King of artificial hearts

National | Self-contained heart pump keeps a man alive, the AHA revises estrogen standards, and Connecticut regulates Ritalin advocacy in schools

Issue: "Rolling the dice," Aug. 4, 2001

Electric pump
The world's first self-contained artificial heart has kept a sick man alive for over three weeks this summer. It impresses even specialists and encourages hope that it could become a common heart-disease treatment. The softball-sized pump is called the AbioCor, named for its manufacturer, Massachusetts-based Abiomed Inc. What makes it unique is that no wires or compressed air tubes stick out of the patient's chest. Instead, an external power pack transmits electricity through the skin. A man, described only as a diabetic in his mid- to late 50s with a history of heart attacks, received an Abiocor artificial heart during a seven-hour surgery at Louisville's Jewish Hospital. Doctors say the device has worked perfectly so far. He is expected to remain hospitalized at least two months. "My goal, long-term, is to have him walk out the front door and go home and have a good quality of life," said Dr. Robert Dowling, one of the surgeons who performed the procedure. According to the hospital, the experiment is especially important because heart failure is on the rise. More people survive heart attacks, but still have tissue damage. Last year, only about half of the 4,200 Americans on a waiting list for donor hearts received them. Most of the rest died. The stakes are high, but doctors still don't know if the AbioCor will ever become commonplace. The Food and Drug Administration has given approval for five experimental surgeries with the device. Experts say it must prove itself over long-term use. Hormones and heart disease
The American Heart Association has revised its guidelines on the use of estrogen for women. Due to evidence that hormone supplements might cause harm, it recommends that doctors not prescribe solely to prevent strokes and heart disease. About 20 million American women take a combination of estrogen and progesterone, usually to treat post-menopausal symptoms and to lower the risk of brittle bones. Dr. JoAnn E. Manson, chief of preventive medicine at Harvard's Brigham and Women's Hospital, estimated that 20 percent use hormone replacement therapy expressly to prevent heart disease. Those taking estrogen for non-cardiac purposes do not need to stop, according to the AHA. However, the lead author of the guidelines, Dr. Lori Mosca, said there is no clear evidence that the drugs reduce the risk of heart disease in women. She said a research review actually found a higher risk in some cases: "The thing we thought was giving a benefit may cause problems in some women." What researchers know about the correlation between hormones and heart disease seems inconclusive. Hormones can help a woman's cholesterol and relax blood vessels, but it can also cause inflammation of blood vessels and blood clotting. Medicated kids
How much Ritalin is too much? Complaints about the overuse of behavioral drugs on children have led to the first state law regulating its advocacy. Connecticut now prohibits teachers, counselors, and other school officials from recommending psychiatric drugs for any child. The bill passed the state legislature unanimously. Its chief sponsor, state Rep. Lenny Winkler, is an emergency room nurse who complained that children as young as 2 were taking Ritalin. "I cannot believe how many young kids are on Prozac, Thorazine, Haldol-you name it," he said. "It blows my mind." Angry parents claim teachers drug their kids simply to make life easier for the school system. Nationally, nearly 20 million prescriptions for Ritalin, Adderall, and other stimulants were written last year, mostly for boys under 12, according to IMS Health, a health care information company. Substance abuse counselors report that Ritalin has become a street drug, with kids snorting it to get high. Yale University psychiatrist Andres Martin said schools have no business practicing psychiatry. "We've all heard these horror stories of parents who are told, 'If you don't medicate your child, he can't be in the classroom,'" he said. Doctors prescribe Ritalin to fight attention deficit hyperactivity disorder, which they say is a biological ailment marked by impulsivity and hyperactivity. Critics charge that the problem is related to rampant bad discipline in homes and teachers' inability to handle male students.

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