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␈↓ ↓H␈↓␈↓βS␈↓∧ Department of Computer Science, STANFORD UNIVERSITY, Stanford, California 94305

␈↓ ↓H␈↓∧Telephone 415 497-4430␈↓ 
¬March 31, 1983 





␈↓ ↓H␈↓To the editor of the Stanford Daily:

␈↓ ↓H␈↓        Kathy␈αOlmsted's␈αFebruary␈α17␈αarticle␈αabout␈αProfessors␈αBarton␈αBernstein␈αand␈α
Diana␈αDutton
␈↓ ↓H␈↓"questioning"␈α∃"arti≡cial␈α∃heart␈α∃prospects"␈α∃illustrates␈α∃harmful␈α∃aspects␈α∃of␈α∃public␈α∃policy␈α∃studies,
␈↓ ↓H␈↓technology assessment and statism.

␈↓ ↓H␈↓        The␈α
article␈αcites␈α
Bernstein␈αas␈α
saying␈αthat␈α
Americans␈αshould␈α
"beware␈αof␈α
indulging␈α
in␈αhigh-
␈↓ ↓H␈↓tech␈α≡x␈αto␈αa␈αproblem␈αwhich␈αcan␈αbe␈αseen␈αin␈αother␈αways".␈α Bernstein␈αgoes␈αon␈αto␈αsay␈αthat␈αAmerican
␈↓ ↓H␈↓biomedical␈α
research␈α∞priorites␈α
are␈α
distorted␈α∞when␈α
the␈α
federal␈α∞government␈α
spends␈α
so␈α∞much␈α
money
␈↓ ↓H␈↓on␈α
"episodic,␈αdramatic"␈α
and␈αheroic␈α
medical␈α
innovations␈αwhile␈α
neglecting␈αthe␈α
structural␈αproblems␈α
in
␈↓ ↓H␈↓the environment that contribute to disease.

␈↓ ↓H␈↓        This␈α
foolish␈α∞article␈α
suggests␈α∞to␈α
me␈α∞the␈α
following␈α∞right␈α
wing␈α∞science␈α
≡ction␈α∞movie␈α
scenario.
␈↓ ↓H␈↓In∨uenced␈α
by␈α
the␈α
technology␈α
assessment␈αmovement,␈α
the␈α
next␈α
Democratic␈α
administration␈α
drops␈αor
␈↓ ↓H␈↓slows␈α∀arti≡cial␈α∀heart␈α∀research␈α∀and␈α∀appoints␈α∪Bernstein␈α∀head␈α∀of␈α∀FDA.␈α∀ He␈α∀gives␈α∀no␈α∪further
␈↓ ↓H␈↓permissions␈α∞for␈α
arti≡cial␈α∞heart␈α
installations,␈α∞pending␈α∞the␈α
completion␈α∞of␈α
a␈α∞ten␈α
year␈α∞study␈α∞of␈α
their
␈↓ ↓H␈↓desirability.␈α In∨uenced␈αby␈α"critics",␈αthe␈αAMA␈αrules␈αarti≡cial␈αhearts␈αunethical␈αin␈αtheir␈αpresent␈α
state
␈↓ ↓H␈↓of development.

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

␈↓ ↓H␈↓        Shortly␈αthereafter,␈αelderly␈αrich␈αpeople␈αbegin␈αtrooping␈αto␈αHong␈αKong␈αor␈αTaiwan␈αto␈αbe␈α≡tted
␈↓ ↓H␈↓with␈αarti≡cial␈αhearts.␈α When␈αthey␈α
try␈αto␈αreturn␈αto␈αthe␈αU.S.,␈α
the␈αFDA␈αhas␈αthe␈αCustoms␈αService␈α
turn
␈↓ ↓H␈↓them␈αo≥.␈α Organized␈α
crime␈α≡nds␈αsmuggling␈α
arti≡cial␈αhearts␈αmore␈α
lucrative␈αthan␈αthe␈αdrug␈α
business.
␈↓ ↓H␈↓Heart replacement clinics across the Mexican border grow up.

