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'Cloning will play a major role in surgery'

P Rajendran in Bombay

Dr Christiaan Barnard ineffectually pawed the air before him. "I can't see," the world's most famous heart surgeon complained mildly. Would have been worrying but for the fact that few people can see after a battery of flashguns are fired at them.

For those who came in late, Dr Barnard is the world's first heart transplant surgeon. He conducted the path-breaking operation on December 3, 1967. Later, on November 25, 1974, he surprised the world again by placing a second heart in a patient without removing the first one.

If the new one was rejected, the old one could keep the patient going for some time, he reasoned -- correctly.

Dr Barnard is in India to speak at the BPLMobile's Achiever of the World lecture series.

Close up too, Dr Barnard look more the old world doctor -- with a joviality that would must have reassured countless patients -- than the steely-eyed modern professional. That's one reason he chose not to operate outside South Africa -- he wouldn't have his team with him and he would not get to see the patient again. "I'm a doctor, not a technician"

Dr Barnard became a heart surgeon by accident. He'd gone to the University of Minnesota for general surgery and got down to helping someone working on a heart-lung machine. He guessed he had found his calling and soon switched specialities.

Affected by arthirits and asthma, Dr Barnard now leads a quiet life now on his 32,000 acre farm in South Africa. He hopes to take Indian buffalo and blackbuck over, if the customs doesn't play spoilsport.

Though Louis Washkansky lasted just 18 days and though, even now, life is prolonged by an average of only about two years in transplant cases, Dr Barnard feels such operations are worth the cost.

He cites the case of his second transplant patient who told a journalist that he found the operation worth it when he came out of anasthesia.

"I saw I could breathe. breathe freely. Life was different, life was better," Dr Barnard described the patient as telling the journalist.

"Doctors often make that mistake," he says. They think their job is to prolong life but they've got it wrong there, according to him; it is to give a better quality of life. Dr Barnard even advocates passive euthanasia in terminal cases.

"What society does not accept euthanasia," he asks passionately. "I cannot believe god, a god of love and compassion would allow that." In such cases, he does not mind using pain-killing drugs which may reduce lifespan; he did not even censure those who injected lethal substances into such patients. "I would not preach the practice of death. But there is a place for that too...," he says, pointing out that in some cases, "death is often better treatment". He is reportedly against abortion and apartheid though.

Ability, opportunity, imagination and luck. These were the factors that define success he says. He did not mention courage, which helped him do what no one had chanced before. But Dr Barnard has often pushed his luck, to his own detriment.

He was successful, very handsome, relatively young during his early successes. And he had affairs with many women, among them famed Italian actress Gina Lollobrigida, whom he described as sexually uninhibited. In his biography, he even described how she had driven him back to his hotel after a one-night stand, nude under her mink coat. His numerous affairs snapped his first marriage with Aletta Louw in 1969 and his second, with Barbara Zoellner. His third wife is Karin Setzkorn, a former model. He has four children -- daughter Deidre and sons Frederick, Christiaan Jr and Armin. His son from his first marriage, Andre, died, allegedly of an overdose, in 1984.

Dr Barnard did irreparable damage to his professional reputation in 1986 when, for a great deal of money, he agreed to promote an alleged anti-ageing cream, Glycel. Dermatology was not his field anyway and things weren't helped when Glycel was withdrawn from the US market the next year. In retrospect, he always regretted that endorsement.

The heart surgeon had better success with his books, including some that verged on high-school cardiology, a scandalous biography and four thrillers, the last of which, The Donor deals with the transplant of a pig's heart into a human.

Soon after his retirement, the heart unit at the Groote-Schuur hospital began to feel the financial pinch. It may even have to close down, if reports are to be believed. He is assisting the hospital set up a museum there.

"A nation is built on two pillars -- health and education," he says, suggesting that making medical aid an elitist reserve was inhuman and in contravention of medical ethics.

"Do they ask," he continued in a more militant vein, "when a nation goes to war, where's the money going to come from?"

Age now shows up in his spotted hands which, in medical jargon, look slightly oedematous. While speaking, he regularly fingers his blue tie, a gift from Princess Diana.

He is more reflective as he recalls his second breakthrough. A man who was close to his son had to have his heart transplanted. But, for some inexplicable reason, the replacement failed and the man died. His distraught son, who was pacing outside the operation theatre, asked him, "If the new heart failed, why didn't you put his heart back?"

Unable to sleep that night, he saw reason in his son's passion. Indeed, why didn't he put the old one back. Or better, did he have to remove it at all? The mental stage was set for Dr Barnard's second pioneering effort, when he put a second heart into a patient, leaving the first also in place.

Things have improved greatly now and such operations are not called for, says Dr Barnard. The biggest advances have been in immune suppression and new techniques, he says.

Told about the transplant of a pig's heart into a human, Dr Barnard said he himself had tried it with the heart of a gibbon himself. But he had done it as a temporary measure, in desperation. "Sometime the heart is rejected in minutes," he says.

But genetic engineering has already produced a mouse with a human immune system. A pig shouldn't take too long. And from such a pig, who know, transplants may be easier. Dr Barnard himself suggested that in his latest thriller...

Quizzed about the controversy over cloning, he says it isn't a bad idea at all. Wouldn't it be a good thing if a Mozart or an Einstein are cloned, he asks, adding that a Hitler clone might not be. "Cloning," he states unequivocally though, "will play a major role in surgery." Scientists are already working on using the patient's cells to form replacement body parts.

He wasn't very enthusiastic about the demands of traditional medicine for recognition.

Modern medicine, he says, "has to be passed by peers. It has to be scrutinised. (Proponents of traditional medicine) assume the value, claim the value," of their beliefs. This was especially shocking when claims of curing cancer were made to make a lot of money, he said. More control on such claims would not be out of hand, he felt.

There was a need for cheaper, better treatment, he said, adding that the way things were going, despite setbacks, the future was bright.

He himself has no complaints about the ups and downs in his life. "When I die I can say, 'Thank you, god, I have had a great opportunity in life.' "

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