Permissionless Surgical Innovation

(p. 15) When a patient’s heart gave out on the cardiac surgeon Denton Cooley’s operating table in 1969, he refused to let the man go gently into that good night. Instead, he dispatched an associate to find a sheep and pluck out its heart. Cooley sewed it into his patient’s chest. This was apparently the kind of thing you could do — without asking anyone’s permission — in the 1960s.

The patient died (of course) but Cooley pressed on. A year later, he tried another experimental procedure — an artificial heart developed and some would say stolen from his rival at Baylor University in Houston. He never asked the university’s permission because, well, that would have required going through a committee run by said rival. “We administered to Baylor University the biggest enema,” Cooley reportedly told a colleague after the surgery. “It will be remembered in years to come.”

And this, readers, is how the first artificial heart came to be implanted in a patient. (The man survived three days with the device, before receiving a transplant from a donor and dying the following day.) Such are the brazen feats that Mimi Swartz chronicles in her book “Ticker,” a brief history of the artificial heart. Swartz is an executive editor of Texas Monthly, and she is based in Houston, home to four medical schools and much of the last century’s pioneering heart research. These are physicians who have a lot more in common, she writes, “with the people who crossed Everest’s Khumbu Icefall or took the first steps on the moon.”

For the full review, see:

Sarah Zhang. “The Tin Man’s Dilemma.” The New York Times Book Review (Sunday, Sept. 22, 2018): 15.

(Note: the online version of the review has the date Sept. 17, 2018, and has the title “The Quest to Create and Perfect an Artificial Heart.”)

The book under review, is:

Swartz, Mimi. Ticker: The Quest to Create an Artificial Heart. New York: Crown, 2018.

Absence of For-Profit Hospitals Hurts New York State

(p. A17) House Democrats’ new Medicare for All bill asserts “a moral imperative . . . to eliminate profit from the provision of health care.”
. . .
The Empire State’s hospital industry has been 100% nonprofit or government-owned for more than a decade. It’s a byproduct of longstanding, unusually restrictive ownership laws that squeeze for-profit general hospitals. The last one in the state closed its doors in 2008.
A report last year from the Albany-based Empire Center shows the unhappy results. The state health-care industry’s financial condition is chronically weak, with the second-worst operating margins and highest debt loads in the country. And there’s no evidence that expunging profit has reduced costs. New York’s per capita hospital spending is 18% higher than the national average.
The overall quality of New York’s hospitals, even factoring in Manhattan’s flagship institutions, is poor. Their average score on the federal government’s Hospital Compare report card was 2.18 stars out of five–last out of 50 states. Their collective safety grades from the Leapfrog Group and Consumer Reports magazine have also been dismal.
The state’s nonprofit hospitals also fall short on accessibility for the uninsured. On average they devoted 1.9% of revenues to charity care in 2015, a third less than privately owned hospitals nationwide.
Finally, New York’s antiprofit policy doesn’t even prevent people from getting rich. Seven-figure salaries are common among the state’s hospital executives. If banning profit is an effective way to improve health-care, there’s no evidence to be found in New York.

For the full commentary, see:
.Bill Hammond. “Banishing Profit Is Bad for Your Health; The Medicare for All proposal from House Democrats follows New York state’s bad example.” The Wall Street Journal (Tuesday, March 19, 2019): A17.
(Note: ellipsis internal to first paragraph, in original; ellipsis between paragraphs, added.)
(Note: the online version of the commentary has the date March 18, 2019.)

