n engl j med
curred by consuming beef, but they should press
authorities to test more cattle, to strengthen the
regulations on feed production, and to extend the
ban on brain and spinal cord in food for human
consumption to include cattle younger than 30
months of age.
From the Department of Infectious Disease Epidemiology, Imperi-
al College, London.
BSE: homepage. London: Department for Environment, Food
and Rural Affairs (DEFRA), 2003. (Accessed January 16, 2004, at
Anderson RM, Donnelly CA, Ferguson NM, et al. Transmis-
sion dynamics and epidemiology of BSE in British cattle. Nature
1996;382:779-88. [Erratum, Nature 1997;384:302.]
Ferguson NM, Donnelly CA. Assessment of risk posed by
bovine spongiform encephalopathy in Cattle in Great Britain and
the impact of potential changes to current control measures. Proc
R Soc Lond B Biol Sci 2003;270:1579-84.
Monthly Creutzfeldt-Jakob disease statistics. London: Depart-
ment of Health, 2004. (Accessed January 16, 2004, at http://www.
At 10:30 p.m. on December 1, 1982, a retired dentist
named Barney Clark was wheeled into an operating
room at the University of Utah Medical Center in Salt
Lake City. Clark, who was 61 years old, had end-
stage congestive heart failure. When his condition
acutely worsened that night in the middle of a heavy
snowstorm, his doctors decided to press ahead with
the world’s first implantation of a permanent artifi-
cial heart. By the time the seven-hour operation was
over, it had unleashed a blizzard of a different kind.
By all accounts, when Clark was hospitalized in
late November, he was at the end of his life. For
months, he had had virtually intolerable shortness
of breath, nausea, and fatigue. On Thanksgiving
Day, family members had to carry him to the dinner
table at his home in Seattle, but he was unable to eat.
In the intensive care unit in Salt Lake City, he was
placed in a dark room, and visitation was restricted
because doctors feared that any sort of excitement
could precipitate a life-threatening arrhythmia. In
the words of William DeVries, the lead surgeon, and
his colleagues, whose landmark report appeared 20
years ago this week in the
imminent within hours to days.”
Because of his age and severe emphysema, Clark
was not eligible for a heart transplant. When his