Artificial Hearts: The Allure and Ambivalence of a Controversial Medical Technology by Shelley McKellar
Replacing human organs gone bad has long been a cherished goal for physicians and patients alike. Artificial knees and hips help countless people remain upright. [End Page 135] Corneal implants help us see. Dialysis substitutes (albeit imperfectly) for failed kidneys. But some organs “seem” more central to our existence than others. Replacing the brain remains possible only in science fiction. But the heart—the organ long seen as being at the center of our emotions, of our will, indeed of our life—we can now replace. And Artificial Hearts explains how that came to be.
Shelley McKellar tells us that “the ‘things’ of the past have always intrigued me” (p. ix). And indeed, this is a book about things. All sorts of things, for creating the things that are artificial hearts required lots of prerequisites, both technology (the heart-lung machine, artificial valves, pacemakers) and procedures (heart transplants). McKellar uses a wide range of sources, ranging from a careful reading of the published literature and archival collections to interviews with key players and actually handling some of the devices. She clearly explains the technical issues at play. But this book is far more than an inward-looking recitation of advance followed by advance. McKellar draws effectively on sociological and anthropological literature to explore the myriad controversies that accompanied the artificial heart’s development. She tells us much about physicians, but also a bit about patients. The technological story is nicely imbedded within a changing social and economic context.
And the story is a fascinating one. In 1948, as part of the post–World War II surge of federal research funding, Congress established the National Heart Institute (later renamed the National Heart, Lung, and Blood Institute), which in 1964 created the Artificial Heart Program as its first targeted research program. One initial approach to failing hearts was to replace the damaged organ with another. The first transplantation of a heart into a human being was done in 1964 at the University of Mississippi, using a chimpanzee heart; the first transplantation of a human heart followed three years later in South Africa. These transplants formed part of the context within which researchers attempted to create an artificial heart. A high-profile 1980s implantation in Utah was seen as a qualified success by some, as a misguided adventure by others. The 1990s saw increased use of ventricular assist devices (VADs), “partial assist devices” that help the left ventricle but do not require removal of the native heart.
The book does not shy away from controversies of many stripes. There are questions about what constitutes “success” (and who gets to make that determination). There are fights between prominent Houston surgeons about who owns an innovative technology and who gets to decide when to use it. A plutonium-powered artificial heart seemed attractive for a while in the 1960s and 1970s, but eventually succumbed to fears about the dangers of imbedding nuclear devices within the body. Attention to this “failed” nuclear heart is a welcome addition to the history of technology literature, which all too often tends to focus only on the successes.
There are eight color plates and thirty-two black-and-white illustrations. It is unsurprising, but nonetheless worth noting, that in all of those illustrations there are dozens of named men (mostly surgeons) but only four illustrations that include named women: one shows a patient, one the wife of a patient, one a woman modeling a wearable power supply, and one an information officer and a nurse. About the role of nurses we do not read much. As for physicians, the field [End Page 136] of cardiac surgery has hardly been welcoming to women; the first women were not certified until 1961, and only ten had been certified by 1980. Today, only 3 percent of diplomas have gone to women. One might wonder if the machismo nature of artificial heart competition might have been tempered somewhat had there been more diversity among the field’s leaders.
Finally, the United States now spends 17 percent of our GDP on health care, health care that by any population measure is not very good. To reduce spending on health care will require spending less on health care. Artificial hearts and VADs not only are expensive but “exceed the traditionally accepted thresholds for cost effectiveness” (p. 261). Nonetheless, they have become part of the therapeutic armamentarium. This book is an excellent discussion of how we got here.