There can be few areas of medicine that are as emotionally and ethically fraught as the treatment of babies born with life threatening or debilitating illness. Doctors must constantly weigh up potential benefits to the baby of any procedure against risk that the procedure may harm either the baby or mother. Nevertheless, it’s an area of medicine that has seen significant progress in recent years, and as we have discussed before many of the medical advances have stemmed from animal research.
Earlier this week the New York Times reported on a large clinical trial at three medical centres that specialise in fetal surgery, which demonstrated that infants with Spina Bifida were more likely to walk and experience fewer neurological problems if operated on before being born rather than afterward. Spina Bifida is a birth defect caused by the incomplete closure of the embryonic neural tube, the precursor to the brain and spinal cord, which should take place during the first month of pregnancy, and it is associated with major lifelong disability.
Professor Scott Adzik, who led the study published this week in the New England Journal of Medicine, explained the benefits observed in the trial to the New York Times:
Before surgery, babies in the prenatal group had more severe spinal lesions than the postnatal group, but more in the prenatal group had better results, said a co-author, Dr. Scott Adzick, chief of pediatric surgery at Children’s Hospital of Philadelphia.
Those who received prenatal surgery were half as likely to have a shunt, and eight times as likely to have a normally positioned brainstem. There was “much better motor function of the legs,” Dr. Adzick said, and at 30 months old, nearly twice as many walked without crutches or orthotics.
Although they were born at 34 weeks of pregnancy on average, compared with 37 weeks for the postnatal group, there was no difference in cognitive development, said Dr. Catherine Spong, chief of pregnancy and perinatology at the child health institute.
Dr. Adzick said prenatal surgery may “stop exposure of the developing spinal cord and perhaps avert further neurological damage” or stop the leak of spinal fluid that causes brainstem problems. ”
Professor Adzik is one of the pioneers of fetal surgery for Spina Bifida, having performed the first such operation in 1997, and you won’t be too surprised to learn that animal research informed his decision to attempt this procedure.
Before attempting this surgery Professor Adzik needed to know whether the disability seen in Spina Bifida was due to the neural cord defect, or to a secondary effect due to the exposure of the spinal cord to the interuterine fluid. In the first case surgery would not help to prevent disability, in the second case it might help and experimental surgery on human fetuses would be ethically justifiable.
To determine which case applied Professor Adzik and colleagues performed a series of studies in sheep (1). They found that surgically exposing the normal spinal cord of midgestational sheep fetuses to amniotic fluid leads to a human-like Spina Bifida with paraplegia at birth, indicating that the exposed neural tissue is progressively destroyed during pregnancy, and that much of the disability seen in Spina Bifida is due a secondary effect of exposure to the interuterine environment rather than the primary neural cord defect. When they repaired the spinal cord in utero, the disability in animals at birth was greatly reduced. This result gave Professor Adzik and his colleagues at the Children’s Hospital of Philadelphia the confidence to undertake the first operation to correct Spina Bifida in utero, an operation that led to the far larger clinical trial reported this week.
By way of contrast an article in the Seattle Times reports on how the very misleadingly named “Physicians Committee for Responsible Medicine” (PCRM) is trying to stop a medical training program for very early pre-term infants from using live ferrets in its training program. What is very refreshing about this story is how Dr. Dennis Maycock, the leader of the University of Washington program, patiently explaining why simulators are not appropriate for some of the very specialist training they undertake, and the very good care they take of ferrets used in this training. Of course we are very familiar with the anti-scientific agenda of PCRM, and applaud Dr. Maycock for exposing their hollow propaganda.
So all in all it’s been a week that has highlighted the difference between those who seek to save lives through the responsible and ethical use of animals in research and training, and those who would favor animal rights ideology over the lives and health of the youngest members of our society.
Addendum: While we are on the subject of animal rights groups who like to give the impression that they are not animal rights groups, check out this great new post on HSUS by scienceblogger Erv.
