Medical Students: Not Tested on Animals

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In
recent years, a number of medical schools have changed the way they
train students to perform surgery. Whereas medical students previously
received surgical experience on animals before moving on to human
patients, the use of animals in these schools has been quietly dropped.
Now the first surgical experience students at such schools get is
when they operate on a human patient. Given that such a change in
training affects us all, it is important to examine its consequences.

For
generations, all medical students were required to take a laboratory
course in medical physiology that involved hands-on experience with
living animals. The course typically began with the study of basic
physiology in animals such as frogs, turtles and rabbits. It then
moved on to the intensive study of physiology using dogs, which
were usually obtained from a pound.

It
was in the "dog labs" that students learned the basic
techniques of surgery they would later apply to humans. And there
were many techniques to learn. First, it was necessary to anesthetize
the animal and students soon became accomplished in the intravenous
injection of anesthetic solutions (for the animals were never allowed
to feel any pain). Next, the animal was placed on a respirator and
the technique of inserting a breathing tube into the trachea was
mastered. When it came time to operate, students tended to underestimate
how hard they needed to press with a scalpel and skin incisions
in early surgeries were usually imprecise and bloody. Over time,
students learned to make neat and precisely placed incisions with
a minimum number of strokes. But the most important aspect of training
was yet to come, one that no anatomical model or computer program
can duplicate, and that was the control of bleeding.

The
key to successful surgery is quite simple; it's the control of bleeding
– hemostasis. Obviously, uncontrolled bleeding can be life-threatening
to the patient if the amount of blood loss becomes too great. However,
even a small amount of bleeding can be a serious problem. This is
because blood can obscure the surgical field making it difficult
for the surgeon to see what he or she is doing. When this happens,
it reduces the precision with which the surgeon operates and lengthens
the time it takes to complete the surgery.

The
way one learns to minimize surgical bleeding is the same way that
any complex skill is mastered – through practice. This was
exemplified by my own training in neuroscience in which I learned
to perform animal neurosurgery under the direct supervision of an
experienced neurosurgeon. The first few surgeries that I conducted,
although considered satisfactory, were accompanied by a small amount
of bleeding, not enough to be life-threatening, but they obscured
the surgical field making it difficult to see exactly what I was
doing. However, I can still remember the first time I conducted
an operation that was virtually bloodless – from start to finish
the surgical field was clear and from that time on virtually all
those surgeries were equally bloodless. Can I explain what was I
doing differently? The answer to that question is no. Learning surgery
is much like learning how to ride a bicycle or play a musical instrument;
while explanations and demonstrations are necessary, ultimately
you must learn by doing. And the skills one acquires in performing
animal surgery transfer to operating on humans – don't let
anyone tell you differently.

In
addition, working with animals allowed me to experiment with new
techniques. For example, I had been taught always to tie off blood
vessels that crossed areas in which I was operating because to go
under them was to risk breaking them. However, I was reluctant to
tie them off as this reduced the blood flow to other parts of the
brain, which could only have a detrimental effect, and so I attempted
to operate beneath them. Not surprisingly, my first attempt broke
the blood vessel and I had to tie it off. But on the next attempt
I found that I was able to operate under major blood vessels without
breaking them, a technique that reduced the general trauma to the
brain and became my standard procedure. Without access to animals,
however, human surgeons can only improve their techniques by experimenting
on their patients – whether to take such risks with patients
is a personal decision.

The
reason the use of animals in medical training is being abandoned,
of course, is because of the animal rights movement. The main impact
of these groups has not been through public protests, but though
lobbying efforts which have resulted in extensive changes in the
Federal Animal Welfare Act and its enforcement by the USDA. By making
it a law that the use of animals for teaching or research should
be minimized, the Federal government has stigmatized such use as
being morally wrong. Moreover, the practical effect of the Animal
Welfare Act has been to greatly increase the cost of using animals
in both the amount of effort it takes to obtain permission to use
animals as well as the cost of acquiring and housing them. When
faced with such costs, as well as demands from some students who
claim moral objections (and are then rewarded with a reduced course
of study that omits animal labs) even the most dedicated teacher
eventually gives in.

So
we have reached the point at which it is considered immoral for
surgery to be taught using animals, but perfectly acceptable to
use human patients, none of whom are aware that they are being used
for training. For when you go in for surgery, you routinely sign
a consent form that allows the surgeon to let others operate on
you. It is ironic that these forms often contain a clause that allows
you specify whether tissue removed from your body during surgery
may be used for future training, while you are given no say in whether
you yourself may be put to such use.

Fortunately,
the solution to this problem is within reach of anybody considering
surgery. If you wish for the surgeons who will be operating on you
or your child to have a particular level of skill, then write it
in on the surgical consent form, which is, after all, a legally
binding contract. For example, you may specify that anyone participating
in the surgery be board certified or that they have previously conducted
a minimum number of similar operations. Alternatively, you might
volunteer to allow a student whose only surgical experience has
been on animals to participate in the surgery, at a reduced price
to you of course. And if you object to the use of animals for medical
training, then you can request that students who are complete novices
be allowed to participate in your surgery thereby personally reducing
the demand for animals in medicine.

But
most importantly, the Federal government must get out of the business
of legislating morality as its attempts to do so result in contradictions.
For example, the government finds it necessary to send troops into
battle all over the world, yet has forbidden military surgeons to
use animals to learn how to treat gunshot wounds. Similarly, the
idea, embodied in the Animal Welfare Act, that the use of animals
in teaching and research is morally wrong and should be minimized,
and eventually eliminated, makes no sense. If it is true that using
animals for our benefit is immoral, then the Federal government
should also regulate our consumption of animal protein and outlaw
foods, such as double cheeseburgers, that contain more than the
minimum protein requirements.

Some
legislators have recognized that increasing the regulation of animals
in research and medical training may have its drawbacks. Thus, the
recently passed Farm Bill contains an amendment that prevents the
extension of USDA regulations to rats, mice and birds
. While
this is a step in the right direction, what is needed is a thorough
examination of the effects of current regulations on both medical
training and research – regulations that have resulted in human
patients being used without their consent as replacements for animals
in surgical training.

July
15, 2002

Dr.
Henry Heffner
[send him mail]
is professor of psychology at the University of Toledo. Visit his
webpage
.

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