Friday, October 31, 2008

Get a Clue

I quit watching Grey’s Anatomy when it stopped showing at least a little medical science in each show and started becoming all-soap-opera-all-the-time. Curiously, about the same time the real medical science started disappearing, the philosophical voice-over of Erin at the end of the show stated taking a nose-dive in quality as well – I blame writing staff changes, but I don’t care enough to find out if that’s really true. The point is, they lost my interest. My wife, however, still watches it from time to time, and it was on last night while I was putting the insulation on the windows.

I think that l’affaire Wagner has dramatically reduced my tolerance for stupid, and last night’s Grey’s was chock full o’dumb.

Let’s start with the portrayal of the surgeon who rotated back from Iraq. What a slap in the face to all the good doctors, nurses, medics and corpsmen treating our servicemen and women in the theater of operations. Physicians over there fight to get the best equipment in the field. Modern field hospitals are not the Korean War’s understaffed and undersupplied MASH units, and the surgeons aren’t constantly looking for materials to improvise with. Certainly medics and corpsmen out in the field might use a tampon to stop heavy bleeding from a deep wound, but the hospitals are well-equipped.

And certainly when those doctors come back to the world, they use every advanced material and technique at their disposal, they are not using skin glue to seal a major wound. Finally, the statement by that doc in the show about triage can also simply not be true, because, once again, this is not Korea, and hospitals are not being overwhelmed by massive casualties in Iraq – they don’t need to let the bad cases die for lack of personnel to treat them. The whole sub-plot was a massive calumny on the fine medical cadres of the various Armed Forces, and on behalf of the fine doctors with whom I worked while I was and Navy and Air Force contractor, I can only say – stick it where the sun don’t shine, Grey’s.

But that wasn’t the big stupid last night. The big stupid was the doctor using animals to train for surgery. The whole running argument in the show was a hugely confused mess. The issue is this: animals are as sparingly as possible in surgical training for human doctors, but used very often in special cases where the surgery is experimental, and the Hippocratic Oath requires that the fine details be worked out on a non-human subject.

The models that are used, are used to save patient lives.

Certainly, much training that used to be conducted on animals is now conducted on simulators. Animals are expensive, and if for no other reason than that, they are used only when necessary. But look at those crude simulators. At this point, we can not reproduce the complex vasculature and immune response of a living thing in a simulator. Animals must be used for some training, and the argument in last night's Grey's that we have the technology to completely replace them is a specious one. Grey’s is a close enough simulacrum to real life, that it will get half-educated nitwits up in arms, thinking that they actually learned something on that show.

The greater harm, though was in the justifications of the doctor who advocated the surgical animal models. He continually used examples from the development of vaccines and drugs, not from surgery. Animal models for surgery will be replaced with simulators long, long before animals are replaced in pharmaceutical testing. Surgeons deal with the macro level, organs that can be pretty well understood at the level required for medical practice. Drugs and vaccines interact on the cellular level, and we, the human race, do not know nearly enough biology yet to replace them.

In the words of a real expert on this topic:

It's true: I don't actually like the fact that every successful modern drug has risen to its place on top of a small mountain of dead animals. But not liking doesn't keep it from being true, and not liking it doesn't mean that I have an alternative, either. I don't. What the animal rights campaigners - the more rational ones, anyway - don't seem to realize is that tens of millions of dollars are waiting for the person who can come up with a way of not using so many mice, rats, and dogs. (The less rational ones wouldn't care even if they knew).

They're expensive, you know, animals are. We don't just have them running around in rooms with a bunch of straw on the floor. They live in facilities that are expensive to build and expensive to maintain, and you have to hire a lot of people whose only job is to take care of them. The anti-testing people seem to have visions of drug company employees cackling at the thought of getting to use more animals, when the truth is that we'd dump them in a minute if we could.

But here's the hard part: we can't. Not for now, and not for some time to come. We don't know enough biology to do it. As it stands, if you were able to model every relevant system in a rat, well enough to use your model for predictive screening, you'd have basically built a rat yourself. We get surprised all the time when our compounds go into animals, and every time it happens, it shows how little we really know.

By muddying this issue, Greys did a great disservice to the debate. Grey’s writers – the next time you design an episode around an issue, make sure you have half a clue, will you? We don’t need any more half-baked Wagners running around out there.


Nathan said...

My brother is a veterinarian (one of the largest practices in N. Florida) and he says anybody who thinks animal testing can or should be eliminated in our lifetimes is an idiot.

And OT, I was sort of 1/2 paying attention to the Today Show yesterday (I think that was it) and they were having the whole autism/vaccination debate. At the end of the piece, it was the host and the pro-vaccination lady still on. The host tried to do one of those mamby-pamby "It's a controversy. We'll have to see how this plays out" kind of closes and the pro-vaccination lady stomped all over her. Loudly, she said something like, "There is not a controversy. There are people who want to protect your kids and there are people who are trying to bring back polio." It was great.

Richard said...

In California, Proposition 2 declares that confining an animal so that it cannot turn around for half a day or more is cruel. But exactly such action is permitted for 4-H exhibitions by the law which doesn't go into effect until 2015.

I think this is either an intellectual disconnect or a cynical compromise.