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Prognosis Positive


5 A Doctor Whose Heart Is in the Right Place
Dr. Robert Jarvik captured the world's attention in 1982 when he implanted the first artificial human heart. But the device, while revolutionary, was nowhere near ready for prime time. The fact that the first patient lived for several months without his natural heart was extraordinary, but soon after the patient died, Jarvik and the rest of the medical community began to move away from mechanical hearts and toward devices that assisted, rather than replaced, the body's most important organ.

Fast-forward to 2001. After fourteen years on the drawing boards, the Jarvik 2000, which he calls an "intra-ventricular heart," is now in clinical trials. It's essentially a small titanium pump (about the size of a C battery) that keeps your blood flowing through the weakened left ventricle should you experience heart failure. It's part of a new generation of pulmonary hardware that provides a "continuous flow" of blood -- like a mini-propeller in a tube -- as opposed to more traditional pumping devices, which are much bigger and create an externally audible pumping sound. Jarvik thinks artificial pumps like these could save as many as 100,000 people per year in the U.S. alone whose own hearts would otherwise give out.

At the Texas Heart Institute, where trials are being conducted, the Jarvik 2000 has already been implanted in nine patients awaiting heart transplants. But since there are only about 2,000 human hearts available for transplant each year, Jarvik is most excited about a clinical trial under way in England in which three people have received the pump as
a "permanent" solution, meaning they were not awaiting a transplant; instead, the pump will remain inside them for the duration of their lives. (So far, two have survived.) Jarvik hopes to apply for FDA approval to conduct similar permanent-usage trials in the U.S. early next year. "Our goal is to make the Jarvik 2000 as common as a pacemaker," he says.

Dr. Mehmet Oz, director of the mechanical-heart program at Columbia-Presbyterian, says that the newest round of continuous-flow heart pumps, including the Jarvik 2000, represents a huge leap in terms of treating patients. He believes that these pumps will eventually enable doctors to extend the lives of patients now considered too old or sick to receive replacement hearts.

In fact, Dr. Oz, who did a heart transplant for Frank Torre (Joe's brother), has been leading nationwide clinical trials to determine whether elderly patients can benefit from the technology. So far, the Columbia results are promising, with some patients living as long as two years using a pump. He hopes to begin implanting the new pumps within three months. "It's a big change for us," says Oz. "It's like the original Macintosh coming with a whole new operating system."

6 An Eczema Solution That's More Than Skin-Deep
Three years ago, when Stephanie Armenti was 4, she asked her mom why her chicken pox wasn't going away. But Stephanie, who had endured red, itchy, irritated skin since she was only a year old, didn't have chicken pox. She actually had, and still has, eczema, a skin condition that plagues more than 15 million people in the U.S, mostly children.

Stephanie's mother, Jacqueline, learned that NYU was looking for eczema sufferers to participate in clinical trials and began bringing her daughter from their home in Middletown, New Jersey, to the NYU Medical Center each week to help test a new ointment that appears to be the first significant step in treating eczema in decades. "It's a major advance," says Dr. Irwin Freedberg, chairman of the dermatology department at NYU School of Medicine. "It's a totally different approach, interfering with parts of the immune system that are really the effectors of what you see on the skin."

Eczema is an immunological reaction to physical or psychological irritants. (Because heat, stress, and airborne irritants are among the worst offenders, Dr. Freedberg says that dense urban environments like New York City can be especially hard on eczema sufferers.) Since 1960, the only significant treatment for eczema has been topical cortisone, a steroid-based cream. Cortisone sometimes causes side effects like burning, thinning of the skin, and the visible appearance of blood vessels near the surface of the skin, and kids are often steered away from using it because of its steroid content. "Every time I went to a dermatologist," says Jacqueline, "they gave me cortisone, cortisone, cortisone. She's little. I don't know the long-term effects."

For the past two years, NYU has been one of the lead test centers in the U.S. for clinical trials of several ointments. The one used by Stephanie is made by Fugisawa Healthcare of Japan. It's the first steroid-free topical ointment that suppresses the reaction of the immune system on the skin's surface. It was approved by the FDA in December, and became available under the name Protopic just last month.

And not a moment too soon. "When we first went into NYU," explains Jacqueline, "she was covered everywhere except her trunk." And during the summer, her skin was splotchy-looking, because areas affected by eczema don't tan. But after a year of applying the ointment once a day as needed, her skin looks better than it ever has. And while some people experience slight burning as a side effect, Stephanie has not. "She can sleep a whole night now without itching," says her mom. "And she's not as cranky."

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