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{"id":15783,"date":"2019-02-08T11:10:03","date_gmt":"2019-02-08T16:10:03","guid":{"rendered":"http:\/\/circulatingnow.nlm.nih.gov\/?p=15783"},"modified":"2024-10-21T10:59:15","modified_gmt":"2024-10-21T14:59:15","slug":"sign-of-the-times-how-an-environment-for-innovation-helped-transform-cardiovascular-surgery","status":"publish","type":"post","link":"https:\/\/circulatingnow.nlm.nih.gov\/2019\/02\/08\/sign-of-the-times-how-an-environment-for-innovation-helped-transform-cardiovascular-surgery\/","title":{"rendered":"Sign of the Times: How An Environment for Innovation Helped Transform Cardiovascular Surgery"},"content":{"rendered":"<p><em>By Alyssa Gabay ~<\/em><\/p>\n<p>During the two decades following World War II, Dr. Arthur Voorhees and Dr. Michael E. DeBakey emerged as medical pioneers. This period featured minimal regulation by the FDA, hospital boards and medical societies. Additionally, these post-war years saw the U.S. government pour millions of dollars into medical research for the first time, reflecting a global spirit that cultivated widespread innovation and experimentation.<\/p>\n<p>Dr. Voorhees\u2019 discovery of new grafting material to repair abdominal aortic aneurysms (AAA) and Dr. DeBakey\u2019s later, <a href=\"https:\/\/circulatingnow.nlm.nih.gov\/2016\/02\/12\/a-decade-of-phenomenal-progress-in-heart-surgery\/\">more effective graft design<\/a> are credited with transforming cardiovascular surgery. Any analysis of these surgeons must certainly recognize their intellect, skill, and innovative spirit, but comparatively little attention has been paid to the ideal time-period in which they worked.<\/p>\n<p><strong>Innovative Insight<\/strong><\/p>\n<p>Dr. Voorhees first rose to prominence in 1947, when he noticed a thin film covering silk sutures on the heart of a dog in a post-mortem examination. Instead of the body rejecting the sutures as a foreign object, this film indicated endogenous arterial tissue had begun to grow around them, essentially accepting the sutures as part of the body.<\/p>\n<p>His observation sparked a paradigm shift related to the materials that could be most effective for surgical devices, with previous options including plastic and gold tubes. During his research following the suture discovery, Dr. Voorhees identified a unique fabric called Vinyon \u201cN\u201d that would become the basis for modern AAA repair. His efforts were very well timed, as the incidence of AAA spiked in the United States during the 1950s and 1960s, likely due to the prevalence of smoking cigarettes.<\/p>\n<figure id=\"attachment_15787\" aria-describedby=\"caption-attachment-15787\" style=\"width: 223px\" class=\"wp-caption alignleft\"><a href=\"https:\/\/i0.wp.com\/circulatingnow.nlm.nih.gov\/wp-content\/uploads\/2019\/02\/baylor-line1.jpg?ssl=1\"><img data-recalc-dims=\"1\" loading=\"lazy\" decoding=\"async\" data-attachment-id=\"15787\" data-permalink=\"https:\/\/circulatingnow.nlm.nih.gov\/2019\/02\/08\/sign-of-the-times-how-an-environment-for-innovation-helped-transform-cardiovascular-surgery\/baylor-line1\/\" data-orig-file=\"https:\/\/i0.wp.com\/circulatingnow.nlm.nih.gov\/wp-content\/uploads\/2019\/02\/baylor-line1.jpg?fit=890%2C1200&ssl=1\" data-orig-size=\"890,1200\" data-comments-opened=\"1\" data-image-meta=\"{"aperture":"0","credit":"","camera":"","caption":"","created_timestamp":"0","copyright":"","focal_length":"0","iso":"0","shutter_speed":"0","title":"","orientation":"1"}\" data-image-title=\"Baylor-Line1\" data-image-description=\"\" data-image-caption=\"<p>Dr. DeBakey posing with his wife\u2019s sewing machine preparing Dacron grafts. The Baylor Line, 1955.