Many doctors remember their first experience cutting the flesh of a live mammal – perhaps a dog – sometime during their first four years of medical education. That experience often came as required laboratory exercise in a physiology or pharmacology course, or in a surgery clerkship. In some cases, the aspiring doctors were required anaesthetize a healthy dog and cut it open to display its functioning organs, a sight one would imagine that is difficult to forget.
But, citing student demands for earlier access to live patients and animal rights issues, a 2001 study by Dr. Lawrence Hansen of the University of California San Diego medical school shows the majority of medical schools no longer even offer live-animal labs, and those courses that still offer the labs tend to make them optional.
According to the survey, some schools have axed the labs because their costs have increased. Other schools have adjusted their curriculums to accommodate a rapidly expanding body of medical knowledge to doctors-in-training. The use of live animals in medical education has plunged in fewer than two decades, and while the changes delight some animal advocates, some instructors say they fear it shortchanges students.
The traditional medical school curriculum includes pre-clinical courses in anatomy, physiology and biochemistry in the first year, followed by pharmacology and pathology in the second. In the third and fourth years, students typically work with patients in clinical work. Live-animal labs were once a nearly universal part of traditional medical school curricula.
By the 1970s, however, students’ desires to work with live patients sooner forced many medical schools to rethink their curricula, according to Dr. Kenneth Ludmerer, a historian of United States medical education. The schools began to treat students like customers, Ludmerer said. Students demanded, among other things, earlier access to live patients and curricula that reflected the growing knowledge in genetics and molecular biology. And the schools provided it.
Dr. Michael Stryker, chairman of the physiology department in the medical school at the University of California, San Francisco, said students wanted access to patients and the more fundamental understanding of medicine that access would provide over what they saw as the limited benefits of time-consuming live animal labs. As a result, his school has slashed the amount of time students spend on classical physiology topics and in physiology labs, allowing students to work with patients earlier in their education, he said.
Meanwhile, other forces were rising to combat the use of live animals for different reasons.
By 1986, the American Medical Student Association, the oldest and largest independent association of physicians-in-training in the United States, responded to member concerns by issuing a statement on the use of live animals in medical education. While generally defending the value of live animals in medical research, the association urged schools to use films, videotapes and computer simulations as alternatives for concerned students. The association cited poor care for lab animals and faculty intimidation of students as particular problems with the use of live animals.
External forces have also contributed to the reduction in live-animal labs in many medical schools. Animal activists pushed for state and local legislation that would mandate that schools obtain animals from breeders rather than pounds. Such legislation has increased the price of obtaining, transporting, caring for and disposing of practice animals.
In the 1970s, similar legislation forced the medical school at the University of California, Los Angeles to switch from pound animals to animals from dealers. The school also switched from dogs to cats in their physiology labs because the felines were cheaper, but ended even the cat labs because of political pressure on the dean, according to Kenneth Roos, a professor of physiology at the school.
A 1985 federal Office of Technology Assessment survey found that 80 percent of medical schools used dogs or other animals in their regular courses, mostly in pharmacology, surgery and physiology.
Hansen’s 2001 survey published in the journal Academic Medicine showed only 32 percent of U.S. medical schools continue to use live animals in any courses in those three disciplines – a decline of nearly 50 percent in just 16 years. The 2001 survey also found that of courses in those disciplines that use live animals, more than half offer alternatives of some sort. Pigs now outnumber dogs as the most frequently used animal, according to the survey.
Recent advances in computer technology have convinced some faculty skeptical of other alternatives to live animal practice. Roy Schneider of Ohio Medical College, who creates illustrations for simulation software, said faster processing speeds, general improvements in computer graphics and better attempts to understand the needs of medical school faculty have led to ‘the vast majority’ of schools using high-tech products as substitutes or complements to live practice animals. Schneider said he believes younger faculty more familiar with computers adopt such technology more easily and are more open to ending animal labs.
Schneider said simulations have advanced to the degree that some now offer repeated starts, stops and reviews of simulated dissections of humans and other species in addition to close-up looks at things like the contraction of the muscles that cause facial expressions.
Students can also feel pulses and practice needle sticks on ‘human patient simulators,’ programmable mannequins that have even caused students to cry when they ‘die,’ Schneider said. These mannequins often have simulated diagnostic equipment attached to them, allowing for closer study of treatment in a clinical setting.
Schneider conceded that valid concerns about tactile experiences remain and that realistic artificial tissues for education are some time off, but he contends that for some exercises the simulations are best used as review before unleashing the students on actual tissue.
Some medical school faculty are expressing concern that medical students who do not work with live animals are being shortchanged in their medical education. UCLA’s Roos said he believes that students who do invasive procedures have a better appreciation of physiology because nothing demonstrates the variability in structure and response as live animals do. Roos noted that even instructors, after decades of practicing medicine and teaching animal labs, learn new things by participating.
UCSF’s Stryker has a different concern. He said he fears that students finishing medical school tend to see themselves as consumers, rather than as producers, of medical knowledge. Stryker worries student who are not research oriented will have greater difficulty responding to those who oppose the use of animals in medical research because they will be less likely to view the use of animals as an integral part of medicine.
A 1994 study at the University of Chicago medical school and published in the American Journal of Physiology tested cardiovascular physiology instruction for first-year medical students and found that students ranked computer simulations higher than animal demonstrations. The study also concluded, with some caveats, that at ‘the introductory level, the computer appears to provide an effective alternative.’ Stryker said he believes the study simply shows that alternatives to live animals are popular – not that they are effective.
Despite the decrease in the use of animals in physiology, pharmacology and surgical clerkships, the use of live animals in medical education as a whole may actually be increasing. Tony Mazzachi, of the Association of American Medical Colleges, says he believes the numbers of animals such as mice used for extracurricular research during medical school and for graduate work in surgery or pharmacology are climbing. Mazzachi said he thinks it is misleading to suggest, as some animal activists do, that the average student becomes a practicing doctor without working with live animals.
It seems certain that computers will continue to get faster, and simulations more realistic. There is no sign that students plan to let their schools retake control of their curriculum, nor that faculty will be freed from research and grant writing to spend more time in live-animal labs. The molecular-level research that feeds the medical curriculum is continuing apace. Yet there may be limitations on what alternatives to traditional live-animal labs can provide. As such, live animal labs may never disappear completely from med schools, but their role seems more likely to continue to decrease than to reassert itself. Nobody claims that students are becoming doctors unprepared to practice medicine. The real question may be how, years from now, doctors who do not have experience with live animals will react to those who oppose their use in research.
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