The Rise, Fall, and Laser Resurrection of the "Snake Heart" Operation.

Abstract

In 1964 Bombay surgeon P.K. Sen proposed a new operation for coronary artery disease. His "snake heart" procedure (or "transmyocardial acupuncture") sought to restore a reptilian form of circulation to the human heart. Despite its peculiar therapeutic rationale and limited evidence of its efficacy, the operation was taken up by surgeons around the world. By 1970, however, it had been set aside, done in by critique and a new competitor. Sen's therapeutic concept was surprisingly revived a decade later, not because of a better rationale or convincing evidence of efficacy, but because of the advent of surgical lasers. This case study highlights important features of late-twentieth-century surgery. First, what are the sources of surgical innovation and inspiration? Second, how does science travel? Sen's ability to push his technique onto the world stage was made possible by a Cold War culture of international travel and surgical training. Third, how do doctors judge therapeutic efficacy? Surgeons accepted Sen's operation because of their expansive physiological imaginary and their willingness to consider diverse and subjective therapeutic outcomes. Fourth, what drives therapeutic enthusiasm? Surgeons revived Sen's technique not because of new faith in the procedure but because lasers allowed them to pursue his therapeutic mission with an alluring new tool.