Artificial Hearts: The Allure and Ambivalence of a Controversial Medical Technology by Shelley McKellar (review)

"What a piece of work is man," Hamlet famously complained to Rosencrantz and Guildenstern. And apparently no piece of man has been more work to effectively (re-)create than the heart, as Shelley McKellar demonstrates in Artificial Hearts: The Allure and Ambivalence of a Controversial Medical Technology. Chronicling the manifold difficulties in engineering a mechanical replacement for one of the human body's most vital organs, McKellar shows that in spite of the promises of and massive investment in twentieth-century medical technology, we have still not arrived at a fully viable solution.

McKellar provides an impressively researched account which thoroughly documents the development of many different models of artificial hearts. She situates this history within the history of a large nexus of cardiac devices and procedures: heart lung machines, pacemakers, ventricular assist devices, and the concurrent advances in heart transplantation. Throughout, McKellar maintains a focus on the materiality of artificial hearts, in many cases handling models of the devices she studied herself. McKellar writes that removing the "black box" and describing how each device worked in detail was necessary in order to convey the technological challenge each represented, and to show how building artificial hearts "both reflected and challenged contemporary understanding of heart function and the feasibility of its mechanical replication" (p. 22).

It is precisely this focus on the engineering complexity of the devices that, McKellar argues, led medical teams and prominent cardiac surgeons to emphasize efficacy over effectiveness. In other words, physicians obsessed over whether they could make an artificial heart, not whether they should for the benefit of the patient. Though at the time the American public was concerned about heart failure, McKellar shows how the future promise of artificial heart technology and its often disappointing contemporary reality created a tension in which the public alternately believed the technology would be the fix they wanted and then became disillusioned, fearing that the devices worsened patient outcomes.

Public confidence was important, not only in the debate over the regulation of medical devices, but also because many of the most important artificial heart development programs, including Willem Kolff's team at the University of Utah, were publicly funded through the National Heart and Lung Institute. Even in this highprofile and well-funded program, researchers were unable to develop a device that was an unqualified success. McKellar notes that clinical experiences with the Utah Total Artificial Heart were "more unsettling than not, exposing a flawed technology" (p. 25). This ambivalence ultimately led to artificial heart development being outpaced by the development of ventricular assist devices—less technologically complex, less radical, and, crucially, the result of collaboration with the private sector industry which helped to shepherd the device through the development and manufacturing process.

In Artificial Hearts, McKellar often balances the themes of technological optimism with the ethical implications such experimentation carried. The book makes a compelling addition to the growing study not just of technological innovation, but also of bodily maintenance in the history of medicine. Ventricular assist devices, pacemakers, and artificial valves were more successful, in part, because they did not attempt to replace the heart completely.

McKellar acknowledges up front that Artificial Hearts is an American story. Though there were programs to develop artificial heart technology in other countries, McKellar notes that the U.S. program funded by the National Institutes of Health was the largest, best funded, and ultimately the most successful of the twentieth century. Nevertheless, it would be interesting to know more about the parallel investigations of researchers in other nations, especially in those with public health care systems. The cost of artificial heart technology is prohibitive for many patients in the United States even with insurance, and public health systems are often faced with balancing the cost-effectiveness equations of various therapies for their patients—how has the artificial heart fared elsewhere?

It is also a very gendered story—it seems that most...