<br \/>\nPapers of Michael E. DeBakey, MSC 582, Box 3, FF 13-19<br \/>\nNational Library of Medicine<\/p>\n\" data-medium-file=\"https:\/\/i0.wp.com\/circulatingnow.nlm.nih.gov\/wp-content\/uploads\/2019\/02\/baylor-line1.jpg?fit=223%2C300&ssl=1\" data-large-file=\"https:\/\/i0.wp.com\/circulatingnow.nlm.nih.gov\/wp-content\/uploads\/2019\/02\/baylor-line1.jpg?fit=759%2C1024&ssl=1\" class=\"wp-image-15787 size-medium\" style=\"border: 1px solid #000000;\" src=\"https:\/\/i0.wp.com\/circulatingnow.nlm.nih.gov\/wp-content\/uploads\/2019\/02\/baylor-line1.jpg?resize=223%2C300&ssl=1\" alt=\"A man in a suit using a sewing machine.\" width=\"223\" height=\"300\" \/><\/a><figcaption id=\"caption-attachment-15787\" class=\"wp-caption-text\">Dr. DeBakey posing with his wife\u2019s sewing machine preparing Dacron grafts. <em>The Baylor Line<\/em>, 1955.<br \/><em><a href=\"https:\/\/findingaids.nlm.nih.gov\/repositories\/4\/resources\/931\">Papers of Michael E. DeBakey, MSC 582, Box 3, FF 13-19<\/a><\/em><br \/><em>National Library of Medicine<\/em><\/figcaption><\/figure>\n<p>Dr. Voorhees experienced some initial success with grafts constructed of Vinyon \u201cN,\u201d but the material proved to lack sufficient flexibility and availability, while also demonstrating susceptibility to fatigue. These issues would later be resolved by Dr. DeBakey when he began making grafts with a superior material called Dacron.<\/p>\n<p>His Dacron-based design still represents the surgical standard more than six decades later because of its optimal applicability to vascular grafting. Although Dr. DeBakey has historically received most of the credit for popularizing fabric-based grafts, he <a href=\"https:\/\/findingaids.nlm.nih.gov\/repositories\/4\/resources\/931\">acknowledged in a 1972 interview<\/a> that Dr. Voorhees laid the foundation for these revolutionary devices.<\/p>\n<p><strong>Ideal Environment<\/strong><\/p>\n<figure id=\"attachment_15786\" aria-describedby=\"caption-attachment-15786\" style=\"width: 235px\" class=\"wp-caption alignright\"><a href=\"https:\/\/i0.wp.com\/circulatingnow.nlm.nih.gov\/wp-content\/uploads\/2019\/02\/baylor-line.jpg?ssl=1\"><img data-recalc-dims=\"1\" loading=\"lazy\" decoding=\"async\" data-attachment-id=\"15786\" data-permalink=\"https:\/\/circulatingnow.nlm.nih.gov\/2019\/02\/08\/sign-of-the-times-how-an-environment-for-innovation-helped-transform-cardiovascular-surgery\/baylor-line\/\" data-orig-file=\"https:\/\/i0.wp.com\/circulatingnow.nlm.nih.gov\/wp-content\/uploads\/2019\/02\/baylor-line.jpg?fit=940%2C1200&ssl=1\" data-orig-size=\"940,1200\" data-comments-opened=\"1\" data-image-meta=\"{"aperture":"0","credit":"","camera":"","caption":"","created_timestamp":"0","copyright":"","focal_length":"0","iso":"0","shutter_speed":"0","title":"","orientation":"1"}\" data-image-title=\"Baylor-Line\" data-image-description=\"\" data-image-caption=\"<p>DeBakey cutting and sewing Dacron grafts. The Baylor Line, March-April, 1955<br \/>\nPapers of Michael E. DeBakey, MSC 582, Box 3, FF 13-19<br \/>\nNational Library of Medicine<\/p>\n\" data-medium-file=\"https:\/\/i0.wp.com\/circulatingnow.nlm.nih.gov\/wp-content\/uploads\/2019\/02\/baylor-line.jpg?fit=235%2C300&ssl=1\" data-large-file=\"https:\/\/i0.wp.com\/circulatingnow.nlm.nih.gov\/wp-content\/uploads\/2019\/02\/baylor-line.jpg?fit=802%2C1024&ssl=1\" class=\"wp-image-15786 size-medium\" style=\"border: 1px solid #000000;\" src=\"https:\/\/i0.wp.com\/circulatingnow.nlm.nih.gov\/wp-content\/uploads\/2019\/02\/baylor-line.jpg?resize=235%2C300&ssl=1\" alt=\"A man in a suit cuts a piece of cloth with scissors.