On cultivating prognosis in cardiovascular research

Abstract

I wish this evening to brush gently against a delicate subject, the cost of life. The subject is universal, but the approaches to it are varied and not without national overtones. Let me illustrate the latter by slightly enlarging upon a parable concocted by an Oxford professor discussing the complexities in determining a person’s usefulness to society.’ There is a shipwreck involving two Italians and an Italian woman, two Frenchmen and a French woman, two Englishmen and an English woman and two Russians and a Russian woman. These 12 are stranded on a desert island. By the third day the following situation has developed. One of the two Italians has murdered the other and has settled down with the woman. The two Frenchmen have come to an amicable agreement and have settled down to a m&age a trois. The two Englishmen have done away with the woman and have settled down. And the three Russians have drafted a letter to Moscow asking for instructions. I submit that had the original party been swollen to 15 by the presence of a similar trio of Americans, by the third day, the latter would have been kept fully occupied in dividing the island for better regional planning and by holding a symposium to consider the increase in crime. Social analysis is now a national pastime. This is not to suggest that America has a monopoly on self-criticism or on concern for human values. But we are more and more engaged in the taking of open inventories of social ills. And more and more we are discovering discrepancies between their sum and the resources readily available to correct them. Partly as a result of this, we, as a profession, now find ourselves engaged in tedious amounts of introspection. Indeed, there are times when it seems to practitioners and planners and, above all, to medical school deans, that we have fallen right through the looking glass. And, like Alice, we are confronted with endless unanswerable paradoxes. We sometimes wonder aloud which way we should go. The Cat in the tree at the fork in the road responds, “That depends a good deal on where you want to get to.” Just where is it we want to get to? In our own sector of the profession, the current season of cardiovascular research has produced some spectacular demands for forecast of things to come. As of this evening one man has survived over 60 days with the heart of another. Several other patients are now believed to be alive and leading productive lives because man-made pumps assisted their own failing hearts for periods of many hours or even days. Cardiac transplantation will continue. Pumps will be built that can assist the heart indefinitely. And one of these days-as sure as it is that we will go to the moon-some man will have a heart that is entirely manufactured, powered and controlled by systems sufficiently small and well enough concealed to permit him to live among other men without detection. We do not know that such cardiac replacement will be practical. But we can say that prospects are excellent that life will be extended by such unnatural means.