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- An Intimate Exam
Animals in the Med School Classroom
Every time a medical school stops using live animals in the classroom, as New York Medical College announced it would do last month, John J. Pippin, a Dallas cardiologist, updates his spreadsheet. An adviser for the Physicians Committee for Responsible Medicine, a nonprofit group that pushes universities to use alternative methods of instruction, Pippin proudly notes that his list now tilts heavily toward the category “School with No Live Animal Use in Medical School Curricula.”
While animal research is still common, there's general agreement that fewer schools now offer animal laboratories, in which dogs or pigs are given anesthesia and then euthanized following the lesson, than was true decades ago. Just how many institutions still engage in this practice is ripe for debate. According to Pippin's group, the answer is fewer than a dozen -- and about that many have stopped using animals in classroom demonstrations since last year.
But some question that data. Robert G. Carroll, a professor of physiology at East Carolina University's Brody School of Medicine, says he has anecdotal evidence that shows such labs are far more prevalent. He recently asked a group of medical school professors whether their students had the option of participating in animal laboratories, and says 15 to 20 instructors raised their hands.
Alice Ra'anan, director of government relations and science policy at the American Physiological Society, says the figures depend on the question asked: Counting the number of medical schools that have a lab incorporated into a basic science course will yield a different result than totaling the number that incorporate some kind of experience with animals into their curriculums (exposure to research on animals, for instance), she says.
Groups such as the American Physiological Society don't keep count of the number of animal labs, but do release position statements on the subject. The study of living systems is "an essential component of physiology instruction," the APS's statement says, adding that teaching laboratories that actively engage students in interacting with and observing how living systems work provide experiences that are "qualitatively and quantitatively different from those gained through lecture, small group discussion, or multimedia presentations."
Position statements from the American Veterinary Medical Association and the American Medical Association trumpet the roles animal labs play in research, testing and education that improve the health and welfare of humans. While the groups say such practices must be allowed, they maintain that experiments should be painless for animals and that replacing animals with other methods should be done whenever educationally possible. The AMA stresses that medical schools, when using animal labs, should make clear the learning objectives so that students know why it's necessary for the animals to be used in the classroom.
The American Medical Student Association recently issued a statement encouraging the replacement of animal laboratories with non-animal alternatives in undergraduate medical education, and arguing that all medical school classes and labs involving animals should be optional for students -- a practice that is widely followed.
Medical schools have longed used animal demonstrations in physiology courses to show how, for instance, the cardiovascular system works, and in surgery rotations to show what types of situations students are likely to encounter. Dogs and pigs typically were considered optimal because of their size, but institutions have phased out the use of dogs, in some part due to pressure from animal advocacy groups.
Ra'anan says there has been a decline in animal use in physiology courses since the 1980s. The primary reason, she says, isn't the outside pressure but the cost. Purchasing the animals is expensive, and many teaching labs require handfuls of faculty members to be on hand to take students through lab demonstrations. Schools are more frequently turning to simulators, which are increasingly lifelike, sometimes cheaper and, because of technological advances, can help demonstrate lessons that would have required animals in the past. (On the high end of the scale, instructors can control the emotional or physical responses of the simulated patient on which students are operating.)
And it's hard to discount the increasing pressure applied by groups like the Physicians Committee for Responsible Medicine. (More on that later.)
Moving Away From Animals
New York Medical College, as noted earlier, is ending the practice of using live dogs to teach cardiology and will instead use simulation tools. Instructors can demonstrate physiology principles using echocardiograms, which allow a class to watch on a video monitor heart activity of a student hooked up to the machine.
The cost of running the labs and the pressure from outside groups motivated the college to shutter its animal lab, said Donna Moriarty, a college spokeswoman. She said questions of ethics weren't a driving force in the decision.
Case Western Reserve University's School of Medicine, which used dogs in the past, has discontinued that practice, officials say, and Washington University's School of Medicine is not offering a pig lab this year, although it's unclear whether the program has stopped indefinitely.
