Cognition Switch #6

By Carl Zimmer, Alex O'Brien, Hayley Birch and 6 more

Cognition Switch: An Artefact for the Transmission of New Ideas

Issue #6: June 2019

Featuring Ideas by:
Alex O’Brien, Hayley Birch, Catherine de Lange, Carl Zimmer, Moheb Costandi, Virginia Gewin, Emma Young, Samira Shackle, and Kendall Powell

• Language: English
• Publisher: Cognition Switch
• Release date: Jun 11, 2019
• ISBN: 9788834136737

Book preview

COGNITION SWITCH #6

Featuring Ideas by:

Alex O’Brien, Hayley Birch, Catherine de Lange, Carl Zimmer, Moheb Costandi, Virginia Gewin, Emma Young, Samira Shackle, and Kendall Powell

This work is licensed under a Creative Commons Attribution-NoDerivatives 4.0 International License

Originally published by Mosaic

Published 2018 by Cognition Switch

Please visit us at our website: www.cognition-switch.com

ISBN: 9788829559275

Thank you for your purchase. If you enjoyed this work, please leave us a comment.

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CONTENTS

How to mend a broken heart

Made for the marathon?

Brazil’s billion-dollar gym experiment

Why do we have allergies?

This is what happens after you die

Fighting over fatigue

What the nose knows

Terror, shipwreck, guns – 24 hours in a Karachi ambulance

The superhero in your vagina

How to mend a broken heart

Alex O’Brien is a freelance science and technology writer. She is a regular contributor for German-based Trademark Publishing and has written for Delayed Gratification and The Long & Short, among other publications.

https://mosaicscience.com/story/artificial-heart/

Haskell Karp was 37 when he suffered his first heart attack, and over the next ten years he suffered a variety of related problems. By 1969 even the slightest effort, like combing his hair or brushing his teeth, would bring on chest pain or extreme shortness of breath. There are four grades of heart failure under the classification determined in 1928 by the New York Heart Association; Karp’s was classified as grade IV, the most severe.

The surgeon who treated him at St Luke’s Hospital, Texas, in 1969 was an energetic man called Denton Cooley. The man had a big dilated heart and I hoped we could reduce the size of that heart, so it could regain some of its own function, says Cooley. But Karp did not respond well to the treatment; half of his heart was beyond repair. Cooley had expected this. He’d discussed it with Karp before the surgery: I don’t think your heart’s going to be strong enough to tolerate this operation, he’d told him. But Cooley had made a suggestion: if Karp’s heart were to be too weak at the end of the operation, how about taking a replacement – an experimental artificial heart they’d been developing in the lab.

The mechanical heart was a temporary ‘bridge’, intended to provide additional time for patients waiting for a donor heart to become available. It had an implantable part, larger than a human heart, connected to an exterior console the size of an upright piano powering it. The contraption drove compressed air through two hoses made of silicone and fabric (which entered the patient’s body below the ribcage) and into the chambers of the artificial heart: one side a left pump, the other a right, each with a balloon inside. When the chamber filled with blood, the balloon filled with air and pushed the blood out, keeping Karp alive.

The need to mend broken hearts has never been greater. In the USA alone, around 610,000 people die of heart disease each year. A significant number of those deaths could potentially have been prevented with a heart transplant but, unfortunately, there are simply too few hearts available.

Until fairly recently, doctors were limited in how much they could do when a heart breaks. The first notable milestone took place in 1912, when the French surgeon Théodore Tuffier used his fingers to dilate a patient’s aortic valve (which helps control the flow of blood out of one side of the heart). But it was the first ‘blue baby’ operation at Johns Hopkins Hospital in Baltimore, Maryland, in November 1944 that symbolised to some the real dawn of heart surgery. Following a diagnosis by his colleague Helen Taussig, Alfred Blalock joined a baby girl’s aorta (the main artery leaving the heart) to her pulmonary artery (leading to the lungs), giving the blood a second chance at oxygenation and relieving the lack of oxygenated blood that gave the infant her distinct blue cast.

Yet the possibility of doing more to fix the inside of the heart remained impossible for years; opening it meant the death of the patient within minutes. What was needed was something that would stop the blood flow into the heart’s chambers, so it could be operated on, but that would keep the blood flowing around the body so the vital organs were not deprived of oxygen. That would take until 1953, when the first successful open heart surgery using a heart–lung machine took place at the Jefferson Medical College in Philadelphia.

Even so, the only solution for many people with heart problems was – and still is – a transplant with a healthy, natural heart. In 1967 the South African surgeon Christiaan Barnard performed the world’s first human heart transplant in Cape Town. It seemed like a starting gun had gone off; soon doctors all around the world were transplanting hearts.

The problem was that every single recipient died within a year of the operation. The patients’ immune systems were rejecting the foreign tissue. To overcome this, patients were given drugs to suppress their immune system. But, in a way, these early immunosuppressants were too effective: they weakened the immune system so much that the patients would eventually die of an infection. It seemed like medicine was back to square one.