\" width=\"235\" height=\"300\" \/><\/a><figcaption id=\"caption-attachment-15786\" class=\"wp-caption-text\">DeBakey cutting and sewing Dacron grafts. <em>The Baylor Line<\/em>, March-April, 1955<br \/><a href=\"https:\/\/findingaids.nlm.nih.gov\/repositories\/4\/resources\/931\"><em>Papers of Michael E. DeBakey, MSC 582, Box 3, FF 13-19<\/em><\/a><br \/><em>National Library of Medicine<\/em><\/figcaption><\/figure>\n<p>Both Dr. Voorhees and Dr. DeBakey benefited from an ideal environment for medical innovation. Physicians enjoyed nearly total control over testing new devices in the post-war era, due to minimal FDA regulation and strong public support for research and experimentation.<\/p>\n<p>This atmosphere enabled Dr. DeBakey and his colleagues to design their own working conditions when developing the Dacron graft. By 1955, he famously began implanting dozens of synthetic vessels constructed with his wife\u2019s sewing machine. One contemporary photo depicts Dr. DeBakey sewing a graft while not wearing gloves or using surgical scissors, and with the grafting material lying nearby on an unsterilized table. Such grafts would not meet today\u2019s FDA standards due to a lack of sufficient protection from pathogens.<\/p>\n<p>Sweeping medical innovations during World War II had led to drastically improved government and public opinion regarding medical research in the post-war period. Both audiences no longer viewed medicine as a profession of elixirs and quackery, and in fact became strongly supportive of continued discoveries. In his book, <em>The Social Transformation of American Medicine<\/em>, medical historian Paul Starr argues that World War II made medical research quickly become a high priority for the government. This greater appreciation was evidenced by the NIH budget skyrocketing from $180,000 in 1945 to $4 million in 1947.<\/p>\n<p>Cardiovascular medicine also came into high demand at mid-century in first-world countries, due to a shift in focus from infectious to chronic diseases. This happened primarily because successful treatment of infectious diseases became commonplace during World War II, thanks to penicillin and vaccines.<\/p>\n<p><strong>Personal Publicity<\/strong><\/p>\n<figure id=\"attachment_15789\" aria-describedby=\"caption-attachment-15789\" style=\"width: 273px\" class=\"wp-caption alignleft\"><a href=\"https:\/\/i0.wp.com\/circulatingnow.nlm.nih.gov\/wp-content\/uploads\/2019\/02\/honolulu-star_crop.jpg?ssl=1\"><img data-recalc-dims=\"1\" loading=\"lazy\" decoding=\"async\" data-attachment-id=\"15789\" data-permalink=\"https:\/\/circulatingnow.nlm.nih.gov\/2019\/02\/08\/sign-of-the-times-how-an-environment-for-innovation-helped-transform-cardiovascular-surgery\/honolulu-star_crop\/\" data-orig-file=\"https:\/\/i0.wp.com\/circulatingnow.nlm.nih.gov\/wp-content\/uploads\/2019\/02\/honolulu-star_crop.jpg?fit=1092%2C1200&ssl=1\" data-orig-size=\"1092,1200\" data-comments-opened=\"1\" data-image-meta=\"{"aperture":"0","credit":"","camera":"","caption":"","created_timestamp":"0","copyright":"","focal_length":"0","iso":"0","shutter_speed":"0","title":"","orientation":"1"}\" data-image-title=\"Honolulu-Star_crop\" data-image-description=\"\" data-image-caption=\"<p>Dr. and Mrs. DeBakey in a photo taken by Pan American Airways. \u201cNoted Texas Heart Surgeon Will Treat Honolulu Woman, \u201d Honolulu Star, 1956. Papers of Michael E. DeBakey, MSC 582, Box 3, FF 13-19<br \/>\nNational Library of Medicine<\/p>\n\" data-medium-file=\"https:\/\/i0.wp.com\/circulatingnow.nlm.nih.gov\/wp-content\/uploads\/2019\/02\/honolulu-star_crop.jpg?fit=273%2C300&ssl=1\" data-large-file=\"https:\/\/i0.wp.com\/circulatingnow.nlm.nih.gov\/wp-content\/uploads\/2019\/02\/honolulu-star_crop.jpg?fit=840%2C923&ssl=1\" class=\"wp-image-15789 size-medium\" src=\"https:\/\/i0.wp.com\/circulatingnow.nlm.nih.gov\/wp-content\/uploads\/2019\/02\/honolulu-star_crop.jpg?resize=273%2C300&ssl=1\" alt=\"For article, Noted Texas Heart Surgeon Will Treat Honolulu Woman witha photograph of Dr. and Mrs. DeBakey in leis.