DR AYESHA NATHOO writes that about 50 years ago, a breakthrough was recorded in human-to-human heart transplant in medicine by a South African surgeon, Christian Barnard
Fifty years ago – on 3 December 1967 – the heart of a 26-year-old road accident victim, Denise Darvall, started to beat inside the chest of a 54-year-old grocer, Louis Washkansky.
News of the first human-to-human heart transplant, led by South African surgeon Christiaan Barnard, made headlines around the world.
Journalists and film crews flooded into Cape Town’s Groote Schuur Hospital, soon making Barnard and Washkansky household names.
Initial reports widely hailed the operation as “historic” and “successful”, though Washkansky only survived a further 18 days.
The first heart transplant attracted unprecedented media attention for a medical undertaking, ushering in a new era of doctor and patient celebrities, post-operative press conferences and medical PR.
It became one of the most famous events of the 20th Century, on a par with the moon landing two years later.
As one journalist reflected, it had “everything a reporter could wish for”.
It was an extraordinary technological feat involving the most symbolic human organ – and an intimate story of one life lost that allowed another to be saved.
In the limelight
From his hospital ward, Washkansky’s daily activities and emotions were reported in minute detail. That he sat up, spoke, smiled, and had a boiled egg for breakfast, all made front-page news.
His wife and the father of the donor also featured prominently in the media coverage. They were pictured together as Mrs Washkansky wept in gratitude to Mr Darvall for agreeing to donate this precious “gift of life”.
After Washkansky developed pneumonia and died, their grief was publicly shared. Mr Darvall lamented the loss of his daughter for the second time, now that no part of her was “still alive”.
Barnard, meanwhile, remained firmly in the limelight.
Charismatic and photogenic, he appeared on magazine covers, met dignitaries and film stars, drawing crowds and photographers wherever he went.
But disquiet over heart transplantation also began and medical opinion was divided. Several other surgeons were technically ready to perform a heart transplant, and Barnard’s operation prompted a flurry of international activity.
In 1968, more than 100 heart transplants were performed worldwide by 47 different medical teams. Each transplant was attended by vast publicity that crossed new lines for a traditionally reticent medical profession.
Yet most of the early recipients survived only a short time – some just for hours – prompting public unease and medical critique over the visibly high mortality rates.
Some questioned whether immunological management could keep up with the surgical ability, and if these hi-tech operations were worth the resources.
Complex ethical and legal issues arose concerning the removal of a beating heart – the traditional signifier of life and death – and whether this amounted to killing the donor patient.
Ethical dilemmas
The incentive of doctors to save the lives of patients identified as potential donors was also called into question, especially after Barnard’s second transplant, in January 1968, used the heart of a ‘coloured’ man – the term used for mixed race in South Africa – for a white recipient in apartheid South Africa.
“Spare-part surgery” brought hope to some and fear to others.
In February 1968, a special episode of the BBC’s Tomorrow’s World programme – Barnard Faces His Critics – provided a key forum for probing such social and ethical implications.
Involving a studio debate with Barnard alongside dozens of identifiable, eminent doctors, it also broke with professional codes of conduct regarding doctor anonymity and patient confidentiality.
As elsewhere, Britain’s first heart transplant in May 1968 was also conducted and scrutinised under the media spotlight – and ultimately the publicity surrounding the controversial operations contributed to a moratorium through the 1970s.
Heart-transplant programmes restarted alongside significant advances in immunological treatments.
They now commonly provide transformative, life-extending interventions, but the transition from Barnard’s pioneering operation to today’s routine surgery was far from smooth.
Source: BBC
Assessing new strategy in fight against fake baby formula
PADRAIG BELTON of BBC reports that the battle against deadly fake goods particularly baby formula, have gone hi-tech
“I have strong concerns over infant formula,” admits Zeng, mother of 11-month-old Yiyi.
She is worried about the health risks her daughter faces from fake baby milk. Her concerns illustrate the human aspect of a lucrative global scandal which has seen millions of dollars-worth of different dodgy products hit the market.
And while fake jeans may only prove to be a fashion disaster, counterfeit medicines can prove extremely harmful.
