Medical Schools Stop Using Dogs and Pigs in Teaching; Training of future doctors now largely depends on new technologies rather than lab animals
by Katherine Mangan, The Chronicle of Higher Education (12/10/2007)
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Medical students who have qualms about practicing their surgical skills on dogs and pigs no longer have to worry that refusing to participate will hurt their grades. In most cases today, the medical schools themselves are opting out of live-animal teaching labs.

Although animals are still widely used in research, only a dozen of the nation's 125 accredited medical schools still use live animals to teach skills in physiology, pharmacology, and surgery. That number is dropping fast: nine schools stopped in the past year alone.

Medical educators say three main factors have prompted the shift: the increasing availability of realistic alternatives, such as interactive computer simulations, cadavers, and lifelike mannequins; students' ethical concerns about using live animals; and the expense of staffing and maintaining animal labs.

One of the leading advocates of the change is John J. Pippin, a cardiologist and a former medical researcher at the Medical College of  Virginia and the University of Oklahoma, who now works with a group called the Physicians Committee for Responsible Medicine. He has been writing to medical schools that use animals and urging them to stop.

Medical students can test drug interactions, for example, on mannequins with anatomically correct airways, pupils that constrict and dilate, and heart and lung sounds. The devices are programmed to show human responses to dozens of drugs.

"You can correct your mistakes as you go along, rather than giving two to three drugs to a dog, recording what happens to the heart rate, and then killing the dog," he says.

What's more, Dr. Pippin argues, animals' responses don't necessarily mirror those of humans, and simulated humans and even cadavers provide more-reliable measures of results. Surgical trainees can practice on mannequins equipped with fake blood and simulated tissue layers.

Those options weren't available to Dr. Pippin in the late 1980s, when he was a graduate student at the University of Texas Southwestern Medical Center at Dallas. He says he had a grant from the American Heart Association to conduct a study in which he induced heart attacks in dogs and monitored their responses using imaging technology.

When he realized that he was scaring and hurting the animals without learning anything that directly translated to humans, "it was a real epiphany for me," Dr. Pippin said in a telephone interview punctuated by barking from one of his nine rescued dogs. "I felt my career was a fraud."

Defending the Use of Animals

Some medical professors, taking issue with the Physicians Committee for Responsible Medicine, say its name is misleading. Far from being an impartial advisory group, they say, it is an animal-rights advocacy group with ties to the controversial group People for the Ethical Treatment of Animals, a connection that Dr. Pippin denies.

"Only about 5 percent of their members are physicians, and I refuse to respond to them until they change their name," says Robert G. Carroll, a professor of physiology at East Carolina University's Brody School of Medicine.

Dr. Carroll, who leads the committee that oversees the use of animals at the school, challenges the estimate that only a dozen schools still use animals for teaching. He believes that at least half of them do so in at least one lab, but that many are reluctant to divulge that for fear of angering animal-rights activists.

At East Carolina, fourth-year medical students practice life-support skills on pigs in an advanced trauma lab. No matter how realistic a computer simulation, Dr. Carroll says, it won't give a student hands-on practice in serting an endotracheal tube when a patient's airway closes, or stanching severe and potentially fatal hemorrhages.

"I don't agree with the argument that it is morally reprehensible to use animals for teaching purposes," as long as the animals are well cared for and properly anesthetized during surgical procedures, he says. "I believe faculty members should have the option to use animals if it meets their educational goals."

That's the same stance taken by the Association of American Medical Colleges, says a spokeswoman, Retha Sherrod.

Labs Without Pigs

Among medical schools that have recently given up the use of animals in training, the St. Louis University School of Medicine has discontinued a cardiovascular teaching lab that had used live pigs, and a teaching hospital affiliated with the State University of New York at Stony Brook has dropped its last animal teaching lab.

It did so after receiving a letter from the Association of the Bar of the City of New York warning that the hospital might be violating the federal Animal Welfare Act, which requires medical schools that use live animals in teaching labs to demonstrate that they have adequately explored nonanimal alternatives.

The Stony Brook affiliate, Winthrop-University Hospital, used live pigs in a surgery lab geared toward medical residents but open for observation by fourth-year students. The trainees practiced performing laparoscopic surgery on the pigs, making small incisions in the abdomen And inserting surgical tools to repair injuries.

The U.S. Department of Agriculture cited the program in March for failing to adequately document its efforts to find acceptable nonanimal alternatives, a problem the hospital corrected by turning over additional records.

But in July pressure on the medical school escalated with a letter, not from students or animal-rights groups, but from two officers of the bar association: Jane E. Hoffman, chair of its Committee on Legal Issues Pertaining to Animals, and Joyce Tichy, chair of its Committee on Health Law.

"We strongly urge you to discontinue the use of live pigs in your physiology and surgery laboratories on legal, scientific, and ethical grounds," the lawyers wrote. They described how other medical schools used simulators in surgical training, and interactive computer models to show students how to measure heart rates, blood pressure, and the effect of medications on patients.

Continuing an outmoded practice that results in "the suffering of sentient beings" could also violate the Animal Welfare Act, the letter stated.

A similar letter was sent in June to New York Medical College, the other medical school in the state that still uses live animals in the curriculum.

Officials there declined to comment but said a committee had been assigned to evaluate the school's use of live animals in physiology and surgery labs.

The letter writers relied heavily on statistics provided by the Physicians Committee for Responsible Medicine, Ms. Hoffman said in an interview.

'Not a Veterinarian'

As advances in technology make alternatives more educationally sound, the pressure to drop animal labs is increasing. An article last month in Academic Medicine, the journal of the Association of American Medical Colleges, said animal use in the undergraduate medical curriculum had "dropped dramatically."

In March the American Medical Student Association approved a resolution that "strongly encourages the replacement of animal laboratories with non-animal alternatives in undergraduate medical education."

For years students have had the option of skipping animal labs if they objected to them, and a small percentage of students have done so.

Jeffrey Tomasini, a second-year student at the Medical College of Wisconsin, says he opted out of a physiology lab in which students opened an anesthetized dog's chest, placed catheters in the heart, and injected it with drugs to see how the dog reacted. Aside from his ethical objections to the exercise, "I don't care what a dog's heart looks like," he says. "I'm not going to school to be a veterinarian. I'm interested in human hearts."

But some educators wonder whether a computer model or a rubberized mannequin can adequately prepare would-be doctors for the first time they are responsible for the life of a living, breathing human patient. As distasteful as the prospect might be, these professors and students believe that animal labs deserve a place in the curriculum.