Paul Browne
1) Meuli M, Meuli-Simmen C, Hutchins GM, Yingling CD, Hoffman KM, Harrison MR, Adzick NS. “In utero surgery rescues neurological function at birth in sheep with spina bifida.” Nat Med. 1995 Apr;1(4):342-7. PubMed:7585064
Speaking of Research 
“So all in all it’s been a week that has highlighted the difference between those who seek to save lives through the responsible and ethical use of animals in research and training, and those who would favor animal rights ideology over the lives and health of the youngest members of our society.”
In terms of the spina bifida treatment, It’s not the “youngest members of our society” that benefits, but in fact the parents. By performing surgery on a fetus, you’re essentially preventing the existence of one individual (that which would have grown up with spina bifida) and replacing it with another (that which is spina bifida-free). I don’t mean literally replacing in terms of a genetically different individual of course, but rather in the sense that a person with a completely different personality will come to exist. If that’s not a problem, then why not simply abort and start again?
” why not simply abort and start again?”
Because we’re pro-choice.
But if the choice is based upon flawed reasoning, and doesn’t actually achieve what people think it achieves, then it’s simply a waste of time and resources.
Wow. This is just silly.
The point is clearly that causing suffering to prevent already preventable suffering needs some justification.
And you reply–we believe you get to choose to cause suffering to prevent otherwise preventable suffering.
That’s not an answer that’s just dumb.
C, you appear to be assuming that the only the fetus and the animals potentially suffer in this equation (a fetus does not suffer in an abortion if it is performed early enough), the potential suffering – both physical and psycological – of the mother also needed to be taken into account.
I once listened to an interview with the late George Tiller where he very eloquently described the trauma of many of his patients who were forced to abort wanted babies because of severe health problems or fetal abnormalities, their suffering was certainly real.
Matt,
You are failing to consider the potential suffering to the mother in aborting the fetus. For some this may not have a large impact, for others it can have tremendous consequences.
The one in the best position to evaluate the interests of *both* the mother and the fetus is the mother, it seems reasonable to let her decide what is best in their interest.
But, is it reasonable for her to decide if in deciding she imposes suffering on a 3rd?
Of course, you hold that the third doesn’t matter. It’s only an animal. And, you construct the scenario in such a way that many mothers would willingly (and perhaps justifiably) sacrifice the lives of other human beings for their child’s welfare, never mind animals.
The view you hold is ultimately incoherent. (And I’m the one defending this research).
As I said earlier: “In terms of the spina bifida treatment, It’s not the “youngest members of our society” that benefits, but in fact the parents.”
But question needs to be asked: what causes the mother to suffer? Is it the loss of a child? But performing this sort of surgery or gene therapy on a fetus will drastically change the person it will develop into: essentially, the original child is lost and is being replaced by a different individual.
If the mother prefers to have surgery because they believe they are saving a person, then I believe this is based on a lack of understanding of what constitutes personhood.
So, it depends in part upon how the ewe is being treated, but lets assume that the ewe is treated well and given adequate housing etc. and lets assume that the ewe is given adequate pain medication. Then the benefit would seem plausibly to outweigh the harms.
And yes it might be a mark of speciesism if we discount the animals interests, but I take it that the sheep fetus doesn’t have preferences on Singer’s view so there wouldn’t be much of a problem on that side. Presumably performing this experiment on a human mother would be far more distressing than on a well kept sheep and so he could, it seems,have little problem with this research given its benefit. (Though interestingly he might question whether there is a benefit since preventing a being with spina bifuda from coming into being can be done right now for cheaper, through abortion and Singer doesn’t hold that anyone is harmed through abortion. So he might quibble as to whether this surgery will ever actually benefit anyone over the alternative, but there we’d be getting into some difficult stuff).
