By Andrew Simpson ~
In a 1994 article titled “It’s a Business. No, It’s a Religion,” The New York Times profiled two of Houston’s most famous cardiac surgeons—Dr. Denton A. Cooley and Dr. Michael E. DeBakey. The article cast each man as an example of a growing divide in American medicine, with Cooley serving as the champion of a more overtly commercialized approach to health care and DeBakey taking up the side of the beleaguered, and seemingly over-regulated, American physician whose practice standards were increasingly dictated by the whims of private insurers and government officials. While the idea that the two bitter rivals were emblematic of a deep division within health care may have made for good copy, it was not necessarily an accurate reflection of how either approached the business of medicine. In fact, despite the public perception of DeBakey as an opponent of medical commercialization, a review of his papers at the National Library of Medicine reveals a more complicated legacy. During the 1990s, DeBakey lent his name to a range of enterprises including new spaces to deliver care and new medical technologies. Examining how not for profit hospitals and for-profit companies sought to use Dr. DeBakey’s endorsement allows historians to understand the evolution of the business of American medicine in the last two decades of the twentieth century.
Michael DeBakey and the Changing Business of Medicine
The medical profession of DeBakey’s youth was dominated by general practitioners and part-time medical educators. In this model, every physician was a businessman. By the time he came to Houston in 1948, the emergence of the postwar academic medical center with its full-time medical faculty and emphasis on specialization was creating a new type of doctor—one that could leave revenue management to others and thereby appear to be above the coarseness of the market. DeBakey, however, was more than just an academic physician. Because of his role as a department chairman and Chancellor of Baylor College of Medicine, he was often forced to confront the role that revenue generation played in shaping medical decision-making. This tension is evident in a 1993 letter from DeBakey to consumer advocate Ralph Nader where he acknowledged a “commercial factor” that infused modern medical practice while simultaneously decrying the burdens it could place on the activities of individual physicians and medical schools. Despite these concerns, he noted that “there is much that is right with the American Health System and that should be preserved,” including the market-driven imperatives to find better ways to deliver specialty care to more Americans and to develop new medical technologies.
Delivering Better Care: The DeBakey Heart Centers
The line between promoting the profession and promoting the individual was often blurry. Positive media coverage was a critical part of how DeBakey’s name acquired commercial value. Each successful, and high-profile, surgery helped transform him from just another doctor into a commodity known for exacting precision in the operating room (both for himself and his associates) and innovation in the laboratory. DeBakey’s reputation, and physical presence, then helped the institutions he was affiliated with, like Houston’s Methodist Hospital, to stand out in an increasingly competitive, and globalizing, health care system. As the financial viability of smaller community hospital was threatened, these institutions also sought ways to differentiate themselves in their respective medical markets. Some followed similar strategies to Methodist’s and sought the endorsement, and involvement, of marquee figures like DeBakey to improve the content and reputation of their specialty surgical programs.
One of the first community hospitals to seek out DeBakey to do this was the Kenosha Hospital and Medical Center in Kenosha, Wisconsin. In September of 1991, hospital CEO Richard Schmidt traveled to Houston to meet with him. According to documents held in the Baylor College of Medicine’s archives, DeBakey subsequently connected Schmidt with consultant Ted Bowen, formerly the President of The Methodist Hospital, whose firm conducted a feasibility study and determined that Kenosha was “well positioned to start a cardiovascular surgical program.” When the board voted in early 1992 to proceed with the program, DeBakey remarked that “You have done a great thing for your community…your facilities—in particular, your surgical facilities—are absolutely magnificent, in fact, it’s the best we’ve ever seen.”
DeBakey’s contributions to Kenosha’s program were multifaceted. A 1995 promotional video notes that he helped to design the operating suites and recruited Dr. Robert Johnson from his Houston-based team to become the chief surgeon for the new heart center. But perhaps his most important contribution was that his endorsement convinced the hospital’s board, and Kenosha residents, that a heart center in the community was worth supporting.
The Hays Medical Center, located in rural Western Kansas, also sought DeBakey’s endorsement for their new heart center. In 1998, representatives from that medical center also made the trip to Houston to learn from DeBakey and Methodist, although this trip now included a delegation from Kenosha, presumably to provide additional advice about developing specialty care lines in smaller markets. After gaining DeBakey’s endorsement, both hospitals were able to advertise that their new services had the stamp of approval of the “father of heart surgery.”
What did he get in return? The records are not totally clear. However, an unsigned contract with the Hays Medical Center, held in the Baylor College of Medicine’s archives, hints at some of the benefits and obligations. In return for “an annual stipend of $30,000 and other valuable consideration,” DeBakey would agree to not license his name to another hospital in Kansas and would be held harmless for any legal liability incurred by the new heart center. DeBakey also traveled to Kenosha and Hays to promote the creation of each program and to view each facility after it opened.
Marketing Medical Technology: The DeBakey VAD
Becoming the public face for new types of medical devices was another way that DeBakey blurred the lines between the perception of an altruistic medical profession and the reality that it was becoming a commercial enterprise. The DeBakey VAD was developed in conjunction with the National Aeronautics and Space Agency (NASA) and fellow Baylor College of Medicine surgeon George Noon. The critical factor for the device’s success was its lower weight and innovative pump design which, could, in theory, allow for “long-term implantation” helping it to become a “bridge-to-recovery and as an alternative-to-heart transplant.” This distinction was more than semantic—it was the difference between a market of $255 million or $5.2 billion. This broader reach, was described by one health executive as the “holy grail” for VAD usage.” A for-profit company named MicroMed Technologies was formed in 1995, and given an exclusive license from both Baylor College of Medicine and NASA to market the device and to conduct additional clinical trials.
Once again, DeBakey’s role was more than just lending his name and stepping away. Not only did he serve as the chairman of the Medical Advisory Board (also called the Scientific Advisory Committee), and hold a three percent equity stake in MicroMed, he also appeared to be to be actively involved in securing a $500,000 sponsored research contract between the company and Baylor College of Medicine to further refine device for U.S. markets.
DeBakey’s endorsement paid off. By 1998, the company was implanting devices in Europe, and four years later the DeBakey VAD had come to the United States. Globally there were more than 450 implants of it and its successor devices by 2010. Early estimates put the cost of each implant at roughly $85,000. While the updated and improved DeBakey VAD no longer bears his name, and MicroMed has been integrated into a new company called ReliantHeart, promotional materials in his papers show that the use of DeBakey’s name was essential for encouraging physicians and the public to embrace the idea of the VAD as more than simply a bridge to transplant, thereby potentially creating a new multi-billion-dollar market.
Until his death, Michael DeBakey cultivated a public image as a steadfast critic of the growing commercialization of medicine. Yet, his relationship with it is more complicated than simply serving as an opposing voice to the changing values of a profession. DeBakey’s papers at the National Library of Medicine show that during the 1990s, he actively lent the power of his name to small community hospitals like Kenosha and Hays and to new medical devices like the DeBakey VAD.
Were his public statements and private actions contradictory? DeBakey did not think so. Instead it appears that he saw the use of his name by not-for-profit hospitals and for-profit corporations as an essential way to advance medical science in a market-driven system, rather than to merely carve out profit for shareholders or institutions. In embracing this understanding, DeBakey’s actions highlight the challenges faced by physicians and medical educators as they sought to negotiate the changing U.S. health care system in the closing decades of the twentieth century.
Andrew Simpson, Ph.D., is Assistant Professor of History at Duquesne University. He was a Michael E. DeBakey Fellow in the History of Medicine at the NLM in 2017 and is working on a forthcoming book, Making the Medical Metropolis.