Conversations with Laureates
Michael DeBakey talks with Richard M. Cohen, former CBS News Senior Producer, and Mahlon Hoagland about his life in medicine.
Cohen: You developed an interest in the human heart pretty early, didn't you?
DeBakey: I became interested through my work as a medical student technician in the research laboratory and I was working for some faculty members who were interested in circulation. That got me interested in circulation, and that is how I developed the roller pump because one of the faculty I was working for wanted a pump. So they asked me to find a pump.
Cohen: You were a senior in medical school. Tell us what the roller pump was.
DeBakey: He was interested in the pulse wave, and he wanted a pump so he could study the pulse wave. He asked me to get a pump. Of course I didn't know anything about pumps, but the first thing I did was go to the library to see if I could learn something about a pump. I went to the medical library, and to my astonishment there was very little in the medical library about pumps. One night I was with my old classmate, who was going into engineering. We were classmates in the arts and sciences college. I told him about my experience, and he said, "Well, you went to the wrong library." He said you should go to the engineering library. I did, and I found out a lot about pumps at the engineering library. You know, as far back as 23 years ago, Archimedes had devised a pump for irrigation purposes. So I learned a great deal about pumps, and that acknowledgment led me to develop the roller pump.
Cohen: Was that in a funny way a precursor to what people refer to today as "high-tech medicine"?
DeBakey: In a way, yes, because all of high-tech medicine is based on research. And it's research that gives you new knowledge. Research may not get you new knowledge, but the one thing you can be sure of: without research, you can be sure you are not going to get new knowledge.
Cohen: When did you learn about research?
DeBakey: When I was a medical student working in research laboratories. And that got me very interested in research.
Cohen: Did you do basic research?
DeBakey: I wouldn't say in light of what we call basic research, it was basic research—but you know, any research that is designed to give you new knowledge is basic. We artificially designate certain types of research that are clinical and certain types that are basic. Somebody said a basic research concern was developing new knowledge that may or may not be of any value, whereas clinical research was based upon new knowledge that will be of value. But a lot of clinical research is based on basic research. So all research I think is fundamentally fruitful—sometimes not immediately. I am sure that when Marconi first started with electricity, he didn't have any idea it was going to be what it is. The same is true with other types of electronics. When they first started working on ultrasound, they had no idea it would go where it is today.
Cohen: But as you started your career and became a cardiologist, did you purposely maintain a level of research as well as clinical involvement?
DeBakey: Well yes, my research and interest in circulation led me to look at diseases of circulation, you see, and as my clinical experience revealed these diseases to me, I began to address the diseases from a standpoint of research that might provide a means of solving the problem. For example, when I learned about occlusive disease—where an artery is blocked and no circulation goes beyond it—then I became interested in addressing the question, how do you get circulation beyond it.
Cohen: Going to the 1940s, you were involved the in the second World War. Tell us about your involvement and the creation of MASH Unit.
DeBakey: During World War II, we found ourselves with an acute shortage of well-trained surgical personnel. Now you have to look at the background of that: prior to 1942, there had been small developments in finding ways and means of training surgeons more efficiently. But there weren't many institutions doing it. So there were only a small proportion of institutions across the country engaged in the clinical training of surgeons.
Now when World War II broke out, one of the methods that was used to get good personnel into the service was to take these named units for universities—medical schools—and ask them to take over certain functions. They became general hospitals. Now the general hospitals in any field of operation are always at the base and not at the front. So here we were with the best surgeons at the base and not at the front. And the field hospital, which is our foremost hospital in terms of being at the front, had very, very few well-trained surgeons.
We soon became to realize that the sooner you could treat the wounded, the better chance they had. So I came up with the concept that we would mobilize some of these surgeons in the bag—who at the time were doing relatively little because they had very few casualties—create a team of surgeon and assistant surgeon, anesthesiologist, operating room nurse, and technician as a unit. When we needed them at the front, when we got casualties in the field hospital, we would just move them over there. So they became mobile, what we then called mobile auxiliary units. That proved to be highly successful, and they became very popular. At that time, in World War II, we had established the concept. This was a good concept. When the Korean War started, instead of having a general hospital and a field hospital and so on, they just made a hospital mobile and moved it with the units in it. Then instead of calling it the auxiliary surgical unit, they called it the mobile auxiliary surgical hospital, or MASH.
Cohen: Is there any way to know how many lives were saved?
DeBakey: There have been estimates made, but it is very difficult to say. There is no question we saved a lot of lives by having someone there who were good thoracic surgeons as well as abdominal surgeons. And operating on them early.
Cohen: Now on another front, when did you learn about the importance of the policy wars that are fought in Washington—about the work of Mary Lasker, about the lobbying efforts to increase the involvement in research funding?
