<nettime> Index of this Fabulous World

["McKenzie Wark" <mckenziewark@hotmail.com>]

Vectoral Times / 24th August 2001

C is for Cyborg…
McKenzie Wark

"Not having a heartbeat" is what Robert Tools of Franklyn, Kentucky finds 
most peculiar. Surgeons implanted an artificial heart in his chest, which Mr 
Tools says makes a constant whirring noise, making it hard to get to sleep 
at night. The Abiomed company, maker of the AbioCor (TM) heart, claims the 
motor is "remarkably quiet"on its web site. And so it may be to anyone but 
Mr Tools, who has to live with the thing inside his body. As the first 
recipient of an AbioCor, Mr Tools speaks from the frontier of cyborg life.

"It feels real heavy", he says. The pump, energy coil, battery and 
controller of the AbioCor artificial heart weigh four American pounds. It is 
"made primarily of titanium and Angioflex™, Abiomed’s proprietary 
polyurethane plastic" It pumps blood automatically, powered by internal and 
external lithium batteries. The internal battery will run the device for 
eight hours or so, but is continually recharged from the external batteries. 
Power is transferred "with a TET (transcutaneous energy transmission) 
device. The TET system includes a set of coils, one internal and one 
external, which transmit power across the skin, without piercing the 
surface."

The device was implanted in Mr Tools by Dr Robert D Dowling, and Dr Laman 
Gray at the Jewish Hospital, Louisville. They claim their patient has been 
doing well on the device, despite problems such as a respiratory infection 
and intestinal bleeding. Abiomed has insisted on a policy of restricting 
information about Mr. Tools during his recovery. They claim this is to 
protect Mr Tools’ privacy, but there is also the reputation of the hospital, 
the surgeons and the company to protect.

They may be thinking of the fate of Dr Barney Clark, who was implanted with 
the Jarvik-7 artificial heart in 1982. The Jarvik was a less advanced 
device, requiring a refrigerator sized unit and wires and tubes that stuck 
out of the body, limiting mobility and increasing the risk of infection. Dr 
Clark’s operation received a blaze of publicity, but the patient fared 
poorly and the reputation of the technology suffered.

"Yes, its been hard," Dr. Clark said in his only interview after the 
operation. "But the heart itself is pumping right along, and I think it's 
doing well." As George J. Annas, a professor at Boston University's School 
of Public Health notes: "Dr. Clark's comment acknowledged what his surgeon 
could not: at some point he and the artificial heart had switched roles. As 
he became more ill and depressed, Dr. Clark became the means of sustaining 
the artificial heart. When he died 112 days after the surgery, his surgeon 
said that the heart was still performing perfectly."

Robert Tools is in the same position with his AbioCor. He is the human unit 
sustaining the reputation of the device and the fortunes of the company that 
makes it. Abiomed stock (NASDAQ symbol ABMD) traded as low as $12 in April 
2001, but perked up to $27 at the time of the press coverage of the 
successful operation. If he lives, so does Abiomed.

Abiomed are pioneers in a new era of cyborg life. All human life is 
inderdependent with machines. Human life has always been a mix of biological 
and technical systems. As the technical side of life develops, the flesh to 
which it connects lives longer, but becomes more fragile, requiring still 
more technical support. As Robert Tools says: "I realise that death is 
inevitable, but also I realise if that if there is an opportunity to extend 
it, you take it." Life, an economist might say, is one commodity for which 
demand is inelastic.

The business opportunity for Abiomed lies in the number of patients who, 
like Mr Tools, don’t want the deterioration of the heart muscle to end their 
lives. "Each year, Abiomed estimates that over 100,000 Americans are in need 
of heart replacement, while the annual number of donor hearts available in 
the U.S. remains at approximately 2,000." Many patients, like Mr Tools, are 
too weak to be considered good candidates for a transplant, but, the company 
hopes, may live longer on an artificial heart than with their own failing 
biological one.

The Abiomed story is not just a bio-cybernetic story. As Boston Globe 
reporter Jeffrey Krasner discovered, "prior to the July 2 operation at 
Jewish Hospital, Abiomed filed 23 patent applications… the start of an 
aggressive campaign to insulate its device from competitors." The company 
strategy has always been based on the assumption that it will take decades 
to develop an artificial heart. They do not want to file for patents any 
earlier than they have to, fearing that the patents will expire before the 
device is fully ready for market.

But in the wake of the Tools surgery, Abiomed is seeking protection for a 
range of innovative technical hacks, including the transfer of data between 
the device and external monitors, the management of pumping between the left 
and right ventricles; and the design of the shape of the heart, which they 
claim protect blood cells.

But for all the technical brilliance of the AbioCor, the skill of the 
surgeons and the stoic forbearance of Robert Tools, there’s still something 
creepy about his comments on the sound of the heart. Imagine lying still 
nodding off to sleep, not to the pulse of your heart but to the sound of a 
machine. I sure hope Tools lives long enough to get used to it, but in a 
sense he is a pioneer for all of us in getting used to it. We all get used 
to cyborg life, one incremental step at a time.

A HACKER MANIFESTO 2.0
http://www.feelergauge.net/projects/hackermanifesto/version_2.0/

NOTES
Lawrence K Altman, 'Life Is Wonderful' for the Man With a Self-Contained 
Artificial Heart, New York Times, 2nd August, 2001; Lawrence K Altman, ‘Whir 
of Artifical Heart Gives Patient New Reason to Smile’, New York Times, 22nd 
August, 2001; George J Annas, ‘The Unknowns of the Mechanical Heart’, New 
York Times, Opinion, 23rd August 2001, www.nytimes.com; Associated Press, 
‘Tenn. Doctor Guided Heart Patient’, 23rd August, 2001; Jeffrey Krasner, 
‘Abiomed's pulse is on its patents‘ Business, Boston Globe, 8/1/2001, 
www.boston.com; Ambiomed  website, www.abiomed.com; Jewish Hospital web 
site, www.jhhs.org

McKenzie Wark, Brookyln, NY


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