Learning not to kill

New techniques mean medical students can learn without killing animals. Why won't BU get with the program?

by Sarah McNaught

At Boston University, spring is the time for first-year medical students to put their textbook learning to the test. Each week, students break up into groups of three and attend three-hour labs in which a professor straps a rabbit to a table, anesthetizes it, cuts it open, and shows the students how various medicinal injections affect the animal's heart rate and blood pressure. When the lab is over, the animals are killed.

This type of lab has been offered at BU since 1970; this year, 120 of the 200 first-year students participated in the optional experiments. What the students are supposed to walk away with is a clearer perception of the way a human's organs might function under the influence of medications like dopamine and epinephrine. "It's all for the sake of science," says Dr. Benjamin Kaminer, chairman of the medical school's physiology department.

But some students leave the room feeling that they have done a cruel and unnecessary thing. And although the labs are not required (those who opt out can "learn what they need to know from books and drawings," says Kaminer), some students say that their peers and professors seem to expect them to take part.

"I had a rabbit as a pet when I was young, and he didn't look as healthy as the ones I see cut open and killed in the animal labs," says one second-year medical student, who says he attended the labs last year because he saw professors become hostile to students who asked what the alternatives were.

Until about a decade and a half ago, this kind of experimentation on live, healthy animals -- usually dogs, pigs, or rabbits -- was just part of learning to be a doctor. But today, medical schools are finding ways to avoid these senseless deaths. Many students are learning in new ways: by observing real-life operations on humans, for example, and by using sophisticated interactive computer programs. In Massachusetts, according to the Washington-based Physicians Committee for Responsible Medicine (PCRM), only one medical school has refused to adopt the new techniques: Boston University's.

"Live-animal labs are a relic of the past that sends a message to medical students that lives are disposable," says Dr. Neal Barnard, founder and president of PCRM. The group, a nonprofit organization founded in 1985, has sent Kaminer an instructional video on alternative teaching techniques and has taken out an ad in BU's newspaper, the Daily Free Press, calling for "medical education without the pitter-patter of little feet."

But Kaminer says the animal labs are crucial because they put what students learn from textbooks and drawings in perspective -- and allow would-be doctors to observe the organs functioning as a unified system.

"When you limit a student's education to particular procedures, such as cardiac bypasses, the student is not getting a proper grasp of what reality is in the world of medicine," says Kaminer. "No one can tell me that 300 years of scientific development using animals is unproductive."

In recent years, however, there has been "a steady decline in the number of schools using live animals," according to a 1994 study by the Association of American Medical Colleges. AAMC assistant vice president Patricia Green says that half the 126 medical schools in the US now rely exclusively on alternatives to live-animal labs, such as operating-room observation or interactive computer programs. Of the half that still offer animal labs, 40 schools offer one of these more modern alternatives for any student uncomfortable with the live-animal procedures. Only 23 schools still require first-year medical students to attend animal labs.

Harvard is one of the schools that's made the switch, thanks in part to students like Rachel Freelund. When she arrived at Harvard Medical School, Freelund says, she and some of her classmates were appalled to learn that they had to witness the death of a beagle in order to observe the effects of drugs on the body. She had serious ethical problems with killing healthy animals in the name of learning.

Freelund, now a fourth-year student, took her concerns to her physiology professor, Dr. Bruce Zedder, who she says was open to the idea of alternatives. He directed her to PCRM, which helped Harvard update its curriculum so that students could study the effects of medication on the body's functions without killing animals.

Instead of emphasizing animal labs, Harvard now sends students to Mass General, Beth Israel, and Brigham and Women's Hospitals to watch surgical procedures. Although the students are not allowed to take part in operations, they do get hands-on experience in procedures such as administering medication. Four years into the program, more than 100 Harvard students have benefited.

"By observing actual operating-room procedures, medical students will understand what it takes in medicine to truly help people and to attain an outcome that will save a life or improve the quality of life," says Dr. Henry Heimlich, the world-renowned physician who developed the maneuver used to save people who are choking or drowning. "After all, isn't that the goal of a doctor -- to save lives, not destroy them?"

Kaminer counters that in order to save a life, doctors need to understand how the entire body works. This understanding, he says, can't be gained simply by observing surgery on a specific organ. "Students aren't allowed, for instance, to touch a patient in an operating room," he points out. "In a lab, the students can hold the heart and get a true sense for a healthy organ and its function."

Yet students can learn plenty from watching doctors perform operations, says Dr. Michael D'Ambra, a cardiac anesthesiologist at Mass General who heads the Harvard Medical School's operating-room program. In his experience, students who participate in operating-room procedures gain firsthand knowledge of the functions of the heart, lungs, kidneys, nervous system, and hormones.

"The only thing a student can do in a dog lab that we don't cover in the operating room is killing the animal after the observation process is over," D'Ambra says.

Another technique that allows students to gain experience without killing animals is to set up virtual experiments using interactive CD-ROM technology. To some medical school students and professors, these high-tech programs are even more effective teaching tools than animal labs are. Students can work at their own pace, and repeat their experiments until they have a solid grasp of the information they are studying.

"Computer-simulated experiments give the student the chance to control the experiment and repeat it until you understand," says Aysha Akhtar, a third-year medical student at Eastern Virginia Medical School, in Norfolk, Virginia. "Animal labs are a one-shot deal."

"Computer programs allow students to administer a wide range of medications in varying dosages," adds Allen Goldberg, a researcher at the Johns Hopkins University School of Public Health and Hygiene.

"Knowledge doesn't come from computers," responds Kaminer. "A little kid is growing up and experiencing the world through touch and feel. If a kid only experiences a picture of a hammer and nail and then is asked to build a cabinet, that picture is not enough of a tool to know how to make that cabinet."

Some of Kaminer's counterparts at top medical schools disagree, however. Larry Mathers, head of the Stanford School of Medicine's department of anatomy and embryology, says that live animal labs are merely one way to reinforce what students learn in books.

"The administration of drugs and the observation of their effects are just as effectively observed using technology," says Mathers, whose institution eliminated the use of live-animal labs several years ago.

Alternative methods of medical training are also less expensive than animal labs. According to PCRM's Barnard, a single animal-lab course costs between $5000 and $6000 on average.

"There is no cost for [observing] surgery that is being performed anyway," says Barnard. "And the cost of computer technology, which can be reused repeatedly, is much less than an animal used only once."

But neither the financial argument nor the pressure from PCRM is enough to persuade Kaminer. "Yes, labs are expensive. Exercises have been cut down for financial reasons," he admits; each of his labs uses 32 rabbits per semester, at a cost of several hundred dollars per animal.

Yet he remains convinced that when it comes to learning how the body works, there's no substitute for demonstrating on live animals. Not only does he plan to continue the animal labs, but he wants to offer more in the future.

"Sixty percent of my students take the animal labs, and the majority of responses I get are laudatory," he says. "I see no reason to change."

Sarah McNaught can be reached at smcnaught[a]phx.com.