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To the editor of the Stanford Daily:

	Kathy Olmsted's February 17 article about Professors Barton
Bernstein and Diana Dutton "questioning" "artificial heart prospects"
illustrates harmful aspects of public policy studies, technology
assessment and statism.

	The article cites Bernstein as saying that Americans should
"beware of indulging in high-tech fix to a problem which can be
seen in other ways".  Bernstein goes on to say that American biomedical
research priorites are distorted when the federal government spends
so much money on "episodic, dramatic" and heroic medical innovations
while neglecting the structural problems in the environment that
contribute to disease.

	This foolish article suggests to me the following right wing science
fiction movie scenario.  Influenced by the technology assessment movement,
the next Democratic administration drops or slows artificial heart
research and appoints Bernstein head of FDA.  He gives no further
permissions for artificial heart installations, pending the completion
of a ten year study of their desirability.
Influenced by "critics", the AMA rules artificial hearts unethical
in their present state of development.

	A multi-millionaire - call him J. R. -
who has had two heart attacks, offers to continue the artificial heart research,
because he wants one.  Bernstein believes in equality and threatens
doctors who consider working for the millionaire that they will
be blacklisted from future Federally funded medical research.
The millionaire takes his project to Taiwan or Hong Kong
and manages to save his own life.  We can have a chase scene down Lombard
street, while his henchmen are smuggling a vital part out of the U. S.

	Shortly thereafter, elderly rich people begin trooping
to Hong Kong or Taiwan to be fitted with artificial hearts.
When they try to return to the U.S., the FDA has the Customs
Service turn them off.  Organized crime finds smuggling artificial
hearts more lucrative than the drug business.  Heart replacement
clinics across the Mexican border grow up.

	The science fiction story is unrealistic, because "critics"
like Bernstein will give in before smuggling artificial hearts
becomes an industry.  They will at most succeed in stalling the
commercialization of artificial hearts for a few years.

Here are some relevant considerations:

	1. The artificial heart will probably turn out to be the
greatest invention of the twentieth century.  Perhaps half the
400,000 people who die of heart attacks each year will be able
to live five to ten years longer.
.skip to column 1
	2. The development scenario that would save the most lives
would be extremely disorderly.  It would be a furious effort by
hundreds of companies and thousands of doctors to cash in.
There would be bungling, and there would be fraud, but the winners
would be determined quickly, and standards would then be raised.
The present policy optimizes bureaucratic convenience and orderliness
and minimizes lawsuits at a high cost in lives.

	3. The FDA's authority to regulate medical products was
established for the purpose of preventing fraud and incompetence.
It is natural for "the public policy community" and our other
would-be masters
to suppose that this gives the authority to regulate on the basis
of social desirability.

	4. The $10,000,000 spent by NIH over ten years at Utah on artificial
heart research is small by Federal standards, contrary to what
is implied by Bernstein and Dutton.  I hope that the Reagan
Administration will increase it, and it would be especially
appropriate if this were done at the cost of the "program on medical
innovations and public policy at the Medical School" that supports
Bernstein's project.

	5. An artificial heart like that implanted in Barney Clark
is good enough - assuming it continues to function - for millions
of people to prefer it to death.  Clark, if his unrelated lung and
kidney problems improve, will be better off than a paraplegic, and
very much better off than a quadraplegic, and we know that these
people prefer to live.  Naturally, artificial hearts with fully
implantable power sources will be better, and Clark will want
a retrofit should he live so long.

	6. With almost negligible exceptions, an adult is the best judge
of his own interests.  I find Bernstein's, Dutton's and the Olmsted's
apparent
assumption that the Federal Government should decide whether I am
better off dead than living with an artificial heart presumptuous,
frightening and offensive.

	7. Part of my science fiction scenario seems realistic to me,
even though optimistic.
If the Federal Government lags enough in the further development of artificial
hearts, they will be developed by private industry - if not in the U. S.,
then abroad.  Fortunately, the genie cannot be put back in the bottle.

	8. If the Government doesn't fund the installation of artificial
hearts, then those who can afford them will find a way to get them.
This will cause social strain, but that's tough.

	9. Many people have died and will die in the next few years
whose lives could have been substantially prolonged by a more vigorous
program of developing artificial hearts.

	10. As is typical of public policy articles, the language
is ambiguous.  We have "critics question", "Americans should beware",
"wonder if the initial euphoria is warranted".  What does this stuff
mean?  Does "question" mean "oppose", as it often seems to?  Does
"Americans should beware" mean that regulators should stall?  Does
"wonder if the initial euphoria is warranted" mean to assert that
artificial hearts are a bad idea.  The language seems
%2not entirely undishonest%1 - to coin a euphemism.

	11. The main long term effect of studies like that of Bernstein
and Dutton will be to kill more people.  Suppose they succeed in
delaying by three
years the commercialization of artificial hearts, and suppose that
half of the 400,000 people who die each year of heart disease in
the U.S. can have their lives prolonged for five years by artificial
hearts.  That's only 600,000 lives.

	Perhaps I have misunderstood the purpose of their study and
its intended application to artificial hearts.  My question for them
is this.  Do they propose to delay the availability of artificial
hearts to the American public beyond what is required to make available
something that people with heart disease will prefer to dying?

.sgn
Please send copies of daily.11 to the following:
.<< bcc: Barton Bernstein, Diana Dutton, Sidney Hook, Edward Teller,
. Lowell Wood, Elliott Bloom, Steve Kline, Edwin Good, Robert McGinn>>