The origins of the world’s first artificial heart lie with Michael E DeBakey, Denton Cooley’s former mentor. A titan of American heart surgery, DeBakey was known as ‘the Texas Tornado’. He was mean as hell, says Oscar Howard ‘Bud’ Frazier, one of the many surgeons trained under the Tornado. He ran his hospital like a marine training camp, with most residents working up to 72 hours on a regular basis. Once he fired seven chiefs of department at the same time because they failed to meet his standards. But DeBakey’s exacting standards helped establish Baylor Medical School, and his funding campaigns helped kick-start research into various devices – including the artificial heart. We would never have these devices without him, says Frazier.

Indeed, DeBakey is widely credited for starting the field of artificial heart surgery with a 1964 grant from the National Heart, Lung and Blood Institute (NHLBI). The 1969 device used on Karp was the product of this, but at the time it had only been tested on calves, and none of the animals had survived for more than a few hours. It had never been tested in human patients. Until Haskell Karp.

The thing is, Cooley didn’t actually tell DeBakey what he was going to do. When Karp went under the knife, DeBakey was at the NHLBI in Washington DC, appealing for additional funding. Unbeknownst to him, two of his protégés had been making tweaks to the artificial heart for months. In his book 100,000 Hearts: A surgeon’s memoir, Cooley tells how he was brought the device in December 1968 by Dr Domingo Liotta, a research fellow in DeBakey’s lab. Frustrated under DeBakey’s leadership, Liotta (according to Cooley) thought his life’s work was being cast aside as DeBakey began to have doubts about the feasibility of a totally artificial heart and became more interested in developing pumps for a ‘partial’ device that would bolster the patient’s own organ.

And so the story, according to DeBakey, goes that in 1969 Denton Cooley took the device and implanted it without permission so that he could be the first to implant an artificial heart. Cooley and Liotta had altered the design of the valves and renamed the device ‘the Cooley-Liotta heart’, intending it as an emergency bridge while patients were waiting for a heart transplant.

The professional fallout was bad. DeBakey first heard about the operation from the press, who – knowing he was in Washington – had gone knocking on the door of his hotel room for comment. DeBakey called Cooley a thief. He considered it a betrayal, a childish act to claim a medical first. The feud lasted for 40 years and made the cover of Time magazine in 1970.

Time and again, Cooley has defended his behaviour. He says he was only ever driven to try the desperate move to save a life. Which he did, for a time. Haskell Karp lived longer than any of the cows DeBakey had operated on – long enough to find a donor heart. After 64 hours with the artificial heart, Cooley transplanted in a natural donor heart. But Karp died 36 hours later of pneumonia and kidney failure. Karp’s wife later sued Cooley, claiming he’d never told them that the artificial heart was experimental. Cooley successfully defended his action in court.

Seventy-four years old with a full head of white, floppy hair, Bud Frazier is still visibly affected by the moment he literally held the life of a young man in his hands.

It was 1965, and Frazier was in medical school. The patient was about 18 years old and had a problem with one of his heart valves. He was sent over from Italy, where no heart surgery was performed at the time. Italian patients were mainly sent to the USA, most of them treated by either DeBakey or Cooley.

During the surgery, led by DeBakey, the young man’s heart stopped and Frazier was asked to take it in his hand and massage it to keep the blood circulating. At one point the young man even regained consciousness and looked Frazier right in the eye. The problem was that the man’s heart did not start beating by itself. After a while, DeBakey told Frazier to stop: We can’t save him, he said. The chief resident agreed. They both told Frazier to stop. He didn’t want to. Stopping would kill the man. But it was no use; the heart wasn’t responding. Eventually, Frazier had to stop.

That was almost 60 years ago, but he can still hear the cry of the mother whose son he could not save. The death inspired an all-consuming thought in Frazier: My god, if I can do that with my hand, we must be able to develop something we can pull off a shelf that does the same thing.

After medical school Frazier served in the Vietnam War. He returned to Texas and Baylor Medical School in 1971, keen to work on heart pumps. But after the artificial heart incident, DeBakey had fired Liotta and got rid of everyone else in the lab. The whole pump programme was dead, but it restarted at the nearby Texas Heart Institute with one Denton Cooley at the head.

By then Cooley was doing more heart surgery than anyone else in the world. Frazier made the difficult decision to leave DeBakey’s lab and finish his residency across the road. DeBakey didn’t talk to him for ten years.

By the mid-1960s, as open-heart surgery began to take place around the world, Texas Heart Institute doctors were doing more than at all of the other hospitals in the USA combined. Houston had wealthy oilmen who wanted to do something meaningful with their money, and the hospitals were more than willing to receive their philanthropy.

Today, Houston is home to the Texas Medical Center, one of the world’s largest medical complexes. It’s located three miles south of Houston’s Midtown and resembles a financial district, with its many skyscrapers stretching into the clear blue sky and glistening in the Houston sun. It is home to 21 hospitals, 13 support organisations, eight academic and research institutions, three medical schools, two universities, a dental school and over 100,000 workers – more than at Apple or Google – in an area nearly the size of Gibraltar. And in 2014, more heart surgeries were performed here than anywhere else on the globe, many of them by Bud Frazier.

It’s a tough business, the heart transplant business, says Frazier. As he puts it, you just guarantee them a premature death, though less premature than would otherwise be the case. Half of transplant patients die within ten years, and only about 10 per cent live 20 years. Outside his office hangs the picture of a man who lived for 33 years. He was an exception.

The heart is basically a bag of muscle divided into four interior chambers. The two upper chambers are called atria, and