Practice What You Preach

RECENT INNOVATIONS in the field of medicine have shaken up the medical hierachy in an unprecedented fashion. Little-known hospitals and doctors have managed to perform two of the most controversial and difficult operations without publishing their techniques for medical scruitiny and with a seemingly total disregard for the future of public health.

These doctors must be stopped, and Ivy League doctors know it. But it is markedly hypocritical to condemn the use of expensive state-of-the-art technology while Harvard and other schools don't follow their own dictums.

In what some doctors might call the "good old days," almost all medical breakthroughs emanated from the major university teaching hospitals, especially Harvard, Columbia and Johns Hopkins. But as suddenly as heart transplant recipients Barney Clark, William Schroeder and Baby Fae made nationwide headlines, the traditional medical colleges were shoved out of the limelight. And they are fighting back. Calling doctors at the Loma Linda Hospital--where Baby Fae became the first person to survive for any length of time with an animal heart--"unethical, impractical and immoral," Harvard doctors have broken the usually silent ranks of the medical profession lest the public become overly enthralled in the aberration. Likewise, the Humana Hospital has been charged with a gross neglect of established health policy by venturing into the artificial health field with an eye for publicity and profit.

DEAN OF the School of Public Health Harvey V. Fineberg '67 has publicly voiced his displeasure with the recent artificial heart transplant in Louisville, Ky. Fineberg called the operation a waste of money and criticized the hospital for not maintaining a broader perspective on public health. And numerous doctors at the Harvard-affiliated Brigham and Women's and Childrens Hospitals have similarly called the Baby Fae operation premature, unresearched and a waste of valuable resources.

They're right. Both operations ran up tabs of well over $100,000--money which could have been used to save 20 times as many fatally diseased patients with considerably more success. In addition, the traditional checks and balances in the medical profession--which do not include government interference--would usually weed out such hopeless operations as the one performed on Baby Fae. But the Loma Linda Hospital published no information, and consequently violated the code of ethics which keeps American medicine so respectable.

Harvard doctors, partially as a consequence of the attention focused on less respectable institutions, have argued that health care should primarily center on operations which promise the most success for the least amount of money. For example, doctors should perhaps invest their energy into programs which discourage smoking--the single biggest cause of death in this country. Hypertension and high blood pressure are other major causes of disease which, if effectively dealt with, could save millions of lives in the future.

But if Harvard and other prominent schools are to continue to lead the way in health care, they must cut their own expensive heart and liver transplant programs. Professor of Political Economy Marc S. Roberts recently estimated that heart transplants in Harvard-affiliated Boston hospitals will cost as much as $200,000 apiece while liver transplants may run upwards of $300,000. Certainly the venerable doctors at Harvard could put such enormous sums to better use, and set an example for the rest of the country.

AT LEAST the operations at the Humana and Loma Linda Hospitals promised some widespread application in the future, compensating for their violations of the sacred medical code of ethics. The number of organs available from organ banks in this country will never match the number of needed transplants, and experimentation with artificial and animals hearts offers some relief in this area. If the medical profession decides to continue with expensive transplant procedures despite the somewhat hypocritical warnings from Harvard, certainly research devoted to finding other sources to supplement the scarce human organ supply is wanting. In effect, Harvard has harshly criticized procedures which are no worse in sum total than their own.

If Harvard is concerned with discouraging expensive procedures with relatively few real benefits, it should take its own advice and regain its national prominence by boasting the number of lives it saves using reasonable medical practices rather than by advertising advances in the esoteric transplant field. Only then will this country realize the wastefulness of expensive operations performed in profit-and publicity-seeking hospitals.