Last summer, Lt. Col. Michael Ricci, a National Guard reservist, landed at a hospital outside Baghdad and began treating gunshot wounds and other trauma cases. It wasn't his usual line of work. Ricci, who started his career at Fletcher Allen Health Care in 1989, is a vascular surgeon. That means he usually focuses on blood vessels, not punctured vital organs.
To prepare for his trip, the doctor had taken a course called Advanced Trauma Operative Management, or ATOM, at the University of Vermont's College of Medicine. During the one-day course, surgeons operate on wounded pigs. Ricci, who has since returned from Iraq, patched a bleeding swine heart under the supervision of a local cardiac surgeon. The collaboration was invaluable, he said, "because I don't really know what options I'll have in Iraq to fix a hole in the heart."
For $1500, ATOM offers practicing surgeons like Ricci a quick yet intense refresher in basic trauma-surgery techniques. Supporters of the course say it is a useful primer for surgeons who work in war zones and rural regions. But animal-rights advocates, as well as medical students and faculty around the country, believe ATOM and other live-animal training sessions have no place on college campuses.
Last Wednesday, about 20 bandana-clad protestors showed up at UVM to protest ATOM, which the college has offered three times this year. The course relies on a "porcine operative experience," which involves 50-pound anaesthetized pigs, surgically punctured, operated on, and then later killed.
Among the activists carrying signs with messages such as "PIGS ARE NOT TOOLS" and "NOTHING IS LEARNED FROM TORTURE" was Adam Bister of Vermonters for Immediate Animal Liberation. He wondered: "How much can you really learn from a pig about humans? If we want to learn about humans, we should study human anatomy."
Indeed, the nonprofit Physicians Committee for Responsible Medicine (PCRM) reports that, since 2001, when ATOM was first conceived at the University of Connecticut, 32 accredited medical schools in the United States have stopped using live animals in their curricula. At the moment, only eight out of 154 do so, and two of those are slated to close their labs next month.
A lengthy article on the issue in The Chronicle of Higher Education last October noted several factors driving the shift away from live-animal training, including lab costs and students' ethical concerns. There is also an increasing number of teaching alternatives, such as computer simulations and sophisticated mannequins.
"We've got to overcome the inertia of the old way of doing things," said John Pippin, senior medical and research advisor for PCRM, in an interview last week. " One way to overcome that inertia, he suggested, is a new technology being developed at the University of Arkansas that pumps blood through cadavers. "They are just like live patients," Pippen noted.
Not likely, said Michael Ricci, who hasn't heard of the so-called profusion pump. You can't simulate the feel of real tissue using anything but a live organism, he asserted, and pig hearts are the closest you get to human ones.
Nonetheless, according to a UVM lab technician who spoke with Seven Days on the condition that his name not be published, some faculty and employees at the medical school do question the ethics of using live pigs for surgical training.
Carol Whitaker, UVM's assistant dean for medical communication, stressed that ATOM is for practicing surgeons, not medical students. About 20 universities, including two in Canada and one in West Africa, offer the training, which was designed to counter a nationwide decline in "penetrating" trauma cases. A preliminary study by a medical journal specializing in trauma concluded that, despite ATOM's "controversial" nature, surgeons who have taken it showed "significant increases in self-efficacy."
In October, the American College of Surgeons assumed sponsorship of the program. A spokesperson for the organization declined to comment or provide any information about it. Mary H. McGrath, vice president of ACS's Board of Regents, did not return repeated phone calls.
Whitaker said she's familiar with such alternatives as the profusion pump. In fact, she said, the university receives federal grants to purchase surgical simulators and supports related research into non-animal training devices.
But pumping blood through cadavers doesn't adequately reflect a real trauma situation, she said. "Difficult as it is to justify, [ATOM] absolutely helps to save peoples' lives."
Students and animal-rights activists at last week's protest said they were moved to act when they heard the next ATOM course was scheduled for early June. Whitaker, however, said no course has been scheduled. As of Tuesday, the school's ATOM website had apparently been shut down.
Whitaker denied a request by Seven Days to visit the lab where the training takes place, saying it is not a public space. Asked where UVM gets its research swine, Whitaker replied, "We get them at the same place where we get all our research animals."
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