Animals in research and medical training

Over the weekend, some readers sent me a link to a story that, presumably, they thought would be of interest to me, given that I graduated from the University Michigan Medical School back in the late 1980s. Specifically, it’s a report that U. of M. has halted the use of dogs in its surgical training:

Surgeons training at the University of Michigan Health System will no longer use live, healthy dogs to learn drastic surgical procedures that can save people’s lives, the university announced Thursday.

The anesthetized animals — obtained from shelters — were used to teach tracheotomies, how to fix collapsed lungs, and other emergency procedures. The animals’ injuries from the procedures forced them to be euthanized.

As anyone who’s read this blog since at least last July knows that I’m a dog lover. Anyone who has any doubt of that should simply go back and read my post about the premature death of our dog Echo last summer, and that should refute all doubts. In fact, it’s because I like dogs so much that I’ve always had a bit of difficulty using dogs in research. I realize that it is not entirely rational. Indeed, as a medical student I experienced a bit of the very training that has now, some 20 years later, come to an end.

The first time I ever dealt with the reality of dogs in medical research and training was when I was an undergraduate doing a summer research stint at at a lab in the Ann Arbor VA Hospital back in 1983. The animal lab was in the basement, and I sometimes had to go to that floor because some of the shared equipment that we sometimes needed to use was down there. I could frequently hear the barking from the animal facility on that floor. One day, I had to go downstairs for something or other. As I opened the door from the stairwell, I was greeted with the site of a dog running frantically towards me. The dog was a black and tan mutt, some sort of medium-sized mix, perhaps with a bit of terrier, and it was terrified, whining and running. I quickly shut the door behind me, and the dog continued running around the corner and down the hall, with two lab techs running behind it, ineffectively trying to corral it. If it hadn’t been for the palpable sense of fear emanating from the fleeing canine, I would have laughed out loud, because the incompetents pursuing it reminded me of, more than anything else, a Benny Hill sketch.

All I could think of was: That poor dog.

My next encounter occurred during my third year in medical school in the very program at U. of M. that is being terminated. Some of the students interested in a career in surgery were allowed to participate in the training exercise at the dog lab. I remember that it took place in a very old part of the medical school campus in what seemed to be the oldest laboratory I had ever seen, some place where Louis Pasteur might have worked, had he been an American and lived in Ann Arbor. The dogs had already been anesthetized and were laid out on operating tables, with endotracheal tubes in place and ventilators running. That means I did not see the frightened dogs being led into the room, having IVs inserted, and then being anesthetized. It was with some unease that I, along with several other students, practiced venous cutdowns, placing chest tubes, inserting central venous catheters, and suturing lacerations. When the session was over, we did not stick around to see the dogs euthanized, and for that I’m very glad. I also remember that all I could think about while working on the dogs was that these were probably once someone’s pets.

In my fourth year, I became interested in transplant surgery. Indeed, I did a two month elective in which I did research in the laboratory of one of the transplant surgeons. As part of my research there, I operated on rabbits in order to remove their livers and perfuse them ex vivo to test various hypotheses, but what really excited me at the time was that I was allowed to first assist in the pig laboratory doing liver transplants. It turns out that pigs are a fairly good model for human liver transplantation, and the transplant fellow there was expected to practice in the pig lab as part of his training and educations. Even more amazing to me as a young, fourth year medical student, I was even invited to accompany the surgeons on organ harvests, during which I got to ride in the helicopter and, once, even in a Lear jet flight to Chicago for an organ harvest. Ultimately, I decided that, whether or not I had what it took to be a transplant surgeon, I couldn’t possibly fulfill my dream of running a laboratory and be a transplant surgeon as well. The surgery, particularly liver transplant surgery, was too technically demanding; the harvests inevitably occurred at night; and the patients were just too sick, requiring more attention that I could give them with anything less than 100% effort.

I’ve written time and time again that I support the use of animals in animal research. However, I can’t help but acknowledge that the use of certain animals is less troubling than others. For example, I am fortunate in that there really isn’t much use for dogs in cancer research. Indeed, most of my preclinical research involves mice or cell culture, and I have no problem using mice. If the research requires it and the question being asked is sufficiently important to human health, I continue to support animal research, the fruits of which have brought us numerous advances in treatment and surgery. But, these days, I’m not as sure about using animals for surgical training–at least not as much as I used to be.

That’s not to say that there are at least a few advantages to using animals rather than simulators or cadavers for training. For some procedures, mainly technical procedures such as tracheostomies cadavers and simulators work just fine. However, for some procedures, there needs to be aspects of a living organism, such as blood flow through blood vessels, in order to do a good simulation. It would be nice for a surgeon in training to practice cannulating real blood vessels, with real blood flowing through them, or how to divide and tie such vessels so that they don’t leak and bleed before practicing on a human patient, even under supervision. No simulator that I’ve ever seen has been able to replicate that.

It is clearly true that societal norms and bioethics have shifted decisively over the years away from the indiscriminate use of animals in research and medical training. Some of this is spurred by fear of the animal rights movement, some of whom use terroristic tactics to pursue their agenda. Speaking with the veterinarians at our animal facility, I’ve learned that they are quite paranoid about protests, invasions of their facility to “free” animals, and even violence. Security to get into the animal facility seems almost as tight as that for entering the White House, with multiple ID checks and card readers. And our university isn’t even one that’s been threatened recently! (Thank you, flyover country!) Certainly, this shift in societal attitudes likely has played a major role in the way that using animals for surgical training has fallen into disfavor, but I suspect one reason may be an even better explanation: Technology.