92-Year-Old American Airline Mechanic

(p. A19) Azriel Blackman, an airline mechanic for American Airlines, is not allowed to climb ladders, drive on the airfield at Kennedy International Airport or even use any tools.
That’s understandable — Mr. Blackman turns 92 next month.
But those constraints have not stopped him from showing up to work at a job he started in an era when trans-Atlantic commercial flights were novel feats.
“He loves coming to work,” said Robert Needham, Mr. Blackman’s boss and the station manager for the airline’s New York maintenance base. “His work ethic is something I’d love every one of my 368 mechanics here to have.”
Five days a week, Mr. Blackman drives himself from his home in Queens Village to the airport long before sunup and well before his 5 a.m. start time. His job as crew chief is to review paperwork detailing what maintenance has been completed and what remains to be done on 17 jetliners that are kept overnight at the airport. Then, wearing a lime-green vest and clutching a paper containing a list of planes and service requests, he starts his walk through a massive hangar, often passing below an enormous mural on the wall featuring his portrait surrounded by four types of aircraft flown by American.
. . .
“Every day the job is different,” Mr. Blackman said. “You’re not doing the same thing repetitively, and that’s good. If in my journey around the hangar I see something I can help on, I do that.”

For the full story, see:
Christine Negroni. “For 75 Years, Helping to Keep Planes Aloft.” The New York Times (Tuesday, June 18, 2017): A19.
(Note: ellipsis added.)
(Note: the online version of the story has the date June 17, 2017, and has the title “For 75 Years, a Mechanic Has Helped Keep Planes Aloft.” The online version identifies the page number of the New York edition as A18. The page number in my copy of the National edition was A19.)

Medtronic Founded in Garage

(p. A1) In the mid-1950s, heart pacemakers were bulky devices that had to be wheeled around on carts and plugged into a wall socket. A heart surgeon in Minneapolis asked Earl Bakken if he could make something better. After consulting a back issue of Popular Electronics, Mr. Bakken within a few weeks fashioned a wearable pacemaker powered by a battery.
. . .
Mr. Bakken, who died Oct. 21 [2018] at the age of 94, had no inkling he was creating anything more than a local repair shop when he and a brother-in-law, Palmer Hermundslie, set up Medtronic. “We didn’t analyze or study the market,” he wrote in “One Man’s Full Life,” a 1999 memoir. “We just did it.”
Medtronic’s inventions eventually sustained him physically as well as financially. “I’m on my second pacemaker, and I’m on about my third or fourth insulin pump,” he told the St. Paul Pioneer Press in 2010. “So I’m glad I invented the company, or I wouldn’t be sitting here.”
. . .
Noting his talents, university medical personnel sometimes asked Mr. Bakken to fix their equipment. He noticed that few hospitals had technical staffs to maintain their electrical gear. A chat with his brother-in-law, Mr. Hermundslie, prompted them to fill that niche by setting up a repair shop inside a garage.
. . .
In 1957, a power outage was blamed for the death of a baby dependent on a plug-in pacemaker. A University of Minnesota heart surgeon, Dr. C. Walton Lillehei, asked for alternative technology. Mr. Bakken found a design for an electronic metronome in Popular Electronics and used that as the model for a circuit. He housed the circuitry in a metal box small enough to be taped to a patient’s chest. After a successful test on a dog, Dr. Lillehei began using the device. Articles he wrote about it created a stir, and soon Medtronic was receiving orders from around the world.

For the full obituary, see:
James R. Hagerty. “Founder Started Medtronic as a Local Repair Shop.” The Wall Street Journal (Tuesday, Oct. 27, 2018): A6.
(Note: ellipses, and bracketed date, added.)
(Note: the online version of the obituary has the date Oct. 26, 2018, and has the title “Medtronic Founder Earl Bakken Turned a Tiny Repair Shop Into a Giant of Medical Technology.”)

The autobiography mentioned above, is:
Bakken, Earl E. One Man’s Full Life. Fridley, MN: Medtronic, Inc., 1999.

