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According to a 1982 study published by the U.S. Office of Technology Assessment, as many as 66,000 Americans a year might qualify for an artificial heart, should it be approved for general use. Clearly, very few individuals could afford the device. The U.S. Government now spends $1.8 billion a year on Medicare assistance for the 60,000 Americans who require kidney dialysis. If Medicare were to be extended to artificial-heart patients, that could mean an added burden to tax payers of as much as $5.5 billion annually. Dr. Willard Gaylin, president of the Hastings Center, an institute just north of New York City for the study of biomedical ethics, points out that such patients might be a drain on the nation's health-care system throughout their lives. Says Gaylin: "We Americans like to think of ourselves as having an open-ended attitude toward health care, the more the better, but we've come to the point where we're running out of resources."
A better course would be to develop ways of preventing such chronic ailments as cardiomyopathy and coronary artery disease. "If such work is not done," wrote Dr. Lewis Thomas, chancellor of the Memorial Sloan-Kettering Cancer Center, "we will be stuck forever with this insupportably expensive, ethically puzzling halfway technology." But preventing heart disease, as Thomas readily admits, is a long way off. Says Dr. William Friedewald, associate director of the Na tional Heart, Lung and Blood Institute: "Of course, our goal is prevention, to have no Barney Clarks in the future, but right now that's pipe-dreaming."
Though the Utah team is looking for a second artificial-heart candidate, it plans to proceed slowly. "The artificial heart today is at the stage that the transplants were when those operations began 16 years ago," says Stanford Cardiologist Philip Oyer. "Then no one knew how a patient would do, and there was a lot of skepticism." An encouraging note is that the world's first mechanical-heart recipient survived nearly six times as long as the first heart-transplant patient, who lilived only 19 days. And Clark, for all his suffering, said he would not hesitate to recommend the procedure to others "if the alternative is that they will die." Said the gallant pioneer: "It is worth it." — By Claudia Wallis. Reported by Cheryl Crooks/Salt Lake City and Joseph J. Kane/Los Angeles