[Memorandum from Clarence Dennis [on meeting among Drs. Ringler, DeBakey, Hegyeli, and Dennis on November 15 concerning implementation
of the plan of collaboration agreed upon in Houston October 19, 1974]]
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1974-11-20 (November 20, 1974)
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Directing the Artificial Heart Program at NIH, 1972-1974
Subject: Meeting among Drs. Ringler, DeBakey, Hegyeli and Dennis on November 15, 1974, concerning implementation of the plan
of collaboration agreed upon in Houston October 19, 1974.
The plan was critically reviewed and the memorandum prepared by Dr. Dennis on November 6 with suggestions as to patterns of
implementation was similarly reviewed. Dr. DeBakey was somewhat hesitant to settle on specific items as suggested in my memorandum
of November 6. He felt that it was better to see what the Russians want and what they feel they must do before making a firm
suggestion. Under item 1.3) an example in the discussion was the pacemakers, valves, and prostheses. These are all clinical
already and it is questionable where one should draw the line as to what should be worked upon jointly with the Russians.
Left ventricle assist devices are not yet clinical, but it is questionable whether they are yet ready for exchange. Perhaps
it would be better for us to list all of these devices which are in the process of development and to get an elegant advisory
committee to select which should be proposed for collaboration with the Russians. It was the consensus that we should not
let the Russians make the selection. We in the Program might select a few of the members of this advisory committee ourselves
and perhaps get recommendations from some special societies such as ASAIO. Dr. DeBakey was of the opinion that Dennis should
continue to help. The difficulty in settling upon devices to consider is that the Russians do not have the necessary data
or devices and that they want both, but that they do not have the ability to evaluate them as yet. Dr. DeBakey suggested
that he and Dennis fix a catalog of devices and then pick an ad hoc group as suggested above. It was suggested that a formally
organized committee be avoided for the moment; perhaps that Dennis and DeBakey do what they feel they can do and then get
such consultants as appear to be appropriate.
It was agreed that following the meeting of December 6, the afternoon would be utilized in working on this list.
Dr. DeBakey expressed doubts about the wisdom of continuing with the total artificial heart program as it currently exists.
The problem is that the basic scientific problems have not been solved and that one cannot run an integrated program unless
the basic technology is well in hand. The people at Baylor are running an in-house critique on the matter of the artificial
heart and a copy of this will be sent to Dr. Ringler. We must be very careful in regard to this because a decision on our
part at the present time to pursue the artificial heart will be upsetting to our relationship with the Russians. It was suggested
that an ad hoc special committee be very quietly gathered in order to review all of this. It was agreed that there have been
many benefits from the artificial heart program even though we do not have an artificial heart and the basic science to produce
one has not yet been developed. Much information has come from the program with regard to valves, with regard to velour on
vascular grafts, with regard to the physiologic understanding on controls of the heart (for instance, the nervous components),
and with regard to the pyrolytic carbon surfaces. The criticism which both DeBakey and Dennis put forward was that neither
of us can see justification for iterative, unproductive, extravagant experiments, such as the 56 thermal implants performed
at Travenol in an effort to get a survivor with a thermal engine, or such as the addition of three or four days of survival
by virtue of spending tens of thousands of dollars at the University of Utah when there is precious little basic scientific
information and when one knows that the mechanism of nonsurvival will be essentially as it has been in the previous animals
and when one realizes that the basic problems have not been corrected.
It was agreed that we should at the present time not make any statements with regard to budget. At the present time of budgetary
difficulty any announcement with regard to the proposed budget for the program of collaboration would almost certainly run
into heavy opposition. It would be far better to make our plans quietly and go into the matter of costs only when inquiries
are made concerning them.
With regard to item 1, 1), that of exchange of personnel between the United States and the U.S.S.R. it was agreed that there
is no sense in sending junior people, but that the exchange should be made of top level investigators in the field. Three
names that were suggested were John Kennedy, William Hall, and Clarence Dennis.
There appeared to be agreement that there is no point in talking about turning off all research with regard to the total artificial
heart, but rather that there should be a change in the mechanism of approach to the problem. In other words, since systems
engineering is successful only when the basic technology is well in hand, it would be far better to have these matters instigated
by the grant mechanism.