These days, a lot more surgery is performed using “minimally invasive” techniques. These techniques include laparoscopy and various minimal incision techniques. If there’s one thing about laparoscopy, it’s that it lends itself very well to computer simulation, as well as simulation devices that allow the practice of surgical skills. On the low tech side, there are various boxes into which a laparoscopy camera and laparoscopic instruments can be inserted in order to practice knot tying, suturing, and cutting. On the higher tech side, there are electronic, computer-aided simulators, that give the surgeon a highly immersive experience that approximates the “real thing.” Many of these simulators even incorporate haptic feedback, complete with realistic-feeling variable resistance to motion, so that it feels as though the trainee is really tugging on tissue. Indeed, my own department of surgery is very much into this technology, which it regards as the future of surgical training, not to mention a good way for the department to distinguish itself from other departments, and I’ve played around with these simulators even though I don’t do much laparoscopic surgery anymore. The experience is very impressive. Moreover, having served as an ad hoc reviewer on an NIH study section that reviewed technology grants, I know that what’s coming down the pike will be even more impressive: 3-D combined virtual reality and imaging visualization during laparoscopic surgery.

That’s, why, in the end, I suspect that U. of M.’s decision is probably driven more by technology than ethics. Over the last decade or so, technology has advanced at an amazing pace. At the same time, society has become less willing to cause suffering in animals for purposes that it doesn’t deem sufficiently important. I realize that we’re a bit hypocritical as a society as far as that goes, given how brutal the conditions on industrialized farms and in slaughterhouses can be, but that’s just the way it is. These two forces likely conspired to end the use of dogs in training surgical residents. I have to agree that what has been lost by not using animals anymore to train surgeons is probably not sufficient to have justified the continuation of the program and that it’s likely that U. of M.’s simulation center and simulators such as TraumaMan will only get better and better. My own university is building a new center for medical student and resident training that will house several state-of-the-art simulators, including our department’s laparoscopic simulators.

There is, however, one thing that bothers me about how this came about:

It’s tremendous. All we really wanted them to do was look at it objectively and make a decision. Other schools have done that,” said Dr. John Pippen, senior medical and research adviser for the Physicians Committee for Responsible Medicine, a national animal-welfare group based in Washington.

His group filed a complaint against the university in January with the U.S. Department of Agriculture, claiming Dr. Richard Burney, the surgeon who runs the Advanced Trauma and Life Support class, made false statements about the utility of simulators to justify using animals to the university’s animal-care committee.

The PCRM is anything but an “animal welfare” group. Rather, it is a radical animal rights group tightly affiliated with PETA. Indeed, its former national spokesperson was Jerry Vlasak, whom we’ve encountered on this blog before as the surgeon who has openly advocated the assassination of animal researchers on repeated occasions. The page I just linked to as it currently exists at PCRM no longer mentions Vlasak (gee, I wonder why), but the all-powerful Wayback Machine reveals all, and another page also reveals the connection between the PCRM and Dr. Vlasak. Don’t forget, either, that Vlasak is the one who justified the firebombing attacks on researchers’ homes by animal rights activists at UC-Santa Cruz last year, even going so far as to dismiss the threat to the researchers’ children:

If their father is willing to continue risking his livelihood in order to continue chopping up animals in a laboratory than his children are old enough to recognize the consequences. This guy knows what he is doing. He knows that every day that he goes into the laboratory and hurts animals that it is unreasonable not to expect consequences.

No wonder the PCRM distanced itself from Vlasak, although Vlasak has a long history of spewing similar venom, including when he was the spokesperson for the PCRM. Fortunately, four suspects in the firebombing were arrested last week on terrorism charges. here’s hoping that, if found guilty, the judge throws the book at them. That didn’t stop Jerry from spewing his hate in the wake of their arrests:

None of the four suspects could immediately be reached, but a spokesman for the animal-rights movement, Los Angeles surgeon Dr. Jerry Vlasak, said the protesters should be congratulated.

“We applaud anybody who steps up to the plate,” he said.

Truly, the PCRM is not an organization to be accusing anyone of making “false statements” about anything. Indeed, here are a couple of revealing quotes by Neal Bernard, its longtime President:

Neal Barnard is more circumspect about violence. The Animal Rights Reporter has written of him: “Although he disavows the use of violence, he says that researchers ‘have set themselves up for it’ and ‘have to worry’ about animal rights violence. And in an interview with Washingtonian magazine, Barnard says: “We’re demoralizing the people who think there’s a buck to be made in animal research. And they’re starting to get scared, and they’re starting to get angry, and they’re starting to give way.”

Those hardly sound like the words of an animal welfare supporter; they’re the words of an animal rights activist. Moreover, Barnard has even written letters with SHAC, one of the premiere animal rights terrorist organizations in the world.

The bottom line is that, although it is true that technology and changing mores led to the decision by U. of M. to discontinue the use of the dog lab in medical training, U. of M., like many other research universities, should be wary. The arguments that technology will eliminate the need for animals has more traction when it comes to surgical education than it does when it comes to medical research, but that doesn’t stop animal rights zealots like the PCRM from making the same sorts of bad arguments against animal research, complete with fallacious claims that animal research actually hinders medical advancement and that computer and cell culture models can replace the need for animals. The first argument is a load of fetid dingo’s kidneys, while the second argument is a gross exaggeration. It may be true that someday alternate methods may obviate the need for animal testing and research, but that day is definitely not now. In the meantime, animal research is heavily regulated based on the “three R’s“: reduction, refinement, and replacement.

It is likely that the use of animals in medical education and research will continue to decline, and that is a good thing. As much as I appreciate that it’s probably a good thing that my alma mater has finally decided to close its dog lab for surgical residents, I worry about how it came about. Worse, I fear that the PCRM will not stop there. U. of M. researchers had best be on their guard.