OV“

June 24, 1964

pr. Ralph E. Knutti, Director
National Heart Institute
National Institutes of Health
Bethesda, Maryland

Dear Dr. Knutti:

Fer sometime I have been puzzling why an artificial heart has not yet been
made available as a fruit of our technicolopical developments. A number
of my colleagues jgined in some extensive discussions on this topic and
would join in the conclusions I present here. I am sure you have given
considerable attention to this problem and I would be grateful for your
thoughts as well as for your constructive action on some of my suggestions.

I believe the problem is technically difficult but easily managable within
the framework of our present scientific knowledge and technical proficiency.
We have, however, permitted it to remain a subject of fragmentary sclentific
studies rather than of a unified engineering program. On balance it should
be of the same order of complexity as designing a sophisticated instrument
in spacecraft, this of the order of $100,000,000, and quite unlikely to

overreach the requirements of a system like the supersonic transport ten
times that figure.

LL

jee

Traditionally, health research is not exploited at techniques of systems
development that have been elaborated for military defense and spece flight.
We are fortunate to have been able to reserve what we could for the viability
of basic research, But we do ourselves a great disservice to neglect the
opportunity of a systems response to what is now a well-defined technical
problem, which is so much a matter of engineering design, material develop-
ment, and empirical testing, and should not be confused with the basic
research that was needed at its foundations.

To jump right on to the brass tacks, I would propose that you take the
initiative in exploring the technical possibilities with this development
with industry, especially the aerospace industry. There are a number of
possible routes that I could comm@énd to your attention:

1. Informal conference with the R&D Vice-Presidents, separately or in
a group session.
Dr. Ralph E. Knutti, Director 2 June 24, 1964

2. Your isauance of a Request for Proposals for an Introductory Systems
Study. This might have to take about 20 man-years to cover the
situation properly, i.e., about $1,000,000 - and some of the initial
funding would, to be sure, be relatively inefficient because of the
cost of familiarization.

3. Consult with your opposite numbers tn NASA or the Air Force how they
would evaluate the problem and meet it.

4. Even ask these agencies to do the job on your behalf. Since a sur~
rogate heart could play an important role in supporting streneous
life in challenging circumstances other than medical emergencies,
they would have legitimate reasons in joining such an effort.

I realize how constrained NIH's experience has been with industrial contracts,
and suspect that this is one of the obstacles to a rational solution to the
heart problem. But these precedents, or lack of them, should not confuse the
isaue: how to harness an efficient technicological system for humanitarian
purposes at a time when this is almost too abruptly relieved of its call for
national defense purposes.

You may well wonder how I happen to concern myself with this issue which is
not in my own field of research. Anecdotally, from the consideration of the
probable success of tissue transplantation over the next few years, hearts
will be transplantable too, but the problem of equitable access to a very
Rarrow supply seems insoluable. Artifical surrogates could bypass what would
otherwise become a very serious social stress. But machine development also
attracts a parallel concern. There should be a minimal delay between the
first and generally available implantable pumps. Many other factors have to
be taken into account; bet it would be very unfortunate if we have to face a
frenetic selection of contractors and hasty tooling up for production only
after the first feeble successes,

I am discouraged to think that many academic investigators now actually
working on this problem would probably shout down the more concentrated
approach that I recommend. I would by no means wigh to displace academic
research from its creative role in this story, but these laboratories should
be concentrating on more basic issues than designing and teating the pumps.
I am sure a much more fruitful allocation of talent will evolve analogous to
the interplay between government, industry and she academic laboratories in
the construction of space launch vehicles, the desipn of spacecraft and the
implementation of experimental goals in space resaarch, Parenthetically, I
should say that my own experience in this area (exobiology), has given me an
experience and understanding I might otherwise lack of the connection and
the contract between academic science and industrial technology.
You may ask whether one of the other parties to these concerns should not
take the initiative, for example to apply to you for study contract rather
than for you to take the first step. If there were already better communi-
cation between industry and the NIH this letter would probably be unnecessary.
Meanwhile, I think we are in an illogical impasag one which you could most
readily resolve. I know that there are many competent firms, certainly in
California, who could and would readily undertake such an assignment, but

to redirect their interest requires some top level inducement and encourage-
ment such as you could most readily furnish.

I am sure you are sensitive to the need to cope with the solutions as well
as the substance of these problems. Indeed, I detect in some of my friends,
even in my own thinking, some latent resistance in moving ahead for this
reason. But it should be far better to have some plans and sense of policy
as we escalate to these problems of the "brave new world", The alternative
is no happy status quo ante, rather chaotic advances whose lack of balance
and forethought meaely aggravate the fpeoplexity.

Sincerely yours,

Joshua Lederberg,
Professor of Genetics

JL:as