DeBakey: When I became, you might say, politically active to promote an idea with the National Library of Medicine. During World War II, what was called the Surgeon's General Library was probably the biggest and best medical library in the country. It was housed in an old building in Washington, where when it rained they had to put tarpons over the stacks of books because the roof of this old building leaked when it rained. They actually had an outhouse. But I used to work over there a great deal because I had to do the writing for the Surgeon General for almost all surgical policies.
I was not a military surgeon, so I had to learn, and I would go to the library and learn. I became enamored with this huge treasure, one of the greatest medical libraries in the whole world housed in this terrible building. So I started a movement to do something about that. One day, the Surgeon General told me that they had been trying to get a new building for 30 years, but every time they put it in, it simply could not compete with tanks. That is what triggered in my mind involving more in the library than military. This was a national treasure and should be taken out of the military.
I started a movement at that time. Well, I was not very popular. But I had the good fortune to work for the Hoover Commission after the War, and I wrote the Medical Task Force with Hoover. In fact, I worked full time in Washington for about nine months on that. And in that I put in the need for that library. So when I was asked to brief Mr. Hoover on the report, I went to New York. He was sitting at the Waldorf Astoria, and he very kindly asked me to have lunch with him and brief him on the Medical Task Force. I did, and there were about I suppose nearly 25 recommendations. He turned around to the Chairman of the Task Force, and he said, "Do you know how many Task Forces I have got?" And she said. "No sir." He said, "Well, I have over 50 Task Forces, and if everyone of them came in here with 25 or 30 recommendations, who the hell do you think would read this report?" And he said I want the single most important recommendation you have got in here.
Before he could say anything, I blurted out, "The library." Turned out that is what he put in the report. So it stuck out. And John Kennedy was in the house and Lester Hill, who was in the Senate, picked it up, and I worked with their staffs.
Cohen: You must have developed a very keen sense of how powers worked in Washington.
DeBakey: I began to realize it and appreciate it, yes, certainly.
Cohen: Now where did you meet Mary Lasker, the wonderful lady for whom this Foundation is named?
DeBakey: I met Mary shortly after that. Mary called on me because she knew I was interested in these activities, and I became in a sense one of her coworkers. Whenever she needed help in going to Congress, she would call on me and say, "I want you to come with me." So we would walk the halls of Congress lobbying.
Cohen: What kinds of issues would you lobby for?
DeBakey: For example, when she wanted to increase the funding for medical research in any area, whether cancer or heart disease or so on, she would meet with these key Senators and show them the large number of people dying of heart disease and cancer, and say the only way we are going to stop this or reduce it is to get more new knowledge. And that has only come by research.
Cohen: But you people had extraordinary entree to the oval office and to....
DeBakey: Yes, I would say Mary had the primary ability to open the doors because Mary reached a stage with these key congressman where she was kind of beloved. She was highly respected, she was trusted, and they began to like to talk to her because they were getting knowledge from her. They began to realize that she was a lobbyist in a very, very I would say restricted sense, but an admirable sense because she would lobby for the people. I thought so. She was lobbying for a good cause, you see. They began to appreciate it. So the doors were always opened to her.
Cohen: This went from essentially Truman through Carter.
DeBakey: Yes.
Cohen: And do you think people understand that their health and their lives are better because this group existed?
DeBakey: I am not sure they understand it fully at all, especially the new generations.
Cohen: How would you define it?
DeBakey: I think she had as a single individual the greatest impact on the development in health in this country than anybody else, than any adoption. Because what she did was to provide the means and the opportunity for doctors to work in research in developing new knowledge and she supported that very, very strongly. She in a sense made it possible. You have to remember that many of the institutes at the NIH were largely dependent because of her. She initiated, she nurtured them, she got all the political muscle to finally get the bills passed; she very often nurtured the bill going from one place to the other to get the support on an individual basis. She had an uncanny [knack], and I am not sure whether it was instinctive, intuitive, or in a sense intellectually made to find the right people to touch at the right time, to persuade them to support the thing and to lead the way.
Cohen: How do you assess her role in the organization which included you in the extraordinary growth of the NIH over the last half century?
DeBakey: Oh, I think she had more influence on the expansion and development of the National Institutes of Health than anyone else. Absolutely. She recognized the mechanism of the NIH. And while she was sometimes critical of it because she thought it was too slow to adopt practices and procedures she felt were needed as rapidly as they should be, she still appreciated the mechanism, and that no other country in the world has it.
Cohen: We are moving into a new era of medicine that is very high-tech, that is very expensive. Do you see this as a good thing or as mixed blessing?
DeBakey: It is a mixed blessing in the sense that there isn't enough money available to give high-tech medical care to everybody. I mean if you take...for example, if it costs, let's say, 100,000 to 150,000 dollars to take care of some high-tech work and you have got a million people that need it, it is very questionable whether we have the total facility to do that. So what do you do? Do you ration, and if you ration what are the criteria of rationing?