On Regan, OK he would have a problem with using the ewe because he believes that it would violate its right to freedom and, perhaps, its right not to suffer. Though on the assumption that the ewe did not suffer significantly, it is primarily the question of freedom for the ewe, and that might depend upon what he means by freedom. But, nevertheless, it would not be an egregious form of animal experimentation even on Regan’s account. Not exactly a case of Science vs Animal Rights as the tendentious title suggests.
Neither Regan nor Francione would be interested in ranking forms for experimentation from reasonable to egregious. To them, they are all morally wrong. Period. They are not interested in such rankings.
I have never heard PCRM nor PeTA say any form of experimentation is justified either. Claims that alternatives exist and scientists simply refuse to adopt them is wrong and unethical.
Francione probably agrees with that. I’m not sure Regan would.
Equal consideration does not require equal treatment for Singer. For Regan there are situations where the some rights holders might have their interests overridden (miniride and worse-off principle). I don’t know what peta or pcrm thinks of this research. If claims exist, then certainly we all agree that subjecting to ewe to invasive surgery is not justifiable. But, I haven’t heard that argument made in this case, though apparently they were right about the intubation and rabbits.
This form of research involves (a) a high degree of translatability (i.e unlike irresponsiblte scientists just seeing how stuff works–I mean “basic science” :) ) (b) ability to minimize impact on test subjects. So, assuming that the resulting surgery in fact results in less harm than terminating the pregnancy, this seems likely to be justifiable.
There are plenty of animal rights positions that allow for some “use” of animals. Robert Garner argues that animals don’t have a right to freedom, though they do have a right not to suffer unjustifiably and a right not to be killed for others benefits. I don’t know what his view of a case like this would be, but it seems to me that he might hold that under the right circumstances this could be innocent.
“… believe neither Peter Singer nor Tom Regan would have arguments against, since the subjects are neither sentient nor subjects of a life.”
I am not sure about that. What about the mother? She is sentient and a subject-of-a-life! Also, wouldn’t Singer ask you to consider doing the surgery on a human fetus with down syndrome instead of the normal sheep fetus?
So, this is a surgery that was developed on mid-gestational sheep, i.e. sheep fetuses, which were then brought to term. So it’s a procedure that I believe neither Peter Singer nor Tom Regan would have arguments against, since the subjects are neither sentient nor subjects of a life.
I don’t know about Francione’s views of the rights of sheep fetuses. Perhaps he would have qualms about it.
But, just to be clear that this is not a “use” of animals that would presumably be opposed by Singer or Regan.
However, using ferrets, even anaesthesized ones, for practice intubation, is a different issue, and the argument is that it is unnecessary to use live animals for this training. This is an empirical question that perhaps you disagree with, but it is certainly not beyond the pale that someone might hold that a use of an animal that is unnecessary should be stopped. The 3R’s, to which I assume you accede, would entail it. You just disagree, presumably on the basis of your wide experience of intubuation training programs, that this is use is necessary. (And just to note that according to the article, chest intubation training on euthanized rabbits which was also opposed by those “anti-scientists” (seriously? if you question the use of animals you are anti-science? No wonder IACUC’s are useless) at the PCRM was stopped because it was unnecessary by that same program–do you read these articles?)
Apples and oranges and some really shoddy thinking, but you’re learning from ERV and his Humanewatch buddies everyday.
Actuallt the anti-scientific/pseudo scientific agenda of many PCRM members is well documented, with a few examples listed in this link I added to this post above.
https://speakingofresearch.com/2009/03/10/restoring-science-to-its-rightful-place/
Dr. Maycock’s point is that while appropriate simulators are available for babies born later during pregnancy, and dead chickens were recently found to be a good alternative to rabbits for babies born earlier, for the most pre-term births they do not yet have a viable alternative to the use of live ferrets. Possibly dead ferrets would do, but that would mean using a lot more ferrets, which would violate the “reduction” element of the 3Rs.
It may be possible to develop a simulator for the very early pre-term infants, but it’s clear that this is a small specialist area of pediatric medical training, and there may not be a viable market for such a simulator.