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| Vol. 20, No. 2 |
| February 1, 1998 |
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A Conversation With Dr. DeBakey 
Recently, Dr. Michael E. DeBakey talked with the Texas Medical Center News about some of his pioneering work in heart surgery and other matters. TMCN: You must be very proud of the many surgeons who have trained with you and who have gone to other hospitals across the country and over the globe. MED: Oh, yes. We've worked with and trained nearly as many outside of this country as in the U.S. They've done very well. And they have carried on a tradition of training in their own countries. TMCN: Academic medicine - which you have been such a part of during your lifetime - is facing a critical period. What do you think academic health centers will be like as we enter the next millenium? MED: As you probably know, I've written several articles about this subject, about the threat that managed care poses to academic health centers. Everyone recognizes that managed care is a real threat. Managed care basically provides the least amount of care for the patient. That's the way money can be made, and it's really impossible to make money practicing medicine if you are taking care of a large population. If care is restricted to a certain population, a relatively healthy population, then managed care can have the appearance of working. But, of course, a large segment of the population won't receive adequate health care - they are not in the best health and do not have access to provider pools. But academic health centers have traditionally provided care to those most in need of it, and we've been able to do this by cross-subsidizing. Managed care makes this extremely difficult. But I'm optimistic. Americans won't tolerate the kind of policies in health care you see practiced by some for-profit managed care companies. You're already seeing legislation at both the state and federal levels which would restrict some of these practices. Academic health centers will survive because they are needed, and whatever society truly needs will survive. TMCN: How'd you first become interested in surgery? MED: You need to remember that in the early period - 1948-'49, when I first came here - there was virtually no heart surgery. My interest in cardiovascular surgery stems from my early interest in circulation. I did a year of graduate work at the University of Strasbourg before the war and was interested in studying aneurisms. In 1952, we did the first aneurism procedures in the U.S., and at this time - this was at Jefferson Davis Hospital [Houston's public hospital on Allen Parkway, which opened in 1937], which was the city's major trauma center then - the coroner allowed us to do the autopsies, so we had a supply of fresh homografts for aortic and arterial replacements. (In fact, I was able to get a grant in 1949 from the Surgeon General's office - where I'd worked during the war - to establish the first designated trauma center in the U.S. at Jefferson Davis.) I became interested in the ventricular assist concept in the early 1950s when we began doing open heart surgery with the heart-lung machine. We learned that we were able to wean the patient off the heart-lung machine by prolonging the assistance, but in others it was just not possible to wean them off the machine. In 1966 we were able to clinically establish the concept by successful application when we were able to get a patient off the heart-lung by using a ventricular assist device we developed in our laboratory. Now, of course, this concept is well established. We're still involved in experimental work on the ventricular assist device. I had the good fortune to do a heart transplant about 15 years ago for a NASA engineer and he had a good outcome. He became interested in what we were doing and I suggested that some of the hydraulic engineers at Johnson Space Center might also be interested in helping us. So I went out there and they became very interested and started working on their own time, but Dan Goldin, who was director at NASA, heard about it and said he'd like to help formalize the project and help with some financing. NASA gave us a grant for $500,000 and the DeBakey Foundation put in another $500,000. So over the next four to five years we worked pretty much full time on this and it led to the establishment of an axial flow pump. (See box.) Ultimately, what we're working towards is to treat the 5 million Americans with heart disease. This device - which is implanted in a fairly simple procedure - can support many of those people with very bad heart conditions and they can lead relatively normal lives again. Transplantation is limited to about 2,200-2,300 people because of the donor pool, but there are about 400,000 new heart failure patients each year. With this device, a transplant wouldn't be necessary. TMCN: The partnership between Baylor and NASA must be something else you're proud of. MED: It's worked out very well, yes. We continue to work with them on a number of projects. NASA deserves a great deal of support from the American people because of the 'spin-offs' from the various technical things they've developed - the MRI, pacemakers, defibrillators - all of these came from that early technology. TMCN: You placed great emphasis on living a healthy lifestyle - so that some of these interventions can be avoided. MED: People who practice a healthy lifestyle feel better. But there are issues which are difficult. For example, food which is high in fat is usually cheaper than healthier food. So for a family on a tight budget, eating healthy foods can be a challenge. Smoking, the excessive use of alcohol - everyone knows the risks these pose. But there's a problem, too, because when people - especially younger people - feel OK and they're not sick, they don't watch their diet, they don't exercise, they may smoke and drink too much. But in time this catches up to them. I do think the American people are doing better at taking care of themselves - after all, our life expectancy increases every year. Remember though that the population is aging (as well as increasing) so we are doing more heart surgeries. And here's a basic problem: we don't know how to prevent arteriosclerosis. While we can control some risk factors like hypertension and cholesterol, we know that arteriosclerosis can occur without the presence of any risk factors - and, in fact, a fourth or maybe a third of our patients with arteriosclerosis have no risk factors whatsoever. TMCN: There seems to be an increased interest in cardiovascular disease in women. MED: Yes, there certainly has been. In the new edition of our book [The New Living Heart] we have devoted a whole chapter to women and heart disease, largely because there has been a lot of misinformation. For example, there's been a kind of myth that women are protected from heart disease. Well, they are - until menopause, and after that they catch up to men. In truth, heart disease is the most common cause of death in women, almost as much as all other diseases combined. TMCN: On an international level, what's the impact of telemedicine and the Baylor Health Channel? MED: I think they're going to have a very important impact. The Health Channel that we've started at Baylor serves as a means of providing medical knowledge and information very quickly, primarily to physicians but it's available to lay people also. I think it's one of the best ways to improve standards of medical practice - not only across the country but globally. It is so readily accessed via satellite. We're planning on developing the Health Channel for Central and South America, in Spanish. We're working with people in Europe to develop it there. So this is an excellent mechanism for expanding the knowledge quickly and thereby raising the standards of medical practice. And the appropriate agencies are approving it for continuing education credits. TMCN: Speaking of global, how's President Yeltsin doing?
MED: Oh fine. I saw him just before he went to Denver to meet with President Clinton, and he looked very fit. He had had a bad cold, but he was doing just fine. He told me he felt his thinking was much improved since the surgery.
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