\" width=\"273\" height=\"300\" \/><\/a><figcaption id=\"caption-attachment-15789\" class=\"wp-caption-text\">Dr. and Mrs. DeBakey in a photo taken by Pan American Airways. \u201cNoted Texas Heart Surgeon Will Treat Honolulu Woman, \u201d <em>Honolulu Star<\/em>, 1956.<br \/><a href=\"https:\/\/findingaids.nlm.nih.gov\/repositories\/4\/resources\/931\"><em>Papers of Michael E. DeBakey, MSC 582, Box 3, FF 13-19<\/em><\/a><br \/><em>National Library of Medicine<\/em><\/figcaption><\/figure>\n<p>Although healthcare innovations would make headlines during the 1950s, newspapers traditionally omitted the names of the surgeons involved with the advancements, especially in Houston where Dr. DeBakey worked. These publications were acting in accordance with the Harris County Medical Society\u2019s ban on personal publicity.<\/p>\n<p>Dr. DeBakey unabashedly changed Houston\u2019s social mores by making certain to <a href=\"https:\/\/circulatingnow.nlm.nih.gov\/2018\/04\/19\/the-power-of-a-name-michael-debakey-and-the-changing-business-of-american-medicine\/\">connect his name and hospital with the novel surgeries he performed<\/a>. This measure proved visionary because people across the country learned about his risky, yet successful procedures. The national acclaim he received would serve as a catalyst for him to pursue new pioneering surgeries and achievements.<\/p>\n<p>Another aspect of public support for Dr. DeBakey\u2019s risk-taking initiatives stemmed from Cold War sentiment. World War II had demonstrated that scientific application might determine the eventual winner of a war between the U.S. and Soviet Union. Therefore, it was critical that the U.S. pursue innovation to establish technological superiority over the Soviets.<\/p>\n<figure id=\"attachment_14597\" aria-describedby=\"caption-attachment-14597\" style=\"width: 300px\" class=\"wp-caption alignright\"><a href=\"https:\/\/i0.wp.com\/circulatingnow.nlm.nih.gov\/wp-content\/uploads\/2018\/05\/fjbbfy.jpg?ssl=1\"><img data-recalc-dims=\"1\" loading=\"lazy\" decoding=\"async\" data-attachment-id=\"14597\" data-permalink=\"https:\/\/circulatingnow.nlm.nih.gov\/2018\/05\/17\/transplanting-technology-dr-michael-debakey-and-cold-war-technology-transfer\/fjbbfy\/\" data-orig-file=\"https:\/\/i0.wp.com\/circulatingnow.nlm.nih.gov\/wp-content\/uploads\/2018\/05\/fjbbfy.jpg?fit=1209%2C1200&ssl=1\" data-orig-size=\"1209,1200\" data-comments-opened=\"1\" data-image-meta=\"{"aperture":"0","credit":"","camera":"","caption":"","created_timestamp":"0","copyright":"","focal_length":"0","iso":"0","shutter_speed":"0","title":"","orientation":"1"}\" data-image-title=\"FJBBFY\" data-image-description=\"<p>DeBakey is standing third from the right. DeBakey visited the Soviet Union from December 15-20, 1958, at a time when the United States and USSR were locked in a deadly arms race, the Cold War. People lived in fear of nuclear annihilation, anticommunist politicians created an atmosphere of suspicion and paranoia in the United States government, and the people of each country looked upon each other with mounting hostility. DeBakey’s visit, enabled by Boris Petrovsky, Minister of Health, and Professor Alexander Alexandrovich Vishnevsky of the Academy of Medical Sciences of the USSR, was nothing short of remarkable. DeBakey