Pippin said while his group is pleased with the recent announcements, it wants to see an outright end of the use of animals in the medical school classroom. Institutions often pride themselves on providing humane treatment of the animals prior to and during the labs. Pippin said some schools still purchase animals from so-called "class B" dealers, brokers who acquire animals from pounds and other locations and then sell them for a profit. The medical student association has condemned the use of household pets found from pounds, shelters and the class B dealers.
Central to Pippin's argument that animal labs should be extinct is his belief that simulation technology has come a long way.
"We think not only is it unjustifiably cruel to kill animals, but students who go to school where they get this training are getting an inferior education to those who use alternative methods," Pippin said.
Ask students, he added, and they will choose the use of simulators, which make increasing sense in an age when curriculums reflect changes in medical ethics, he argues.
"It's part of the teaching of humane medicine," he said. "The message is that you don't have to kill your first patient."
Defending the Practice
Still, even some institutions that have gone away from using animals still defend the merit of the exercise. No professor or college official interviewed said that their institution's decision to make curricular changes was based on new findings that the animal lab isn't an effective method of teaching.
“Animal labs are still the best methodology," said Moriarty, the New York Medical College spokeswoman. "Living systems are the best way for medical students to learn about the body. Dogs and pigs have a tremendous number of characteristics that can be likened to humans."
Jim Newman, a spokesman for Oregon Health and Science University, agrees. The institution uses pigs in one popular elective course because the educational benefits of studying live animals are unmatched by other training methods, he said.
Newman disagrees with Pippin's assessment of student preference. Nearly three-fourths of students at Oregon's medical school opt to take the course that includes animal demonstrations, he said. The same trend holds true at the Medical College of Wisconsin, where the animal lab component of a physiology course (including the use of pigs, rats and frogs) regularly receives the highest score on a survey asking students to rate the educational benefits of each nine sections of the class, said Richard Katschke, associate vice president for public affairs.
And as many medical school faculty note, sections of a course that include animal demonstrations are typically not required. The Medical College of Wisconsin's section is optional, although students need to show a mastery of the material covered in the lab. That's also the case at the University of Wisconsin School of Medicine and Public Health.
At Johns Hopkins University School of Medicine, students can choose not to attend the part of the class where pigs are used for training, but it is highly recommended that they do, as the course is a requirement. Richard Bianco, an associate professor of surgery and director of experimental surgery at the Medical School at the University of Minnesota, said opting out of the live animal labs is "not a good idea" for students who are considering becoming surgeons.
"We want students to feel real tissue," he said. "You can't learn how to tie up a blood vessel with a high degree of accuracy unless you're under real pressure and have blood on your gloves. Technology can only go so far. I want the next generation of doctors to be properly trained."
Carroll, the East Carolina physiology professor, shares the view of many of the medical school faculty interviewed that the growing number of schools moving away from the animal labs are doing so for reasons other than ethical concerns.
Added Nicholas Benson, vice dean of the East Carolina medical school: “The primary driver is now and always has been what’s the best way to give the information to the student."
But Ra'anan said there's more at play. She's concerned that some colleges are making decisions about whether or not to discontinue animal labs based on external threats.
"Unfortunately, there's so much pressure being brought to bear that it makes it difficult for schools to provide that educational experience," she said.
While several medical school officials interviewed said outside pressure has been noticeable, others said external campaigns played no role in the decisions.
Some officials also take issue with the Physicians Committee for Responsible Medicine, noting that the group is involved in animal-rights advocacy (with ties to People for the Ethical Treatment of Animals) and is not an impartial observer, as its name would indicate. The committee denies that label, and a PETA spokeswoman said there is no formal relationship between her group and PCRM.
Ra'anan said it's important to keep the big picture in mind. The discussion about the animal lab is one part of a broader conversation about the medical school curriculum. In some cases, if there is limited time to teach the basic sciences, it can be hard to justify a time-consuming and resource-heavy animal lab, she said.
But it's common, she said, for physicians to report that participating in a research project or observing a lab involving an animal sparked their interest in physiology.
"We're looking to nurture the next generation of of physicians, so we need to look at questions like are we giving students the opportunities that would encourage them to go down that path?" she said.
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