Author + information
- Spencer B. King III, MD, Editor-in-Chief, JACC: Cardiovascular Interventions⁎ ()
- ↵⁎Address for correspondence to:
Spencer B. King III, MD, Editor-in-Chief, JACC: Cardiovascular Interventions, Saint Joseph's Heart and Vascular Institute, 5665 Peachtree Dunwoody Road, NE, Atlanta, Georgia 30342
As I am flying to San Diego for one of our periodic JACC journals editors meetings, I have time to reflect. One of our only protected times is now being invaded by the Wi-Fi in the sky, or as Delta calls it, the “Go-go in-flight internet.” Resisting this current craze to maximize the use of our time, or as I would put it, to crowd out all thought by reacting to the Web, I settle for a book my wife, Gail, put in my hand as I was leaving home. It is an old one by Robert Fulghum, the author of Everything I Need to Know I Learned in Kindergarten . The first story of the collection of short vignettes, “It Was on Fire When I Laid Down on It,” gives the book its title. There are a lot of stories that are easy to digest between dozing off on a 4.5-h flight. I was struck, however, by a line in the author's preamble, “I believe imagination is stronger than knowledge.” How can this be true? Surely, the accumulation of knowledge is, as we are all told, expanding exponentially, and we must struggle to keep up with it. If we are not storing it all in our heads, we are at least cataloging it in our computers or on that “cloud” that holds all knowledge.
Then, I remembered a day when our son was in the third grade. I was coerced to come to his class and talk about the heart. I was unsure how interested the students would be, but I had a jar with a cow heart in formaldehyde in my attic and I figured I could get their attention with that—and I was right. After ogling the heart and daring each other to touch it, they settled down and became inquisitive. One of the girls had heard of a heart attack and wanted to know what it was. This gave me the opportunity to describe the coronary circulation; after all, I had the knowledge and was a vigorous proponent of coronary bypass surgery. I asked the students if they could find a way to fix the arteries that were clogged; to test their imagination, I gave each student a piece of paper and asked them all to draw a solution for a blocked artery. The year was 1975, and I had my own pre-conceived solution. Surely, they would find a way to route the circulation around the blockage. The solutions were colorful and ranged from Drain-O (SC Johnson, Racine, Wisconsin) to various versions of Roto-Rooters (Roto-Rooter Group, Cincinnati, Ohio), but most were done from the inside of the pipe. What none of them invented was a vascular bypass. (I guess this proves that endovascular therapy is much closer to the primal human condition than bypass surgery). What they gave me was imagination—not knowledge. They and I were unaware that these methods were at that very moment being developed in Zurich.
An example of translating experience through imagination came when we were preoccupied with the problems of providing local drug delivery to suppress restenosis following angioplasty. We had tried the double balloon (Wolinsky catheter), but the infused drugs would just run off through side branches and not remain trapped in the segment between the 2 balloons. Some colleagues from the industry were visiting my home during a percutaneous coronary intervention course at Emory and, in my garden, Gail remarked, “why don't you try that,” pointing to the soaker hose watering her azaleas. In a short time, a laser-drilled balloon was developed that would allow microinjection of drug from the balloon into the vessel wall. The subsequent patent, number 5,087,244 by Wolinsky, King, and Barbere, is now about 20 years old, and all of our attempts to solve restenosis with it failed for many reasons. Now, however, this concept is being tested again with an improved drug-eluting balloon and more effective drugs.
Imagination is needed in all walks of life, not the least of which is our current disaster in the Gulf of Mexico. I recently heard that the oil-drilling engineers were sequestered so that they could use their collective extensive knowledge and not be distracted by the myriad ideas that were being offered to plug the ruptured pipe. I had a feeling of frustration and guilt by not putting forth my own solution, which for the record is a retrograde wire carrying an expanding temporary stent (think Gaspard/Paris around the late 1980s). After that was expanded deep in the pipe, other devices could be delivered to occlude the pipe. I heard Steve Raymee interviewed and he put forth some interventional cardiology solutions for the ruptured vessel.
In these pages, I have sometimes said that the era of coronary interventions has reached the level of a commodity, and therefore structural heart disease and other endeavors should be the interest of interventional cardiologists. Being inspired by my forced quiet reflection time on this airplane, I now want to publicly retract my previous negative stand. Maybe it is not our accumulated knowledge that will solve the problems created by coronary artery disease or the oil spill in the Gulf, but imagination that may come from putting down the laptop, or iPad, and simply thinking. If you run out of imagination, ask your wife, or any third grader.
- American College of Cardiology Foundation
- Fulghum R.