␈↓ ↓H␈↓        The␈α∂science␈α∂≡ction␈α∂story␈α∂is␈α∂unrealistic,␈α∞because␈α∂"critics"␈α∂like␈α∂Bernstein␈α∂will␈α∂give␈α∂in␈α∞before
␈↓ ↓H␈↓smuggling␈α∀arti≡cial␈α∀hearts␈α∀becomes␈α∀an␈α∀industry.␈α∪ They␈α∀will␈α∀at␈α∀most␈α∀succeed␈α∀in␈α∀stalling␈α∪the
␈↓ ↓H␈↓commercialization of arti≡cial hearts for a few years.

␈↓ ↓H␈↓Here are some relevant considerations:

␈↓ ↓H␈↓        1.␈α
The␈α
arti≡cial␈α∞heart␈α
will␈α
probably␈α
turn␈α∞out␈α
to␈α
be␈α
the␈α∞greatest␈α
invention␈α
of␈α∞the␈α
twentieth
␈↓ ↓H␈↓century.␈α Perhaps␈αhalf␈αthe␈α
400,000␈αpeople␈αwho␈αdie␈α
of␈αheart␈αattacks␈αeach␈α
year␈αwill␈αbe␈αable␈α
to␈αlive
␈↓ ↓H␈↓≡ve to ten years longer.
␈↓ ↓H␈↓α␈↓ ¬hMarch 31, 1983␈↓ 
nPage 2␈↓ 


␈↓ ↓H␈↓        2.␈αThe␈αdevelopment␈αscenario␈αthat␈αwould␈αsave␈αthe␈αmost␈αlives␈αwould␈αbe␈αextremely␈αdisorderly.
␈↓ ↓H␈↓It␈α⊂would␈α⊂be␈α⊂a␈α⊂furious␈α⊂e≥ort␈α⊂by␈α⊃hundreds␈α⊂of␈α⊂companies␈α⊂and␈α⊂thousands␈α⊂of␈α⊂doctors␈α⊂to␈α⊃cash␈α⊂in.
␈↓ ↓H␈↓There␈α⊃would␈α⊃be␈α⊃bungling,␈α⊃and␈α⊃there␈α⊃would␈α⊃be␈α⊃fraud,␈α⊃but␈α⊃the␈α⊃winners␈α⊃would␈α⊃be␈α⊂determined
␈↓ ↓H␈↓quickly,␈α↔and␈α⊗standards␈α↔would␈α↔then␈α⊗be␈α↔raised.␈α↔ The␈α⊗present␈α↔policy␈α↔optimizes␈α⊗bureaucratic
␈↓ ↓H␈↓convenience and orderliness and minimizes lawsuits at a high cost in lives.

␈↓ ↓H␈↓        3.␈α∂The␈α∂FDA's␈α∂authority␈α∂to␈α∂regulate␈α⊂medical␈α∂products␈α∂was␈α∂established␈α∂for␈α∂the␈α⊂purpose␈α∂of
␈↓ ↓H␈↓preventing␈α
fraud␈α
and␈αincompetence.␈α
 It␈α
is␈αnatural␈α
for␈α
"the␈α
public␈αpolicy␈α
community"␈α
and␈αour␈α
other
␈↓ ↓H␈↓would-be␈α⊃masters␈α⊃to␈α⊃suppose␈α⊃that␈α⊃this␈α⊃gives␈α⊃the␈α⊃authority␈α⊃to␈α⊃regulate␈α⊃on␈α⊃the␈α⊃basis␈α⊃of␈α⊂"social
␈↓ ↓H␈↓desirability".

