Heart to Heart: The Twentieth Century Battle against Cardiac DiseaseAn Oral HistoryBMJ 2002; 325 doi: https://doi.org/10.1136/bmj.325.7370.974 (Published 26 October 2002) Cite this as: BMJ 2002;325:974
Allan B Weisse
Rutgers University Press, $35, pp 448
ISBN 0 8135 3157 8
There have undoubtedly been some dramatic improvements in the treatment of cardiovascular disease during the past century. Heart to Heart is an attempt to shed further light on the thoughts and ideas behind this progress, expressed through interviews with many of the most important doctors in the field, such as André Cournand (cardiac catheterisation) and Albert Starr (first functioning mechanical valve).
Collections of interviews such as this one are always open to criticism over the criteria used for judging which doctors and researchers are the “most important.” This collection could perhaps more suitably be subtitled “an American oral history of cardiac surgery,” given the focus on US cardiovascular surgery heavyweights. It includes interviews with cardiac surgeons involved in pioneering work with artificial valves, cardiopulmonary bypass, aortic counterpulsation and the artificial heart, and the development of coronary artery bypass surgery.
Heart to Heart is nevertheless an interesting volume for any doctor currently involved in cardiovascular research. The entire process of conducting research was very different in the mid-20th century; there were no ethical review boards and no complicated grant applications. If someone had an idea, they generally just went ahead and pursued it, for better or worse. This approach often led to severe conflicts with hospital administrators and fellow researchers, but it also led to many significant achievements. However, individual patients were subjected to daring and unconventional surgery, with occasionally disastrous results. In discussing a particular procedure that killed a patient, the surgeon in one of these interviews says that it really was a pity, considering the amount of work spent in preparation. The patient may, of course, have had a different view.
Despite these criticisms, this book sheds light on the conflict between the daring of cardiovascular researchers on the one hand and managerial and professional scepticism, allied to the public's demand for control, on the other. With great enthusiasm and courage, many of those interviewed were constantly pushing the limits; their quest to improve cardiovascular treatment drew on research that was not only innovative but also adventurous. Their sometimes complete disregard for ethical discussion, policy guidelines, and sometimes even informed consent led to individual disasters but also to dramatic improvements. Research was clearly driven by a burning desire to find cures for many conditions that at the time were not amenable to any kind of treatment. Without advocating less ethical evaluation or tampering with informed consent, we may learn from the history of cardiovascular research to be slightly more daring, to allow perhaps more lateral thinking, to give more leeway to crazy ideas, and to question more readily the dogmas of today.
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