!!  spellx done
1  The 'Heart Gap' Will Cause Soul-Ache
   The Washington Post, Sunday, July 24, 1966

     This year's news is and will continue to be full of the trial
runs of new medical machines which are a turning point in the
joining of medicine and technology.  For several years, the
artificial kidney has been a technical success, but a soul-ache
for many whose lives might be sustained if this scarce and costly
mechanical substitute were in their reach.

     The artificial heart is now moving inevitably to a level of
practical utility.  No matter how discouraging the early trials of
recent weeks, we must think of the policies needed to cope with the
eventual success of this machine.

At first thought, such an advance appears to be an unmitigated
blessing, but power does not come to man without matching
responsibilities.  This applies especially to a power for life and
death.  As is often the case, the worst perplexity comes from a
technological imbalance.  At this point it appears likely that
machinery that could save lives of at least 100,000 Americans a
year could be perfected by 1970.  But we will then face several
cruel dilemmas during what might be called the "heart gap."

     The first few machines, by the mere postponement of a personal
doom, will be miraculous blessings -- but only for a few.  It is
certain that within our present framework of political decision,
confusion about automation, and technical organization, the machines
and the clinical skills needed to apply them will be pathetically
scarce for several years thereafter.

     But how to choose the few who should receive the benefit may
not be the worst dilemma.  It is equally certain that, while the
early versions of the artificial heart might prolong life, they
will also keep alive many cardiac cripples, persons irrevocably
tied to their machines.  And the worst stage of the gap will be
the period when on a large scale the machines saves life but not
livelihood, when a "plastic heart," rather like an iron lung,
becomes the fount from which the patient cannot long depart.  Such
a gap could well last 10 or more years, say from 1970 to 1980,
at an economic cost on the order of $100 billion.

     It has been suggested that plastic hearts not be used until
they give livelihood as well as life.  The suggestion flies in the
face of human nature as well as medical ethics, especially where
there is substantial hope of future improvement if the patient can
only be sustained a few years longer.

     This problem and its possible remedies are part of many larger
issues of human and social responsibility.  Reason and compassion
join in mobilizing every useful economic resource that can forfend
death.  On this argument, medical machines -- substitutes for
failing human organs -- will become our predominant industry.

     Medicine already takes a growing part of our gross national
product.  Increasingly expensive opportunities for treatment will
soon be available because sophisticated technology has been brought
to bear on medical problems.  Our arms budget is high for quite
comparable reasons -- we feel we cannot afford not to invest several
millions of dollars each for an advanced aircraft or missile, but
only because that costly technology has made it available.

     The human issues, like the shift in age composition and its
impact on family life, are no less perplexing; so are the implications
for world order of ever more poignant demonstrations of the use of
wealth.  Our column cannot even list all of these concerns, but the
public arousal and private conscience that are the root energy of
democracy must start somewhere.

     Should we not have begun yesterday to start thinking of human
biology as one of the main sectors of political responsibility?

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