Last week we started a multi-part interview with Spencer B. King,
III, M.D. Dr. King worked closely with Andreas Gruentzig, the
founder of PTCA, at Emory University. Dr. King currently heads the
Andreas Gruentzig Cardiovascular
Center at Emory, and next year will serve as President of the
American College of Cardiology.
(Click here to access index of previous interviews.)
Q: When PTCA was first developed, some people thought the idea
was crazy. Now some refer to it as a "paradigm shift".
King: It was, and paradigm shifts don’t happen, you know, every
day. Where does genius fit in? Where does a breakthrough, call it
genius, call it charisma, call it whatever causes people to take a
fresh new look at something. There’s always a place for that. People
get staid. You get grant applications. Everybody’s in a mold of grinding
out and moving in one direction. All of a sudden, some young investigator
comes along and they want to do something very differently, and they
throw out a wild idea. So we need ways for craziness to go on in science
and in medicine.
I don’t know if I would characterize the development of angioplasty
as craziness, but it was a little goofy — if “goofy” is defined
as “what do most people think about it at the time?” — and you reflect
on the poster that Gruentzig showed at Miami Beach in 1976. This
was a dog experiment, ligating an artery, putting a balloon, blowing
it up and restoring flow. I took a look at that, and I’m sure I
wasn’t that different from most cardiologists looking at that, spoke
to Andreas a few minutes and said “Hey, this is kind of interesting
physiology here, but this has nothing to do with atherosclerosis.
You can’t do this! You can’t get by with that!” And if I’m going
to invest my energies into worrying about that, or the other 500
posters out here, I mean, you know.... It takes somebody to take
an idea like that and have it percolate out of a vast sea of ideas,
takes somebody with vision.
Some people
had more vision than others. You know Richard Myler got interested
because he had a prior interest in this subject — thinking about
ways to mechanically open arteries. So if you come in there with
some kind of background, that you’re a little bit interested in
that, it may not sound quite as crazy as it does to other people
who didn’t come in there.
Q: Why did Gruentzig wind up coming to the United States, specifically
to Emory?
King:
Well, Andreas started in vascular intervention, angiology. That
was his field, and certain people got him interested in and moved
him into cardiology. Willi Rutishauser helped him in that regard,
among others in Zurich. But here was a young man, a very young man,
who was developing these ideas about opening vessels and was working
largely in the periphery. Then got into cardiology, something through
the back door, if you will. Began to work in the cardiology unit
there in Zurich, relatively conservative group. And as he became
more successful, probably began to crowd the usual way of doing
things a little bit.
His ambitions
were quite extensive in terms of developing the technique. When
I first met him in Miami Beach, when he showed his animal experiments,
he was just an excited guy developing the science. Within a year,
in 1977, he had done the first case, and then of course the worldwide
attention focused on him. And, as that happened, he wanted to do
more cases. He was limited in the number of cases he could do in
Zurich, lab time, I think he was given about two days in the lab,
that kind of thing.
And so in early
1980, at one of the courses, riding in the train out in the Emmenthal
Valley, to a party, Andreas sat down beside me and started to talk
about his idea of moving to the United States, which was quite far
along, as it turned out. I didn't know about it. But he had discussed
this with others already and he was thinking about where to go.
And I said "Where are you thinking about going?" Just a casual conversation.
Andreas said "Well, Cleveland is a famous place for surgery. And
they do a lot of coronary work. And that's where Sones is. And they're
interested in me and I might want to go there." And he mentioned
Harvard, there had been interest shown. He mentioned Stanford, and
Medical College of Virginia had made an overture. There were places
that were interested in him.
So, as we sat
there on the train, I said "Well, what are you going to do?" And
he said "Well, I don't know." And I said, "What's your goal? What
do you really want to do?" And he said, "Well, I want to expand
the technique. As it goes forward, I see the necessity that it's
going to grow and I'm going to lose control of it. And it may destroy
the technique if it's not done right." He said, "I don't think I
can do that here". So coming to the United States was really a way
to develop this. He said, "I want to teach the technique. I want
to shepherd it, and I want to be a professor."
You have to get inside the European mentality, and being a professor,
you know, is quite something. So I said to him (maybe my friends
in Cleveland will shoot me) but I said, "You know, that's not a
medical school." Certainly at that time. "And therefore you can't
be a professor at Cleveland Clinic. Okay?" So he kind of raised
his antenna and he said "Well, what's your advice?" I said, "Well
have you thought about coming to Emory?" And he hadn't really. And
so, that was the first time I ever thought of it.
Whether it
was the first time he ever thought of it, or whether that
was the reason he was sitting beside me in the train, we'll never
know. But the reasons he wanted to come to the United States were
those that I enumerated. He felt that he had gone about as far as
he could there in Zurich, with the constraints that were on him,
and he needed a freer hand in developing angioplasty
Part
III: In the final segment of this interview, Dr. King discusses
how angioplasty was taught through the medium of live television.
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