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Animals in Scientific Research
Science of the Future - Autopsies
The living have much to learn from those who are no longer living. Post-mortem examinations, also called autopsies, have always been an invaluable source of knowledge for scientists. Indeed every disease has been either discovered at autopsy or we have learned more about it because of autopsy.
Performed by specially trained physicians called pathologists, autopsies are performed in rooms that resemble operating rooms. Information learned from autopsies has contributed greatly to our understanding of a host of diseases, from diabetes to hepatitis, appendicitis, rheumatic fever, typhoid fever, ulcerative colitis, congenital heart disease, and hyperparathyroidism. Autopsies have also revealed the mechanism of shaken baby syndrome, sudden infant death syndrome, and head injuries suffered during car accidents. Autopsies allow diagnosis of disorders that could not have been diagnosed otherwise, such as kidney and lung abnormalities and congenital heart disease.
Post-mortem examinations have been responsible for actually discovering the causes of some illnesses in toto or completing the picture in others. By identifying clinical problems for which there may be no other method of analysis, autopsies remain a valuable investigatory tool for physicians who treat critically ill patients.
Autopsies represent such a vitally important opportunity for learning that it is unfortunate how dramatically the rate of autopsies has declined in recent years. In years past, almost every patient was autopsied, which is why so many important discoveries were made. However, the rate of autopsies has dropped to less than one-quarter of what it was in the 1950s. If errors in diagnosis and disease management are not actively sought, improvements in knowledge and future patient care may not occur.
And errors in diagnosis do occur—not due to incompetence, but because arriving at causes of death clinically is an inherently imperfect process. Scientists at the University of Miami School of Medicine in Florida, a Level 1 Trauma Center, reviewed autopsy reports and medical records of 153 trauma and burn patients who survived initial resuscitation but subsequently died in the surgical ICU. They found that major diagnoses were missed in four patients—a large number, considering the skill and expertise of intensivists at a Level 1 Trauma Center. The missed diagnoses might have led to a change in treatment and better outcome if they had been recognized sooner. Twenty-four patients had missed diagnoses that probably would not have changed the course of their recovery if they had been found early. This included 11 cases of pneumonia and three cases of pulmonary embolism/infarction. There were also cases of thoracic spine fracture with epidural hemorrhage, hemoperitoneum, hemorrhagic gastritis, cervical subluxation, and adrenal hemorrhage. Many of these patients had nonsurvivable head injury; nonetheless, the conditions were missed. Autopsies need to be done in order to continue the education process all physicians engage in throughout their careers.
There are several reasons for the decline in autopsies, despite their unquestionable value to medical progress. One of them—perhaps not surprisingly—is money. Quite simply, no one will pay for them. Pathologists do not routinely perform autopsies unless insurance companies reimburse them. But that usually does not happen.
Few universities perform autopsies, because the NIH funds few research projects that utilize them. Another problem is cultural. Western society in general does not deal well emotionally with death. The decision for the next of kin to authorize an autopsy on a deceased loved one is an excruciatingly difficult one. It can be even more difficult when dealing with the death of a baby, but the information these examinations yield can be invaluable for other parents and children. For example, Dr. Malcolm Brodlie and colleagues in Edinburgh measured the rate of post-mortems conducted in newborns over a 10-year period from 1990 to 1999, at a neonatal center in Scotland. They found autopsies were performed in two-thirds of neonatal deaths, and new information was obtained in 26 percent of cases. In 3 percent of cases, the information was beneficial for the parents considering having another baby.
Direct examination of the brain after death is particularly valuable, and opens the door to many of the brain’s mysteries. Often, such an examination is the only way to confirm a diagnosis, such as Alzheimer’s disease. Dementia in the elderly, for example, can be caused by a number of conditions in addition to Alzheimer’s disease, such as stroke, Parkinson’s disease, and alcoholism. The fact that these conditions may occur alone or in combination makes clinical diagnosis even more difficult. It is also very important to study the brains of healthy persons, to see how brains change as they age. Direct examination of healthy brains can help scientists learn which changes in the brain are caused by disease, and which are caused by aging.
In addition to autopsies, there are a number of ways that scientists use the deceased to advance medical knowledge. Cadavers are used in Advanced Trauma Life Support (ATLS) courses and other medical teaching courses. Cadavers of people who donate their bodies to science are used to help researchers in their quest to reduce the number of crash-related deaths in the United States. Once a month, for example, at the University of Virginia’s Automobile Safety Laboratory, a cadaver is placed in the driver’s seat of an automobile for a crash test. This enables scientists to study the resulting injuries using CAT scan and MRI data. Such data helps automobile companies design safer cars.
The US Army uses cadavers to test protective gear for soldiers. For example, one Army study explored how a certain type of anti-landmine boot could protect against landmine explosions. And many people are familiar with the Forensic Anthropology Center at the University of Tennessee in Knoxville, known as The Body Farm. Here, bodies donated to science are left to decay outdoors, so that scientists can study the different rates at which bodies decompose in different environmental conditions. This kind of information is extremely helpful to law enforcement authorities and forensic experts because it helps them pinpoint the time of death of crime victims.
Not only do many people donate their bodies to science, some are even donating their bodies, brain-dead yet heart-alive so that physicians may conduct otherwise ethically impossible research.
This type of research is being done by Renata Pasqualini and Wadih Arap, a husband and wife team at M.D. Anderson Cancer Center in Houston. There, Drs. Pasqualini and Arap have given brain-dead humans medications designed to treat cancer, and they have been able to determine where in the body the drugs traveled and what they did there. The results of one such research project yielded results that were published in the February 2002 issue of Nature Medicine. Other institutions are following M.D. Anderson’s lead and approving such protocols. Only time will tell whether society accepts this form of biomedical research. We hope society will. But clearly, there is a world of difference between what Drs. Pasqualini and Arap are doing, and what happened in Nazi Germany and Tuskegee, Alabama.
Studying the living, dead, and heart-alive but brain-dead—in an ethical manner that preserves the dignity, respect, and rights of all individuals—is the best way humans can learn about the human body and unlock its mysteries for the improvement of human health. Hippocrates knew this centuries ago, and it remains as true today as in ancient times.
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