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“Ticker” by Mimi Swartz: A Medgadget Book Review and Interview with the Author

Of all the organs in the human body, the heart is arguably the most important, well-known, and worried about. Not only is the heart the vital electro-mechanical pump that moves about 2,000 gallons of our blood every day, but for centuries it’s been symbolic of the seat of emotion, reason, and life itself for many religions, cultures, and philosophies.

Yet, despite our long familiarity with the heart, there is still so much we don’t know about it. The various ailments that plague the heart are still some of our most common chronic diseases, and a fully-functional, artificial replacement is considered to be a holy grail of medical technology.

Mimi Swartz, a reporter at Texas Monthly, has chronicled the long (and still ongoing) history of the artificial heart in her upcoming book, Ticker. It’s a fascinating account that Swartz has skillfully written in an engaging style that keeps readers eager to learn more. Drama, suspense, and characters with egos bigger than their heads – it’s all there to show that the artificial heart is no ordinary medical device.

For example, it was interesting to read that, especially back in the 70’s when development first started, medical research was far different than it is now. Swartz recounts numerous experiments and tests that would probably get researchers in trouble with both the FDA and PETA today. It was a “wild west” in many ways, but it almost always seemed to result in improved technology.

Other parts of Ticker that we found particularly entertaining were the roles that seemingly random people played in the development of the artificial heart. Swartz recounts the story of how cardiologist Bud Frazier came up with improvements for a pump after witnessing a drunk winning bar bets holding his breath underwater longer than anyone – the drunk happened to be a TB patient who would secretly open a tube connected to his chest that would allow him to breathe as he kept his head in a bucket of water. Swartz’s research included Medgadget post we wrote back in 2005, which she credits in the book, about the concept of an artificial heart developed by Paul Winchell (the voice of Tigger), Dr. Henry Heimlich (who invented the famous maneuver for choking victims), and indirectly, Ricardo Montalban (Star Trek‘s Khan, Fantasy Island‘s Mr. Rourke). She also shares of the role that Houston’s furniture king, “Mattress Mack,” played in keeping the artificial heart project from going broke.

If there is any small part of Ticker to criticize, it might be that there are so many characters in the story; we often had trouble remembering who was who. But it goes to show that the development of the artificial heart was not the work on a single person; it was a group effort, and at times, a fierce competition among rival doctors, and each character played an important role in its development.

Finally, it’s notable to consider that the story of Ticker is not finished. Companies mentioned in the book, such as Abiomed and Thoratec (now owned by Abbott), are still actively developing artificial hearts and LVAD’s (left ventricular assist devices). The book ends at present-day, where researchers are still searching for viable means of keeping artificial hearts powered, and heart transplant lists are growing longer than ever. It is, hence, a story that Medgadget looks forward to continuing to tell.

With our new understanding and appreciation for the artificial heart’s colorful history, we wanted to learn more about how Ticker came about. Mimi was kind enough to share with us a little more about what she learned in the process of writing the book.

 

Scott Jung, Medgadget: Tell us a little bit about your background.
Mimi Swartz: I’ve grown up in Texas and worked mostly for Texas Monthly magazine as a general assignment reporter, but because I live in Houston, innovation has become a particular interest of mine. It’s an extremely entrepreneurial city, with an always fascinating cast of characters. My husband likes to say that you can’t walk out your front door in Houston without stumbling over a great idea, or a great story. Ticker had everything–an amazing quest that was definitely informed by the Texas culture, and colorful characters who had experienced the same.
Medgadget: How did you end up deciding to write about the history of the artificial heart?
Swartz: I had been looking for another book to write after finishing one on Enron way back in 2003. Nothing seemed right. Then, six or so years ago I was interviewing an artist new to Houston by the name of Dario Robleto, who was fascinated with the history of heart surgery in Houston. I had long been interested in the work of Dr. O.H. Frazier, but it was only in talking with Dario that I realized that the quest to build the artificial heart had been going on for half a century. That sounded like a very good book to me. Always, always good to talk to someone who sees a place with fresh eyes.
Medgadget: In conducting your research for the book, what was the most fascinating thing you learned?
Swartz: My main question was, if we could send a man to the moon, why was it so hard to build a workable artificial heart? In looking for the answer to that question, I came to have enormous respect and admiration for nature itself — for the only organ we can’t live without. The heart’s complexity and resiliency continue to inspire awe in me, as does its profound elusiveness. Enormous progress has been made in creating the artificial heart, but the real one still remains a mystery.
Medgadget: From reading the book, I got a sense that medical research was a lot like the wild west; we’re much more regulated now than we were back in the 1970’s. How do you think this has affected medical research?
Swartz: I think overall it’s been good for medical research, but many inventors will tell you that the rules are too cumbersome and that the regulators don’t really understand what they are regulating. There have been times when the regulations were too tight, I would say, and hampered progress — that’s why so many medical researchers did their early experiments in other countries. But I think we have hit a pretty good balance now, though looking forward I worry that the pendulum could swing toward fewer regulations again, which will result in the kinds of problems we had with the IUD, for instance. From my research on innovation, the pendulum seems to be always swinging and then self correcting, but in that process good inventions have been lost, and bad inventions at other times have been allowed to slip through.
Medgadget: In “Ticker” you write about how the development of the artificial heart involved both doctors and engineers and shared some observations about how they differ from each other. Can you share some of those observations, and why both are necessary to spur medical technology innovation?
Swartz: Now there is so much technological complexity and so much medical complexity that no one person can know everything necessary to really advance the field. Engineers tend to be more cautious and methodical — perfectionists — while doctors tend to be more anxious to try something and refine it over the ensuing years — they want to start saving lives as quickly as possible. Engineers — and even bioengineers — may not understand the body as well as physicians do, and most physicians do not have the technical knowledge to build a machine that would work in the body. Doctors and engineers really need each other at this point in time.
Medgadget: Looking into your crystal ball, what medical innovation being developed right now do you think might make for a thrilling book 30 years from now? Are there any physicians or engineers that you would consider a modern-day Cooley/Frazier/DeBakey/Jarvik?
Swartz: Well, I would love to revise Ticker when people are walking around with artificial hearts and it’s no big deal, but there is also stem cell research. There is a doctor at the Texas Heart Institute named Doris Taylor who is trying to grow new hearts from stem cells, which would be pretty astounding. And then, of course, if there is a cure for cancer…But another thing that interests me is that in the fifties and sixties doctors were the celebrities of their day — they were household names, as were many inventors before them. Now celebrities are the celebrities of their day. Maybe a shift in our values would cause an increase in innovation?
 
Ticker will be released on August 7 in bookstores everywhere and is available now for preorder



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