In two patients we had seen tumors shrink, and in one case disappear, after our immunotherapy. After all the deaths, after all the years in the lab, we had found something that worked. For the first time I believed — rather than hoped — immunotherapy not only could work, but would work.

uring the era of President Richard M. Nixon, political turmoil engendered by the Vietnam conflict reverberated throughout the biomedical research world built by federal funding and NIH sponsorship in the previous decade. The Clinical Center had its antiwar demonstrations and counterdemonstrations, and civil rights issues led to a vigorous affirmative action program to widen the opportunities for minorities.98 The war also brought demographic change within the hospital community. The end of the “doctor draft” in 1972 resulted in a steep falloff in Clinical Associate applications and jeopardized a critical source of new staff physicians. Normal volunteers were less often Mennonites and other conscientious objectors and increasingly were drawn from a national network of small colleges.99

The greatest challenge the Clinical Center faced came directly from the Nixon administration. In the name of budgetary restraint and managerial efficiency, the administration sought to curtail research spending, reduce federal support for biomedical education, and to phase out the PHS hospital system. Congress, however, wanted to redirect spending away from the war effort. A collision course was set in 1971 and 1972 when broad majorities in both houses voted massive new outlays to conquer cancer, heart, and lung disease. The administration supported these initiatives but insisted that off-setting cuts be made in other health areas. As a result, the budgets of NIH categorical institutes other than Cancer and Heart, Lung, and Blood registered absolute declines in 1973.100 A personnel ceiling remained in place for NIH as a whole, so that while NIH funding rose $946 million between 1968 and 1975, permanent staff lost 350 positions, and much of this burden fell on the Clinical Center.101 Departments such as Clinical Pathology were able to contract out as much as half their work load, but others such as Nursing were forced to carry growing program commitments with fewer personnel. In 1972, its bleakest year, that department reported, “The quality of nursing care is obviously deteriorating, even though it is recognized that all personnel are doing their best.”102 Demoralization was rife in scientific leadership as well. After three vetoes of the HEW budget and putative administration efforts to consolidate all the institutes into a single administrative structure, there was a real fear in the scientific community that the federal government might jettison commitments to support medical education, hospital construction, and basic research itself.103