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From: B. Harris)
Subject: Re: Wright bullshit
Date: 28 Jan 1998 20:55:54 GMT

In <6antpb$aqn@clam.Hi.COM> wright@nospam.clam (David Wright) writes:

>Of course, you can't really "pull" a surgical procedure off the market
>as long as someone (a) knows how to do it and (b) decides to do it.
>However, as better or safer procedures come along, they displace what
>came before.  Which isn't any different from other fields of human
>endeavor; you'll notice the dearth of horse-and-buggy traffic on most
>US roads these days, and the scarcity of vacuum tube-based computers.

   Boy, I'll bet there aren't any vacuum based computers working
anymore (upkeep is too nasty), but I still see horses and buggies all
the time, selling pleasure rides.  And in other parts of the country
there are Amish, also.

   You yourself pointed out that internal mammary ligation for cardiac
angina is no longer done.  And there used to be a surgical procedure
called "poudrage" wherein the pericardium was opened and a power of
(get this) asbestos fibers was sprinkled onto the naked surface of
the heart, in the hope that the irritation could cause
neovascularization of the myocardium.  Needless to say, this one was
pulled from the market with a vengeance.

   There are many examples, but none will be known to people who
haven't studied medical history (not a big subject, even in medical
schools-- no room for it).  One of my medical heros is a guy named John
Lillihei.  In the days before there was such a thing as a heart lung
machine, Lillihei discovered that a large man could have his femorals
canulated and his systemic ciculation used to completely support the
heart-lung circulation of a smaller person (a baby or child) of
compatible blood type.  Rather like what happens with a mother and
unborn baby, except here the circulatory connection was direct.
Lillihei solicited some really gutsy volunteers in the 1950's, and used
them to save the lives a great number of children with congenital
cardiac defects who could not be opperated except with stopped hearts
and total cardiac bypass (which at that time didn't, of course, exist).
It worked!  Or it did until an OR error "pumped air" by allowing one of
the canula to leak air into the volunteer's circulation, killing him
(this happens, of course, occasionally even with bypass machines-- but
it kills only the patient).  At that point the proceedure was dumped as
being unnecessarily risky to the volunteers, and within a few years the
heart-lung machine made it unnecessary anyway.  But the children saved,
were saved.

                                     Steve Harris, M.D.

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