continued to foster medical collaboration with the Soviet Union, making a number of subsequent visits from the 1960s to the 1990s, when he advised President Boris Yeltsin’s physicians about his coronary bypass surgery. <\/p>\n\" data-image-caption=\"<p>Michael DeBakey with Russian Colleagues, 1960<br \/>\nCourtesy Katrin DeBakey<br \/>\nNLM Profiles in Science<\/p>\n\" data-medium-file=\"https:\/\/i0.wp.com\/circulatingnow.nlm.nih.gov\/wp-content\/uploads\/2018\/05\/fjbbfy.jpg?fit=300%2C298&ssl=1\" data-large-file=\"https:\/\/i0.wp.com\/circulatingnow.nlm.nih.gov\/wp-content\/uploads\/2018\/05\/fjbbfy.jpg?fit=840%2C834&ssl=1\" class=\"size-medium wp-image-14597\" src=\"https:\/\/i0.wp.com\/circulatingnow.nlm.nih.gov\/wp-content\/uploads\/2018\/05\/fjbbfy.jpg?resize=300%2C298&ssl=1\" alt=\"Seven men in white coats and surgical caps pose outdoors for a photograph.\" width=\"300\" height=\"298\" \/><\/a><figcaption id=\"caption-attachment-14597\" class=\"wp-caption-text\">Michael DeBakey with Russian Colleagues, 1960<br \/><em>Courtesy Katrin DeBakey<\/em><br \/><a href=\"https:\/\/profiles.nlm.nih.gov\/spotlight\/fj\/catalog\/nlm:nlmuid-101743405X81-img\">NLM Profiles in Science<\/a><\/figcaption><\/figure>\n<p>In the midst of this international tension, Dr. DeBakey traveled to Moscow for the Seventh Annual Surgical Conference in 1960. The Houston Chronicle <a href=\"https:\/\/findingaids.nlm.nih.gov\/repositories\/4\/resources\/931\">reported at the time<\/a>, \u201cRussian surgeons are several years behind in the field of heart surgery\u2026 Russian medical centers are not comparable.\u201d Dr. DeBakey mustered support for his trip by <a href=\"https:\/\/profiles.nlm.nih.gov\/ps\/retrieve\/ResourceMetadata\/FJBBJL\">emphasizing that America was outpacing Russia in cardiac surgery<\/a>, and he grew even more popular from being seen as the person most responsible for that superiority.<\/p>\n<p>Such popularity helped Dr. DeBakey withstand failures, which allowed him and his colleagues to continue taking risks. <a href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC4667571\/\">William L. Winters<\/a> and Betsy Parish report in their book <a href=\"https:\/\/books.google.com\/books\/about\/Houston_Hearts.html?id=xKsVnwEACAAJ\"><em>Houston Hearts<\/em><\/a> that Dr. John Ochsner, who was a surgical resident alongside Dr. DeBakey at Baylor University from 1956\u20131961, acknowledged the failure of early AAA procedures, \u201cWe had a lot of infected grafts\u2026 The state of the art was immature, and unfortunately we had to face all of those terrible things.\u201d<\/p>\n<p>Yet the demand for Dr. DeBakey\u2019s services didn\u2019t falter. Widespread support for him as a pioneering surgeon proved crucial, because if those failures had caused mass public outcry, either Baylor or the Houston Medical Society could have restricted him from experimental surgeries. Fortunately for Dr. DeBakey, post-war and Cold War sentiments offered an environment with little regulation and significant freedom to experiment, despite many infections and other harmful side effects stemming from his early surgical interventions.<\/p>\n<p><strong>Modern Medicine<\/strong><\/p>\n<p>Dr. Voorhees and Dr. DeBakey spearheaded vascular surgery in the mid-20th century due to both their individual abilities and the advantages provided by a liberal era for innovation. The Medical Device Amendments of 1976 have since implemented a series of regulations that ensure the safety and efficacy of devices on the market, but also inhibit their ease and speed of diffusion.