There are a few skills every aspiring pediatrician needs to master. Some, such as remaining straight-faced while insisting that a shot won't hurt, are relatively easy to pick up. Others, like intubating an infant -- a notoriously difficult procedure that involves inserting a plastic tube into a baby's trachea to connect its lungs to a ventilator to help it breathe -- require special training. At St. Louis Children' Hospital, which is affiliated with Washington University Medical School, pediatrics residents practice their intubation skills on live cats and ferrets. And PETA is righteously pissed off.
This week the animal rights organization launched an ad campaign targeting the university, with notices in the Post-Dispatch and in Student Life, the Wash. U. student paper. One ad was deemed too inflammatory by local billboard companies; it will appear at gas stations around Wash. U. instead.
"Intubation is the single most painful process," says Justin Goodman, PETA's associate director of lab investigation. "It can cause swelling and bleeding in the throat and collapsed lungs and death if it's not done properly."
The course in question, Pediatric Advanced Life Support, or PALS, is sponsored by the American Heart Association and is administered at medical schools across the country. In recent years, Goodman says, "dozens of programs," including Texas Tech and the University of Michigan, reported that they have switched from live animals to plastic mannequins, and in a survey of 1300 PALS courses, PETA found no other schools that continue to use animals.
The AHA issued a statement regarding the PALS course in 2009 that read: "The AHA does not require or endorse the use of live animals in any of its training courses." It added that schools that continue to use animals "could be targeted by PETA and will be responsible for responding on behalf of their own business/organization." Dr. Robert O'Connor of the AHA added in a letter to PETA three years ago that "the use of lifelike training manikins for PALS courses is the standard accepted norm."
Goodman says PETA has approached Wash. U. with its concerns -- "We've urged them to align their training with the rest of the country" -- but the university has not responded. Dr. Robert Kennedy, the emergency room physician who teaches Wash. U.'s PALS course, says there's a reason for that.
"PETA is on a big harassment campaign," he says. "A few other programs use animals, but they wouldn't share that with PETA. The whole picture PETA is trying to paint of jamming tubes and causing injury is quite false. We have a twenty-year record of never having a cat injury."
Wash. U. uses mannequins in its PALS course, too, but Kennedy believes that cats provide a better simulation. The anatomy of a cat's windpipe, larynx and trachea, he says, is remarkably similar to that of a human infant, and practicing with a live animal gives residents a chance to get a feel for the soft tissue and learn to adjust their movements as the animal breathes.
"The mannequins have gotten much better in terms of anatomy," Kennedy says, "and they can move with a bladder, but they're still made of plastic and are stiff and hard. They can't mimic soft tissue and saliva. With cats, the residents learn to be gentle."
The cats themselves are under sedation during intubation lab sessions, which last 30 minutes and take place three or four times per year. A veterinarian is on duty while the lab is in session. There are nine cats used in PALS classes. When they're not in the labs, the cats live together in a room on the Wash. U. medical campus which, Kennedy says, is compliant with USDA regulations. "They play," he says, "they do cat things. We're very careful with the animals. We treat them as pets." After three years, the cats are put up for adoption.
Ferrets are used more rarely, to simulate premature babies, the final and most difficult stage in learning intubation.
Three years ago, Kennedy conducted a study among 44 pediatric residents in the PALS course. He discovered that practicing intubation on a live animal gave the students more confidence when they were faced with an actual human infant, though it was unclear how practicing on animals improved their overall performance. (Kennedy is still in the process of writing up this study and submitting it to a peer-reviewed journal.)
"They all thought it was a valid reason for use of animals," he says, "with the understanding that they were treated compassionately. The progress should go from lecture to mannequin to cat to ferret to human. Skipping any of the steps would make training less successful."
But if using animals is as benign as Kennedy claims, why have so many other PALS courses phased them out?
"It's very expensive to maintain a colony of cats," says Kennedy. Wash. U. must pay for the cats' upkeep according to USDA standards, for the vet (who is part of the faculty) and for the cats themselves, which are specially bred and cost between $600 and $700 apiece. (In 2009 Heartland Regional Medical Center in St. Joseph paid $46,000 for each of its mannequins, according to an article in the St. Joseph News-Press.)
"Because of the tremendous resources involved," Kennedy continues, "the AHA said that they don't require animal labs as part of the program. That statement has gotten twisted by PETA to say 'discouraged.'"
Kennedy says he has talked to Robert O'Connor, the AHA doctor who wrote the letter to PETA three years ago. "He says the AHA does not discourage the use of animals," Kennedy reports. In fact, the University of Virginia, where O'Connor teaches, also continues to use cats and ferrets.
But Kennedy refuses to engage in debate with PETA.
"There's no common ground," he says. "They won't believe what we're saying. And the AHA is not going to take on PETA. They're just so highly convinced that animal use for anything is wrong. There aren't many situations that residents have to learn this. There aren't enough newborn intubations. They have to prepare with the next best thing. These are human babies we're talking about."
But they're not quite as cute as PETA's baby kittens.