Editors’ Note: Tamara Mann Tweel continues HistPhil’s forum on philanthropy and the state.
This semester, eight of my students spend three hours a week sitting with elders in a long-term care home. They don’t know if the elders, in their words, “are really living or just waiting to die.” They don’t know if the medicine, which seems to help the elders’ bodies, diminishes their minds. And they don’t know if this state of oldness is something to strive for or to do everything in their power to avoid. Old age, scholars have come to understand, “is a season without a purpose.” With meager exceptions, there are few attempts to endow this period of life with communal value. In its stead, the driving narrative of aging is survival and subsistence. The props of this narrative are pharmaceuticals and nursing care. This development can be traced, in part, to the way research into aging has—and has not—been funded.
In the 1930s and 1940s, the philanthropic sector in the United States sought an alternative approach to aging. The Josiah Macy Jr. Foundation funded research that joined a humanistic desire to find value in old age with the medical capacity to describe what healthy aging could actually look like. For the Macy Foundation, old age was not a set of ailments to be eradicated. Rather, from the 1930s on, the Foundation funded scientists and physicians dedicated to returning elders to their positions as respected members of society. In the 1940s, concerned about the financial future of multidisciplinary aging research, and seduced by the capabilities of the expanding National Institutes of Health (NIH), the Foundation decided to sponsor a gerontologist to join the NIH. At the time, they believed that the research arm of the federal government was the appropriate home for holistic scientific research in aging. They were wrong.
In 1872, Josiah Macy and his sons became wealthy men when, after only a decade in the oil industry, the Macys’ Long Island Oil Company became a part of John D. Rockefeller’s Standard Oil. In 1930, Mrs. Kate Ladd, the youngest daughter of Josiah Macy Jr., established the foundation. Inspired by the tenets of Quakerism and the trials of a long illness, Mrs. Ladd sought to reverse medical trends that atomized a patient into body parts and funding trends that privileged biochemical and physiological research over psycho-biological and sociological research. In 1935, the foundation responded to growing numbers of impoverished elders by launching an investigation into the “problems of old age.” Partnering with the scientist E.V. Cowdry, they sponsored conferences and a major publication that brought philosophers, like John Dewey, into conversation with leading scientists. The Foundation eventually funded the multi-disciplinary Club for Research and Ageing, which grew into the Gerontological Society in 1946.
Rather than a cure for disease, early members of the Gerontological Society strove for an operative and descriptive definition of normal or healthy aging. Old age, they explained, was not connected to chronology, but rather to a set of compounded health risks. These physicians and scientists, like Dr. Edward J. Stieglitz of the University of Chicago, argued against a disease-focused model of clinical care. In its place, they wanted to assist patients by helping them create long-term strategies to manage their aging bodies in specific social and economic environments. Cowdry reiterated this approach when he wrote, “What is needed is a return of some physicians to the old time role of guide, philosopher and friend…. Perhaps the greatest economic and humanitarian contribution of public health in the future is to maintain socially useful activity as long as possible in this very large fraction of the population.”
The holistic approach to old age faced economic challenges from the start. Outside of the Macy Foundation, scientists were rarely able to secure funds for interdisciplinary research into aging. The creation of the National Institute of Health in 1938 and the meteoric rise of federally funded scientific research during WWII offered the Foundation an unprecedented opportunity: they could make gerontology and the problems of aging part of the federal government’s scientific research agenda.
In 1940, the Macy Foundation decided to fund the first head of a national Unit on Gerontology at the NIH. When Dr. Edward J. Stieglitz took up the post, Cowdry beamed, “[U]nder the able direction of Dr. E. J. Stieglitz. . . . A new kind of public health is being conceived. It is a union of what is best in medicine and sociology.” For a time, the NIH appropriately reflected and then expanded the Macy Foundation’s multidisciplinary goals, but the drive towards single-disease research and advocacy rapidly diminished the viability of this approach.
In the late 1940s and early 1950s, prompted in part by the advocacy of Mary Lasker and the American Cancer Society, the NIH transformed from a singular institute to a growing conglomerate of institutes, including the National Heart Institute and the National Cancer Institute. In this way, the NIH could benefit financially from the rise of single-disease advocacy groups, which were eager to fund their specific cause. This had a significant impact on the future of government-funded research into old age. Scientists and universities followed funding trends, preferring to set up labs and research projects that sought to cure what they believed were discreet diseases. In 1949, the last of the NIH funds dedicated to multidisciplinary research into aging disbanded, after failing to attract enough applications. Even scientists formerly interested in healthy aging found it best to dedicate their labs to curing heart disease or cancer. The Macy program, which focused on holistic research into a productive and purpose-driven old age, gave way to a decades-long research agenda focused on disease eradication and longevity.
By the 1950s, the hardships of aging, which have always been both physical and existential, came to be scientifically researched as a set of single diseases with particular cures. The benefits of this approach have been extraordinary; we have productive and healthy individuals working well into their 70s and 80s – in short, the bounds of a healthy adulthood have been expanded. But the challenges of aging still loom. Medicine and single-disease research have only staved it off. Loss and frailty come and when they do, our society needs to think comprehensively about the purpose and possibility of this stage of life.
Recently, there has been serious philanthropic attention to the civic and volunteer potential of healthy boomers by Atlantic Philanthropies and organizations like Encore. This is an important corrective, but it is not enough. We also need to make sure we are developing a coordinated effort, aligning both private and public sector initiatives, to reposition our frail elders from patients within healthcare settings to national resources integrated into the life of our country.
-Tamara Mann Tweel
Tamara Mann Tweel, Ph.D., is the John Strassburger Fellow in American Studies at Columbia University where she teaches courses on the history and ethics of philanthropy and aging in America.