especially meat’.

Williams's views capture several themes that recur in early twentieth-century discourses on diet and cancer on both sides of the Atlantic: that cancer was a disease of civilization, of excess, of nutrition and, for many, of meat. The implications for cancer control were clear. If individuals modified their diet, they might reduce their risk of cancer, and perhaps stem the growth of cancers already established in the body: dietary modification might also help them through the trauma of surgery and other treatments. But, if Williams or the many other writers on this subject hoped that cancer campaigns would encourage the public to change their meat consumption, they were to be disappointed.

In July 2008, the United States Department of Agriculture (USDA) announced that it would make public the names of retail stores that received tainted products. Coming soon after the Hallmark/Westland Meat Packing Co. recalled 143 million lbs of meat, then the largest meat recall in United States history, the USDA's plan was to name retail stores only when there was a good chance a person would become ill or die by consuming the meat or poultry product – so-called Class I recalls. Other recall classes, in which there was little or no chance of illness, would not be covered. Richard Raymond, the agriculture undersecretary who oversaw the USDA's Food Safety and Inspection Service, noted: ‘We need this rule to reinstall confidence in the American public that we are in control here’.

For many critics, the USDA's ruling had less to do with public health than with restoring confidence in a meat industry shaken by a variety of health crises, in retailers anxious to avoid a reputation for carrying tainted meat, and in a Department caught unawares. While some lawmakers and consumer groups welcomed the new USDA ruling, many criticized it, claiming that, because it did not include all meat and poultry recalls, it failed to fully protect the public. As the debate spread across the internet and other media, the issues became more confused and complex.

Writing in 1952, Arthur M. Sutherland characterized the psychology of the cancer patient as “the psychology of a person under a special and severe form of stress in which many fundamental underlying emotionally charged convictions are brought to the surface.” Sutherland, a psychiatrist at Memorial Hospital in New York, was interested in how patients adapted to the disease and its treatment. In his view people responded to such stresses in ways that were maladaptive in that they undermined successful treatment and recovery. As he noted in the same 1952 article, “Stresses are often met postoperatively by avoidance or denial, or depression and dependence may develop which the patient may not be able to overcome without help.” In his view, professional persons, including the social worker, best addressed such problems.

I concentrate on Sutherland because his interest was quite different to that of the bulk of publications on stress and cancer in the 1950s. Whereas most focused on the role of stress as a cause of this group of diseases, or on the body's physiological responses to surgery, Sutherland was more concerned with how it affected people's behavioral and emotional responses to cancer and cancer treatments, especially in postoperative recovery. Put simply, for Sutherland stress offered a means of explaining a variety of emotional and behavioral responses to cancer and provided clues to managing these responses.

Today Sutherland is remembered as a pioneer in the development of what became known as psycho-oncology.