Bureaucratic FDA Delays Approvals for Fear “We’ll Be Toast”

(p. A21) Oct. 30 [2018] marks the 36th anniversary of the FDA’s approval of human insulin synthesized in genetically engineered bacteria, the first product made with “gene splicing” techniques. As the head of the FDA’s evaluation team, I had a front-row seat.
. . .
My team and I were ready to recommend approval after four months’ review. But when I took the packet to my supervisor, he said, “Four months? No way! If anything goes wrong with this product down the road, people will say we rushed it, and we’ll be toast.” That’s the bureaucratic mind-set. I don’t know how long he would have delayed it, but when he went on vacation a month later, I took the packet to his boss, the division director, who signed off.
That anecdote is an example of Milton Friedman’s observation that to understand the motivation of an individual or organization, you need to “follow the self-interest.” A large part of regulators’ self-interest lies in staying out of trouble. One way to do that, my supervisor understood, is not to approve in record time products that might experience unanticipated problems.

For the full commentary, see:
Miller, Henry I. “Follow the FDA’s Self-Interest; While approving a new form of insulin, I saw how regulators protect themselves.” The Wall Street Journal (Monday, Oct. 29, 2018: A21.
(Note: ellipsis, and bracketed year, added.)
(Note: the online version of the commentary has the date Oct. 28, 2018.)

P&G Bureaucracy Suffocates New Chapter

(p. A5) Vermonters Paul and Barbi Schulick sold their vitamin business to Procter & Gamble Co. in 2012, hoping P&G ‘s PG’s deep pockets would fund research needed to nurture the small-but-profitable company.
Instead of growing, New Chapter, founded in 1982 by the Schulicks, spiraled downward.
. . .
The Schulicks kept roles at the company training managers and running research and development at its offices in Brattleboro, Vt., but this month they quit. They said excessive bureaucracy hurt New Chapter and that P&G–coming off a fight with activist investor Nelson Peltz–ramped up pressure for profitability and vetoed plans to develop breakthrough products.
M”The patience factor has really worn out” at P&G, Mr. Schulick said in an interview. “There is a lot of pressure to meet targets, and we weren’t responding fast enough.”

For the full story, see:
Sharon Terlep. “At P&G, Vitamins Maker Loses Energy.” The Wall Street Journal (Friday, July 20, 2018: A5.
(Note: ellipsis added.)
(Note: the online version of the story has the date July 19, 2018, and has the title “They Sold Their Startup to P&G. It Struggled. They Quit.”)

Early Medical “Leaps of Ingenuity”

(p. A17) Using a panoply of colorful examples, the author artfully illustrates the frustrations, uncertainty, poorly founded confidence and frequent futility of medical practice in the prescientific age. Employing a consistently light and humorous touch, he effortlessly navigates a cornucopia of fascinating, esoteric and obscure patient histories.
The carefully selected vignettes demonstrate the befuddled mindset of the well-intentioned physicians who were forced to contend with the vagaries of damaged and failing human flesh without the benefit of anesthesia, and armed with little more than the fanciful theories of Galen (a second-century Greek who attributed disease to imbalances of the four “humors”: blood, phlegm, and yellow and black bile) and an elementary knowledge of human anatomy.
Yet despite their lack of mechanistic understanding, these individuals showed leaps of ingenuity no less startling than those of today’s physicians and genome rewriters. To avoid subjecting himself to the dangers of 18th-century surgery to remove a bladder stone, Mr. Morris tells us, the French-born surgeon Claude Martin fashioned an instrument out of a knitting needle and a whalebone handle, which he then inserted through his urethra and used to manually file away the stone.

For the full review, see:
Adrian Woolfson. “BOOKSHELF; Desperate Remedies; Treatments of old for common health ills included tobacco-smoke enemas, arsenic cigarettes–and the “Pigeon’s-Rump Cure.” The Wall Street Journal (Tuesday, Dec. 13, 2018): A17.
(Note: ellipses added.)
(Note: the online version of the review has the date Dec. 12, 2018, and has the title “BOOKSHELF; ‘The Mystery of the Exploding Teeth’ Review: Desperate Remedies; Treatments of old for common health ills included tobacco-smoke enemas, arsenic cigarettes–and the “Pigeon’s-Rump Cure.”)

The book under review, is:
Morris, Thomas. The Mystery of the Exploding Teeth: And Other Curiosities from the History of Medicine. New York: Dutton, 2018.