More Heartache

Surgeons in the U.S. implant about 100,000 new pacemakers each year, at an average cost of $12,000. Last week Cardiologist Allan Greenspan of Philadelphia's Albert Einstein Medical Center charged that the implantations are often useless. In an article published in the New England Journal of Medicine, he concluded that more than half the pacemaker operations he studied were either unnecessary or of questionable need. Concluded Greenspan: "Not all physicians who prescribe pacemakers know as much about the subject as they should."

First developed three decades ago, the small battery-operated devices transmit electrical impulses that correct both irregular and slow heartbeats. However, many abnormal rhythms do not warrant pacemakers; some may be caused by medication or associated with circulatory problems. When Greenspan and his colleagues reviewed the 1983 medical charts for 382 Philadelphia-area pacemaker patients, they found that 20% of the implants were completely unnecessary and 36% were not adequately justified. The solution, he argues, includes better training for physicians and more diagnostic tests.

No one doubts that pacemakers can save lives. But as many as 30,000 may be buried with the deceased each year in the U.S. To avoid such waste, Implant Technologies Inc. of Bothell, Wash., wants funeral directors to recover the devices so the firm can then sterilize and export them to the Third World for $600 to $800 apiece. "In the more than 6,000 cases of pacemaker reuse around the world, there has never been a single reported incident of malfunction attributable to reuse," declares I.T.I. President John Elsholz. If a pacemaker works, he reasons, why abandon it? The company has applied to the Food and Drug Administration for approval, and hopes to begin shipments by June.