<\/p>\n<p>It\u2019s difficult to say whether Dr. Voorhees and Dr. DeBakey could have reached the same level of distinction had they been constrained by modern regulations. There\u2019s little doubt, however, that external factors in the post-war period created a \u201cperfect storm\u201d for innovation. No matter the advantages offered by this environment, both trailblazing surgeons deserve credit for exploring the possibilities presented to them. Louis Pasteur, the father of the Germ Theory of Disease, famously wrote, \u201cIn the fields of observation, chance favors the prepared mind<em>.<\/em>\u201d Dr. Voorhees and Dr. DeBakey were fortunate to live in such an unrestricted era, but their talent and creativity truly enabled them to blossom during this age of opportunity.<\/p>\n<p><em><a href=\"https:\/\/i0.wp.com\/circulatingnow.nlm.nih.gov\/wp-content\/uploads\/2019\/02\/alyssa-gabay.jpg?ssl=1\"><img data-recalc-dims=\"1\" loading=\"lazy\" decoding=\"async\" data-attachment-id=\"15785\" data-permalink=\"https:\/\/circulatingnow.nlm.nih.gov\/2019\/02\/08\/sign-of-the-times-how-an-environment-for-innovation-helped-transform-cardiovascular-surgery\/alyssa-gabay\/\" data-orig-file=\"https:\/\/i0.wp.com\/circulatingnow.nlm.nih.gov\/wp-content\/uploads\/2019\/02\/alyssa-gabay.jpg?fit=479%2C684&ssl=1\" data-orig-size=\"479,684\" data-comments-opened=\"1\" data-image-meta=\"{"aperture":"0","credit":"","camera":"","caption":"","created_timestamp":"0","copyright":"","focal_length":"0","iso":"0","shutter_speed":"0","title":"","orientation":"0"}\" data-image-title=\"Alyssa Gabay\" data-image-description=\"\" data-image-caption=\"\" data-medium-file=\"https:\/\/i0.wp.com\/circulatingnow.nlm.nih.gov\/wp-content\/uploads\/2019\/02\/alyssa-gabay.jpg?fit=210%2C300&ssl=1\" data-large-file=\"https:\/\/i0.wp.com\/circulatingnow.nlm.nih.gov\/wp-content\/uploads\/2019\/02\/alyssa-gabay.jpg?fit=479%2C684&ssl=1\" class=\"alignleft wp-image-15785\" src=\"https:\/\/i0.wp.com\/circulatingnow.nlm.nih.gov\/wp-content\/uploads\/2019\/02\/alyssa-gabay.jpg?resize=100%2C143&ssl=1\" alt=\"An informal portrait of Alyssa Gabay.\" width=\"100\" height=\"143\" \/><\/a>Alyssa Gabay is a first-year medical student at the Philadelphia College of Osteopathic Medicine. Ms. Gabay was an NLM Michael E. DeBakey Fellow in the History of Medicine in 2018, when she graduated with High Honors from the University of Maryland with a B.A. in Social and Cultural History.<\/em><\/p>\n<p><em>We invite you to learn more about the <a href=\"https:\/\/www.nlm.nih.gov\/hmd\/informationfor\/debakeyfellowship.html\">NLM Michael E. DeBakey Fellowship in the History of Medicine<\/a>. Anyone over the age of eighteen, of any academic discipline and status, is invited to apply during the application period each summer.<br \/>\n<\/em><\/p>\n","protected":false},"excerpt":{"rendered":"<p>By Alyssa Gabay ~ During the two decades following World War II, Dr. Arthur Voorhees and Dr. Michael E. DeBakey<\/p>\n","protected":false},"author":19605840,"featured_media":15790,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_coblocks_attr":"","_coblocks_dimensions":"","_coblocks_responsive_height":"","_coblocks_accordion_ie_support":"","advanced_seo_description":"","jetpack_seo_html_title":"","jetpack_seo_noindex":false,"jetpack_post_was_ever_published":false,"_jetpack_newsletter_access":"","_jetpack_dont_email_post_to_subs":false,"_jetpack_newsletter_tier_id":0,"_jetpack_memberships_contains_paywalled_content":false,"_jetpack_memberships_contains_paid_content":false,"footnotes":"","jetpack_publicize_message":"Sign of the Times: How An Environment for Innovation Helped Transform Cardiovascular Surgery - by 2018 NLM Michael E. 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