First do no harm

I tell you the truth, whatever you did not do for one of the least of these, you did not do for me. —Matthew 25: 39-40

What does it mean to be a healer? I wonder how much this question gets asked in our schools of medicine today. Doubtless there are many caring and concerned medical students—doubtless they will make fine doctors. But how well does their medical education serve this goal?

I am thinking of the School of Medicine at Duke. As many of you no doubt saw, the Physicians’ Committee for Responsible Medicine has placed several public service announcements in The Chronicle over the last few weeks. I was shocked by the first of these. To my surprise, I found out that Duke is one of the few remaining schools to use live animals in its medical school curriculum. Live pigs are used as practice subjects in the surgical rotation, “where students are instructed in surgical techniques and fluid management in the operative setting using pigs that are anesthetized. The animals are euthanized at the end of the procedure while under anesthesia.” The quote is from the Dean of the School of Medicine, R. Sanders Williams, who was considerate enough to reply to my inquiries. His frankness is appreciated, but I cannot say I find his reasoning persuasive.

While the other nine of the “top ten” medical schools do not use live animals, Duke alone considers it wise to do so. Why? According to Williams, because students must learn how to handle living tissues and because simulations are inadequate for this purpose. I would not deign to challenge his medical learning, which far surpasses mine.

But it makes me wonder. What must the Harvards and Columbias of the world be doing? Are their doctors ill-trained because they do not operate on pigs before working on humans? Harvard developed a cardiac practicum in response to student concerns about the use of live animals, and instead of animal experimentation the students now train by observing humans patients under the guidance of experienced surgeons. Could we not do this here? While others around the country have taken a stand by linking medical training with recent advances in medical ethics, Duke remains mired in a tradition that claims that the suffering of these animals is necessary. The trouble is, we know that is not so. It isn’t that we should follow the crowd, but that the crowd has shown us that what we thought of as “necessary” is not really so.

The Hippocratic Oath, in its modern version, says this: “I will follow that method of treatment which according to my ability and judgment, I consider for the benefit of my patient and abstain from whatever is harmful or mischievous. I will neither prescribe nor administer a lethal dose of medicine to any patient.” The trouble, of course, is that the “patient” drops out when it’s a pig on the table. Who, after all, cares about pigs? Aren’t they ours to use as we wish?

Ask yourself this question, ye people of faith. When you look upon these creatures, the handiwork of God, can you really say that you treat them with the care and consideration they deserve? Did God, in infinite wisdom, make them to be nothing but little test subjects for us? Is this the best we can do for them? Can we really say that we can find no better place for them than on our surgical tables? Is this why they were created?

We know that alternatives exist: 90 percent of the medical schools in the U.S. no longer use any kind of live animals for educational purposes. What makes us at Duke so special? The Hippocratic Oath concludes thusly: “While I continue to keep this Oath unviolated may it be granted to me to enjoy life and the practice of the art and science of medicine with the blessing of the Almighty and respected by my peers and society, but should I trespass and violate this Oath, may the reverse be my lot.” Indeed.