Cohen: Isn't there a danger that we are going to create a class system of patients with this expensive technology?
DeBakey: You're going to definitely create classes. That is already being done in Europe. They have already accepted rationing. I was visiting the President of one the big medical clinics in London four to five years ago, and we went down to see a patient in a clinic. I was with a doctor, and this was a patient with typical Ayerza's syndrome. Ayerza's syndrome is basically a blockage of the arteries going to the legs. This fellow was having difficulty walking, and the doctor said, "Why do you have to walk, what do you do?" Well he said, "I am a retired postman." So he said, "Why do you have to walk?" Well he said, "I like to go to the pub and I like to putter in the garden." And he said, "Well, I am going to give you some medicine." So when he left, I said to the doctor, "Why didn't you tell him you could do the operation that would restore circulation to the leg?" He said, "I didn't have the heart to tell him that I have to put him on a four-year waiting list." So the doctors now are part of this process.
Cohen: But that means that doctors are going to pick winners and losers, survivors and people who don't make it.
DeBakey: They have accepted it, both the doctors and the people have accepted it. In this country, rationing is not accepted yet. People want it done, and they will demand that it be done. I must say, I sympathize with them, too.
Cohen: Aren't the lines though between science and technology blurring more and more?
DeBakey: When I first went to Houston nearly 50 years ago, shortly after arrival we had a very heavy polio epidemic. They had to build barrack-like buildings to house a large number of patients who came in there with bulbar polio. These youngsters were paralyzed from the leg down. Once they discovered the virus and the vaccine, it was gone. That is the way you develop efficient medicine. The biggest problem we have with heart disease is arteriosclerosis. We don't know what causes this. We talk about cholesterol and smoking and hypertension, but those are risk factors. Thirty percent of the patients I operate on with severe atherosclerotic disease have no risk factors at all.
Cohen: Don't heart transplants qualify as that very expensive, very limited high-tech alternative?
DeBakey: Yes, they average, I would say, 200,000 to 250,000 dollars a year.
Cohen: So that is not necessarily an answer?
DeBakey: No.
Cohen: What is?
DeBakey: Well the answer is to find a way to prevent it. And I think like any other disease, there is bound to be a way to prevent it. We just haven't found it. That is why research is so important. And if always we continue to support research in this country and other countries, we will find it.
Cohen: What do you think is going to be the next frontier? Is it going to be the heart? The artificial heart?
DeBakey: The artificial heart is still not fully developed for clinical use on a permanent basis. The one thing that I think is very exciting in this regard is a left ventricular assist device, and that is something that I first became interested in many years ago. In fact, I did the first successful application of a left ventricular assist device in 1966, 34 years ago, and more recently we have developed a new pump that is called MicroMed VAD. It is only about 3 inches long by an inch in diameter. A little larger than a AA battery, which we can implant in a patient. We have done 32 patients in Europe in the last year and a half with highly gratifying results, and we have done two in this country so far. We just got FDA approval.
Cohen: But do you see that as having the potential for widespread affordable use?
DeBakey: Oh yes, I think so. Sure. It is going to be affordable. Right now we are using it as a bridge to transplant, when the patient is scheduled for heart transplant but is so sick they might not live long enough to get a donor. In Europe, the average time that they were on the pump before they got a donor was nearly 4 months. And they were in much better shape, too.
Cohen: But ultimately are you saying that you think preventing heart disease is going to be the only answer?
DeBakey: Well, ultimately we would hope to use this pump in patients with heart failure who won't get a heart transplant. There are only 2,300 heart transplants a year; over 50,000 patients are waiting for transplants.
Cohen: Did you ever think you were going to see as much progress in your lifetime as you have seen?
DeBakey: No. Wish I could say I saw it, but I didn't. Nobody saw it. No way. It has developed very rapidly, and I think as long as we are in the midst of so much research, it will be more evident.
Cohen: What form is that research going to take?
DeBakey: Research is really in two basic areas. One is to understand the fundamental mechanism of the process that leads to the pathology of the disease. The other is in the development of means by which we can interrupt that process and prevent it from taking place. And that, I think, will be the most important thing from a clinical standpoint.
Cohen: So in conclusion, are you happy and proud of how you have spent your life's work?
DeBakey: I am gratified. I am not happy with some of the things that I don't think have been done yet. We need to concentrate on getting those things done.
Cohen: What things?
DeBakey: Well I want to finish up with the pump. I would like to get the pump done to the point where it would be commercially available so anybody can use it. I would like to find ways of preventing arteriosclerosis like we did with poliomyelitis. We have a ways to go.
Cohen: Thank you.