␈↓ ↓H␈↓        4.␈αThe␈α$10,000,000␈αspent␈αby␈αNIH␈αover␈αten␈αyears␈αat␈αUtah␈αon␈αarti≡cial␈αheart␈αresearch␈αis␈α
small
␈↓ ↓H␈↓by␈α⊂Federal␈α⊂standards,␈α⊂contrary␈α⊂to␈α⊂what␈α⊂is␈α⊂implied␈α⊂by␈α⊂Bernstein␈α⊂and␈α⊂Dutton.␈α⊂ I␈α⊂hope␈α⊂that␈α∂the
␈↓ ↓H␈↓Reagan␈α
Administration␈αwill␈α
increase␈αit,␈α
and␈α
it␈αwould␈α
be␈αespecially␈α
appropriate␈α
if␈αthis␈α
were␈αdone␈α
at
␈↓ ↓H␈↓the␈α∞cost␈α∞of␈α∞the␈α∞"program␈α
on␈α∞medical␈α∞innovations␈α∞and␈α∞public␈α
policy␈α∞at␈α∞the␈α∞Medical␈α∞School"␈α
that
␈↓ ↓H␈↓supports Bernstein's project.

␈↓ ↓H␈↓        5.␈α∂An␈α∂arti≡cial␈α∂heart␈α∂like␈α∂that␈α∂implanted␈α∂in␈α∂Barney␈α∂Clark␈α∂is␈α∂good␈α∂enough␈α∂-␈α⊂assuming␈α∂it
␈↓ ↓H␈↓continues␈α
to␈α
function␈α
-␈α∞for␈α
millions␈α
of␈α
people␈α∞to␈α
prefer␈α
it␈α
to␈α∞death.␈α
 Clark,␈α
if␈α
his␈α∞unrelated␈α
lung
␈↓ ↓H␈↓and␈αkidney␈αproblems␈αimprove,␈αwill␈αbe␈αbetter␈αo≥␈αthan␈αa␈αparaplegic,␈αand␈αvery␈αmuch␈αbetter␈αo≥␈αthan
␈↓ ↓H␈↓a␈α
quadraplegic,␈α
and␈α
we␈α
know␈α
that␈α
these␈αpeople␈α
prefer␈α
to␈α
live.␈α
 Naturally,␈α
arti≡cial␈α
hearts␈αwith␈α
fully
␈↓ ↓H␈↓implantable power sources will be better, and Clark will want a retro≡t should he live so long.

␈↓ ↓H␈↓        6.␈αWith␈αalmost␈αnegligible␈αexceptions,␈αan␈αadult␈αis␈αthe␈αbest␈αjudge␈αof␈αhis␈αown␈αinterests.␈α I␈α≡nd
␈↓ ↓H␈↓Bernstein's,␈αDutton's␈αand␈αthe␈αOlmsted's␈α
apparent␈αassumption␈αthat␈αthe␈αFederal␈αGovernment␈α
should
␈↓ ↓H␈↓decide␈αwhether␈αI␈αam␈αbetter␈αo≥␈αdead␈α
than␈αliving␈αwith␈αan␈αarti≡cial␈αheart␈αpresumptuous,␈α
frightening
␈↓ ↓H␈↓and o≥ensive.

␈↓ ↓H␈↓        7.␈α
Part␈α∞of␈α
my␈α
science␈α∞≡ction␈α
scenario␈α
seems␈α∞realistic␈α
to␈α
me,␈α∞even␈α
though␈α
optimistic.␈α∞ If␈α
the
␈↓ ↓H␈↓Federal␈α⊂Government␈α⊃lags␈α⊂enough␈α⊃in␈α⊂the␈α⊃further␈α⊂development␈α⊃of␈α⊂arti≡cial␈α⊃hearts,␈α⊂they␈α⊃will␈α⊂be
␈↓ ↓H␈↓developed␈αby␈αprivate␈αindustry␈α-␈αif␈αnot␈αin␈αthe␈αU.␈αS.,␈αthen␈αabroad.␈α Fortunately,␈αthe␈αgenie␈αcannot␈αbe
␈↓ ↓H␈↓put back in the bottle.

␈↓ ↓H␈↓        8.␈α∞If␈α
the␈α∞Government␈α
doesn't␈α∞fund␈α
the␈α∞installation␈α
of␈α∞arti≡cial␈α
hearts,␈α∞then␈α
those␈α∞who␈α
can
␈↓ ↓H␈↓a≥ord them will ≡nd a way to get them.  This will cause social strain, but that's tough.

