Science
Have a heart
Bernard Dixon
Every few months, there lands on my desk a fat dossier recounting further steps towards the development of an artificial heart. Much of this research is proceeding in the United States, and its goal is a totally implantable, self-powered, plas tic heart designed to replace the natural organ when it has been ravaged by disease. Surgeons have, of course, been exploiting artificial devices for some time now in buttressing ailing hearts.
They stitch in plastic valves implant pace-makers in the chest wall to stimulate the heart beat; and hook up heartlung machines, outside of the body, to take over the circula tion during cardiac surgery. But as a product of science and technology, and certainly in terms of cost, a totally manmade heart represents an alto gether different dimension. The technical problems to be solved are immense, and a successful prototype would be by far the most expensive gadget ever devised in the name of medical science.
The conventional attitude towards mechanical heart research is to applaud it as a proud symbol of sophisticated science and engineering ranged against one of our commonest, and most crippling, forms of disease. But this orthodox view ignores four important considerations. First, even within the ambit of heart disease, there are far more sensible claimants for the massive funds now fuelling plastic heart development. These include studies on the prevention of chronic heart disease, and on natural organ transplantation — always a sounder approach than mechanical substitution. Second, the financial and social problems of choice and availability that would arise should artificial hearts become available would be so great as to be insuperable. We have seen those difficulties on a relatively tiny scale in the case of artificial kidney machines — and have failed to solve them. Third, when medical science yields an effective method of preventing or treat i n g atherosclerosis, the mechanical heart will become a worthless antique overnight. Finally, and despite gargantuan investment, there are considerable doubts whether an artificial heart is a feasible proposition. Even the difficulties of fixing such a structure in place and of persuading the body to accept it — let alone making it work — are daunting in the extreme. The whole idea may be a mirage.
Such doubts have been voiced from time to time by medical researchers — and not only by those with a vested interest, in the form of counter-claims for research funds. But with historic miscalculations always looming in the background, scientists are usually chary about damning a new idea too strongly, particularly one that in theory could help vanquish a common and intractable type of illness.
All the more significant, therefore, is an attack on the artificial heart programme contained in a recent article by Dr Lewis Thomas, Dean of Yale University School of Medicine. Writing in the science issue of the refurbished Saturday Review (January, p52), he portrays mechanical heart research, at the atronomical cost involved, as a gospel of despair. "To be willing to invest the hundreds of millions of dollars that will probably be necessary for this one new piece of technology," he writes, " almost demands of its proponents the conviction that ,heart disease represents an unapproachable, insoluble biological problem .
It assumes that the best we will be able to do, within the next few decades anyway, is to wait until the underlying mechanisms of heart disease have had their free run, until the organ has been demolished, and then to put into •the chest this nuclear-powered, plastic-and metal, essentially hideous engine."
Such research, Dr Thomas insists, is "the wrong way to go." He is surely right. Kidney machines are an expensive but effective stop-gap until we can prevent chronic kidney failure. An artificial heart would devour immeasurably greater funds. It may never work, and would at best be an unsatisfactory means of treating a condition for which alternative research, aimed at prevention, stands a high chance of success. We should act accordingly — and renounce the seductions of technomania.
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