Technology to the rescue
But technology is coming to the rescue; specifically blockchain. It’s being used to verify the authenticity of baby formula, medicines and even to help reduce the harmful trade in blood diamonds. It’s also being used to help keep our fish supply fresh.
Zeng and her husband Shi live in Jiaxing, a city of 1.2 million not far from Shanghai. Like other new parents, they worry about using formula baby milk after a number of high-profile contamination incidents in the last decade.
Occasional scares
Melamine is sometimes added to fool government protein tests. But it also causes kidney stones and renal failure. Some 300,000 babies fell ill in 2008 from melamine-tainted formula, with occasional scares since.
“I cannot fully trust the baby store, supermarkets, or the internet. I know cash sometimes drives people to do evil,” says Zeng, who asked for her full name to be withheld because of the sensitive subject.
But she discovered that blockchain could be used to verify the safety of formula – by using her phone to link a chip containing proof of the formula’s authenticity.
How does blockchain work
Tech Tent: Will AI and Blockchain be game-changers?
A small wire in the formula label wraps around the container, explains Alexander Busarov, chief executive of blockchain startup WaLiMai. “You cannot open the can of baby food without breaking the label,” he says.
The wire acts as an antenna for a signal from an RFID chip, which a smartphone can read. The chip, like some bank cards, generates a new code each time it is scanned. Authenticating takes about two seconds, says Mr Busarov, then you get the result, the logistics details, a picture of the product and where it was labelled.
The label slightly increases the cost of the product but it is a cost consumers are willing to bear, says Mr Busarov. “With jeans you don’t really care if they’re fake. But under no circumstances would you want you or your baby to consume fake food or baby formula.”
Blockchain offers a powerful way to verify pharmaceuticals, says Suzanne Somerville, from a project called MediLedger, a joint venture between San Francisco start-ups, TheLinkLab, and Chronicled.
It uses a blockchain to track the movements of pharmaceuticals and “help deliver truth in these transactions in decentralised way – parties who don’t necessarily want to work together can agree on the authenticity of these events,” says Ms Somerville.
So far, three of the 10 largest US pharmaceutical companies have signed up. Two wholesalers responsible for more than 50% of prescription drug movements in America have, too.
But what if some of this data is proprietary, and a company doesn’t want it all shared? In August, MediLedger’s team discovered a way to verify a drug’s provenance history, without revealing logistics and price information to competitors, says Ryan Orr, chief executive of Chronicled.
“Traditional, centralised databases are like castles with moats,” says Mr Orr, “a hacker will always find a clever way to sneak inside.”
With blockchain, he says, so long as a majority of players and actors are trustworthy, they can keep malicious ones from tampering with the system.
Blockchain is also being used to combat armed groups in the Central African Republic which are making $3m-$6m a year from conflict diamonds, according to the Washington DC-based Enough Project.
In 2003, the United Nations set up the Kimberley Process to establish standards, in force in 81 countries, to ensure traded diamonds aren’t “blood diamonds” mined to finance armed groups. But it involves governing the $80bn a year world diamond market with a paper-based certification system.
Fake paperwork
And fake paperwork can be obtained for a bribe.
Leanne Kemp, an Australian who in 2015 founded a company called Everledger, has now encrypted the distinguishing features of 1.8 million diamonds and their provenance on a blockchain.
More than 40 features are logged to create a fingerprint for each diamond, logging it from mine to ring.
“I see it as a technical rewiring of trust – a gentleman’s handshake and a promise about a diamond’s authenticity or coming money is no longer enough,” says Leanne Kemp.
Many of us assume that if you call an emergency number like 911, 999 or 112, someone will answer quickly and help will arrive soon wherever we are in the world.
But across Africa, this isn’t always the case.
In Kenya’s capital Nairobi, for example, there are more than 50 different numbers for emergency services. Ringing round trying to find an available crew can be a lengthy – and potentially life-jeopardising – process.
You can wait two or three hours for an ambulance to arrive.
“You just take for granted that 911 [the US emergency services number] exists, and we did as well,” says Caitlin Dolkart.
She and her business partner Maria Rabinovich had both been working in the health industry in Nairobi for years before starting their company Flare.
“We thought – what would we do in an emergency? So we started asking people to spot ambulances and realised there were so many around and no one has any idea where they are,” says Ms Dolkart.