␈↓ ↓H␈↓        9.␈αMany␈αpeople␈αhave␈α
died␈αand␈αwill␈αdie␈α
in␈αthe␈αnext␈αfew␈α
years␈αwhose␈αlives␈αcould␈α
have␈αbeen
␈↓ ↓H␈↓substantially prolonged by a more vigorous program of developing arti≡cial hearts.

␈↓ ↓H␈↓        10.␈α⊂As␈α⊂is␈α⊂typical␈α⊂of␈α⊂public␈α⊃policy␈α⊂articles,␈α⊂the␈α⊂language␈α⊂is␈α⊂ambiguous.␈α⊂ We␈α⊃have␈α⊂"critics
␈↓ ↓H␈↓question",␈α"Americans␈α
should␈αbeware",␈α"wonder␈α
if␈αthe␈αinitial␈α
euphoria␈αis␈αwarranted".␈α
 What␈αdoes
␈↓ ↓H␈↓this␈α∞stu≥␈α
mean?␈α∞ Does␈α
"question"␈α∞mean␈α
"oppose",␈α∞as␈α
it␈α∞often␈α
seems␈α∞to?␈α
 Does␈α∞"Americans␈α
should
␈↓ ↓H␈↓beware"␈α∂mean␈α∂that␈α∞regulators␈α∂should␈α∂stall?␈α∞ Does␈α∂"wonder␈α∂if␈α∞the␈α∂initial␈α∂euphoria␈α∂is␈α∞warranted"
␈↓ ↓H␈↓mean␈αto␈αassert␈αthat␈αarti≡cial␈αhearts␈αare␈αa␈αbad␈αidea.␈α The␈αlanguage␈αseems␈α␈↓↓not␈αentirely␈αundishonest␈↓␈α-
␈↓ ↓H␈↓to coin a euphemism.

␈↓ ↓H␈↓        11.␈α
The␈α∞main␈α
long␈α∞term␈α
e≥ect␈α
of␈α∞studies␈α
like␈α∞that␈α
of␈α
Bernstein␈α∞and␈α
Dutton␈α∞will␈α
be␈α∞to␈α
kill
␈↓ ↓H␈↓more␈α
people.␈α
 Suppose␈αthey␈α
succeed␈α
in␈αdelaying␈α
by␈α
three␈αyears␈α
the␈α
commercialization␈α
of␈αarti≡cial
␈↓ ↓H␈↓hearts,␈αand␈αsuppose␈α
that␈αhalf␈αof␈α
the␈α400,000␈αpeople␈α
who␈αdie␈αeach␈α
year␈αof␈αheart␈α
disease␈αin␈αthe␈α
U.S.
␈↓ ↓H␈↓can have their lives prolonged for ≡ve years by arti≡cial hearts.  That's only 600,000 lives.

␈↓ ↓H␈↓        Perhaps␈α∞I␈α∞have␈α∞misunderstood␈α
the␈α∞purpose␈α∞of␈α∞their␈α
study␈α∞and␈α∞its␈α∞intended␈α∞application␈α
to
␈↓ ↓H␈↓α␈↓ ¬hMarch 31, 1983␈↓ 
nPage 3␈↓ 

␈↓ ↓H␈↓arti≡cial␈α⊃hearts.␈α⊃ My␈α⊃question␈α⊃for␈α⊂them␈α⊃is␈α⊃this.␈α⊃ Do␈α⊃they␈α⊂propose␈α⊃to␈α⊃delay␈α⊃the␈α⊃availability␈α⊂of
␈↓ ↓H␈↓arti≡cial␈αhearts␈αto␈αthe␈α
American␈αpublic␈αbeyond␈αwhat␈αis␈α
required␈αto␈αmake␈αavailable␈αsomething␈α
that
␈↓ ↓H␈↓people with heart disease will prefer to dying?


␈↓ ↓H␈↓Sincerely,



␈↓ ↓H␈↓John McCarthy
␈↓ ↓H␈↓Professor of Computer Science

␈↓ ↓H␈↓Please send copies of daily.11 to the following: