Physician Group Says No to Kittens in Medical Training

May 25, 2012

May 25, 2012 — A medical watchdog group wants Albert Einstein Medical Center (AEMC) in Philadelphia, Pennsylvania, to stop using anesthetized kittens to teach pediatric residents how to intubate newborns for the sake of feline well-being and better training.

The group, the Physicians Committee for Responsible Medicine (PCRM), asked a branch of the US Department of Agriculture (USDA) yesterday to investigate the use of kittens in the center's pediatric residency program. The PCRM said that the medical center is violating the Animal Welfare Act, which governs healthcare facilities that use live animals for research, testing, or training. The USDA's Animal and Plant Health Inspection Service (APHIS), the recipient of the PCRM request, polices compliance with the law.

The PCRM maintains that intubating kittens can injure or kill them. AEMC issued a statement to Medscape Medical News saying that kittens are not harmed by pediatric residents practicing endotracheal intubation on them, and that the animals are eventually adopted by individuals and families.

The action taken by the PCRM is part of its nationwide campaign to remove animals from medical research and training. The group has sought to end experiments on marmosets at Harvard Medical School in Boston, Massachusetts, and the use of pigs in trauma-care training at Baystate Medical Center in Springfield, Massachusetts.

On the kitten front, the PCRM has targeted not only AEMC but also the University of Washington and the University of Virginia. In its letter yesterday to the APHIS, the PCRM said that 192 of the nation's 201 pediatric residency programs rely exclusively on nonanimal methods — namely, programmable human-patient simulators — to teach endotracheal intubation.

One such simulator — the SimNewB — was developed in partnership with the American Academy of Pediatrics (AAP).

AAP spokesperson Deborah Jacobson said that the medical society has no official policy on the use of kittens in intubation training. The use of mannequins and simulators is recommended by the Neonatal Resuscitation Program, a joint venture of the AAP and the American Heart Association. However, the program "leaves the decision to local institutions to determine the most effective method for teaching," said Jacobson.

John Pippin, MD, the chair of the PCRM, told Medscape Medical News that any institution that decides to use kittens is "stuck in the past" because simulators are better.

"If they [AEMC] truly believe that using kittens enhances the training of residents, they're behind the curve," said Dr. Pippin. "They're not up to speed."

The Case Against Kittens

Advocates of animal-free medical training point out that except for their diminutive size, kittens and human newborns differ significantly when it comes to oropharyngeal anatomy. As a 2009 article in the Journal of Emergency Nursing noted, kittens have a proportionately longer tongue and a larger epiglottis than neonates and fully developed teeth, among other differences. In contrast, the SimNewB simulator matches a neonate anatomically. Instructors also can program it to mimic crying, coughing, and chest movement.

"It turns blue when it doesn't have enough oxygen," said Dr. Pippin.

He also said that during an emergency, clinicians frequently do not have enough time to anesthetize a neonate before intubation. Residents, therefore, benefit from practicing on a simulator that responds like a conscious baby does "instead of an unconscious, anesthetized kitten."

In an email to Medscape Medical News, AEMC said that it, too, uses plastic models and simulators to teach intubation to new physicians. "Einstein…believes the teaching of safe airway management skills is enhanced by the use of other methods to care for premature neonates — some weighing as little as a single pound," AEMC stated.

Dr. Pippin said he has heard such arguments before.

"They say working with live tissue adds to the training experience," he said. "But there's no evidence for that."

Meanwhile, there is the question of animal cruelty. An intubated kitten can experience tracheal bruising, bleeding, scarring, airway swelling, and severe pain, according to the PCRM. And some die.

"Unless you think kittens are a piece of lab equipment," said Dr. Pippin, "it's unethical in our view to keep them captive and use them to their detriment."

Dr. Pippin said that if the USDA inspection service investigates AEMC and concurs with his group's charges, it would probably ask the medical center to establish a new training protocol — and retire the kittens.

"The PCRM is not interested in penalties or punishment," he said. "What we are interested in is best practices."

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