Friday, October 01, 1999

Scientists in Bunkers:

How Appeasement of “Animal Rights” Activism Has Failed

By: Frederick K. Goodwin M.D. and Adrian R. Morrison D.V.M., Ph.D.

These neuroscientists warn that propaganda, political pressure, and outright violence by opponents of animal research now threaten to curtail progress in fields from behavior to psychopharmacology, from addiction to stroke. They sound the alarm against further compromise with the notion of “animal rights.” Neither logic nor facts, medical history nor ethics, support the animal rights case; scientists who advocate animal research to serve human welfare, argue the authors, have reason and morality on their side.

When animal research became the target of a new generation of “anti-vivisectionsists,” scientists responded with proposals to strengthen the standards and regulation of animal research and care. But as the handling of research animals became ever more hedged about with restrictions, a strange thing happened. The “animal rights” campaign became more demanding and violent. Scientists doing animal research were assaulted in their laboratories, harassed in their homes, and threatened with death. Many were scientists involved in brain and behavioral research, special targets of activists.

Frederick Goodwin, a former director of the National Institute of Mental Health, and Adrian Morrison, professor of veterinary medicine at the University of Pennsylvania, argue that scientists gave away too much. The radical argument for animal rights, which casts scientists as “torturers,” is an argument for a bogus principle, the authors say, calling for the treatment of animals as moral agents. To concede any aspect of the activists’ argument, they contend, is to buy into a specious principle. The chief “practical” arguments against animal research are grossly misinformed, the authors hold; scientists must become consistent, outspoken, and morally confident in advocating human welfare, rights and needs. These are all now imperiled by the activists, they contend.

The campaign to end the use of animals in biomedical research is based upon a complete misunderstanding of how scientists work, what research requires, and what has made possible our era’s outpouring of life-saving advances in medicine. Leading the charge (sometimes literally) is the radical “animal rights” movement, spreading a profoundly confused philosophy that equates animal research with the enslavement of human beings and views animals as moral agents on a par with people. Unfortunately, neither their misunderstanding of science nor their misguided philosophy has prevented the activists from becoming an increasingly powerful, militant force—one now threatening the discovery of new medical treatments and preventive strategies for serious illnesses.

Neuroscientists have been a frequent target. Two key fields of neuroscience, behavioral and addiction research, were the focus of a chapter on research in Animal Liberation1 by Peter Singer, the acknowledged founding father of the “animal rights” movement. (Singer himself, however, does not base his opposition to animal research on the concept of rights. His American counterpart, Tom Regan, does.) High-profile laboratory invasions hit scientists engaged in brain research. For example, People for the Ethical Treatment of Animals (PETA), which harkens to Singer’s philosophy, established itself by infiltrating the laboratory of Dr. Edward Taub in Silver Spring, Maryland, in 1981, and “exposing” deficient laboratory conditions, which they apparently created in Taub’s absence. Taub was investigating how monkeys perform complex tasks with certain nerve pathways in their arms severed, work that was the basis for the subsequent development of improved methods for stroke rehabilitation. 

...the even more critical damage is to the scientist’s will to continue research, which under the best of conditions demands unusual commitment and persistence.

In 1984, PETA exploited the Animal Liberation Front’s (ALF) invasion of the University of Pennsylvania Head Injury Research Laboratory by cleverly editing videotapes taken in the raid and using the resulting composite as a fund-raising tool. In subsequent literature, PETA made it clear that alleged mistreatment of animals was not the real issue. In PETA’s view, animals cannot be used to alleviate health problems of people—period. Even after more stringent government controls over animal research were in place, by 1985, sleep researcher John Orem suffered a raid in 1989 that resulted in $40,000 damage to his laboratory. In this and other cases, however, the even more critical damage is to the scientist’s will to continue research, which under the best of conditions demands unusual commitment and persistence.

The authors can speak from experience. One (Morrison) became a target of the ALF in January 1990. The attack’s goal was forthrightly declared two months later by PETA’s national director, Ingrid Newkirk:

PETA intends to use Morrison to persuade other vivesectors who were heartened by his strong stand on animal research that it doesn’t pay off. Now the spotlight is on him, and what happens next will deter others who might want to follow in his footsteps.”2

As menacing as this sounds, scientists in Europe have long been the target of actual terrorism, now identified as such by governments. In England, the neuroscientist Colin Blakemore at Oxford University literally lives under siege.3 Police must protect his home, which has been assaulted with his frightened wife and daughters in residence. Why? He spoke out in support of the obvious necessity of using animals to advance medical science—to alleviate the suffering of human beings—and has been in danger ever since that principled act. Earlier this year, Blakemore and other European scientists were marked for death by animal-rights terrorists and lived for months under round-the-clock police protection.

We are loath to think that this terrorism may have intimidated the neuroscience community; but after responding vigorously to the attacks directed at them in the 1980s, neuro-scientists have been curiously inactive during—of all periods—the Decade of the Brain. In an editorial in Science extolling advances in neuroscience during the Decade of the Brain, the authors (the president and past-president of the largest neuroscience organization in the world) failed to mention the word “animal” a single time. This seems a sadly missed opportunity to link neuroscience’s unparalleled recent achievements to their roots in animal research.4

THE LEGAL AND POLITICAL ATTACK

Although for a few years we in the United States enjoyed relative peace, in spring 1999 animal-rights activists struck again, this time at the University of Minnesota, causing thousands of dollars in damage. A scientist studying hearing at the University of California at San Francisco is now suffering what Blakemore has endured for years. But biomedical research is under another kind of siege, one of which many researchers may not be aware.

There has been a campaign in New Zealand to give the great apes constitutional rights, expressing the ideas of the “animal rights” movement and the Great Ape Project.5 The ruling Social Democratic and Green parties in Germany introduced legislation stating that animals have the right to be “respected as fellow creatures” and an individual right to be protected from “avoidable pain.”6 These and two recent developments in the United States underscore that we may be entering a dangerous era in thinking about animals. A federal court recently awarded a man standing to sue on behalf of an animal because this man claimed to have been “harmed” by seeing the animal mistreated in a roadside zoo. There is now a push to have the U.S. Department of Agriculture (USDA) include rats and mice under the Animal Welfare Act—a reaction to pressure from “animal rights” groups.

Many scientists had said to us that things were getting better (at least until the attacks this spring), but regrettably they are wrong.

STIFLING CREATIVITY IN RESEARCH

We are alarmed that growing ignorance about the nature of scientific research and confusion inherent in the notion of “animal rights” are propelling ever-tightening regulation of research, stifling the creativity that is its essence. In the history of medicine many major discoveries have come about by serendipity, when a scientist has had his sights trained on an entirely different topic of research. The story behind the initial discovery that lithium, an elemental substance on the periodic table, might have therapeutic benefits illustrates this serendipity and demonstrates how basic research with animals can lead to a major medical advance.

An Australian psychiatrist, John Cade, asked what might be wrong in the brains of patients with manic-depressive illness. Would a substance called urea have therapeutic value? Testing his hypothesis on guinea pigs, Cade gave them a salt form of urea, which just happened to contain lithium. The guinea pigs became unexpectedly calm. Further experimentation revealed that the urea had nothing to do with this result; it was caused by the lithium—a complete surprise to Cade. Having laid his foundation with animal research, Cade extended his findings by giving lithium to manic patients, who experienced an alleviation of their manic excitement without being sedated. This single discovery has revolutionized treatment of manic-depressive illness, easing the lives of millions and saving billions of dollars along the way. At the same time, it has opened whole new productive areas for brain research.

No one could have predicted the outcome of Cade’s initial experiment with urea. There was no way to list and pledge in advance what the health benefits of using guinea pigs would be. That would have required knowing the answer to a question that had not yet been asked. If one already knows the answer, research is unnecessary.

Some years before the animal rights controversy arose, the National Institutes of Health sponsored a study by Julius H. Comroe, Jr., and R. D. Dripps to ascertain if government funding of basic biomedical research had been a good investment.7 The authors surveyed practicing cardiologists, asking what they regarded as the 10 leading medical advances of their lifetimes; the scientists named advances such as cardiac surgery, drug treatment of hypertension, and medical treatment of cardiac insufficiency as having helped their patients most. Comroe and Dripps then traced the scientific ancestry of each of these discoveries and found that 40 percent of the studies leading to the advances originated from work in a different, seemingly unrelated field of research. Of course, animal research was fundamental to many of these studies. Regulations that require justification of animal research in terms of its specific outcomes, rather than the clarity of the hypotheses and strength of the research design, may end much of the creative research now underway. 

One cannot develop an understanding of a chemical or a gene, then try to ascertain its role in a complex human organism with billions of cells and dozens of organs, without first knowing how it works in the biological systems of animals.

We challenge anyone to produce a working biomedical scientist who disputes the importance of using laboratory animals. Less than a quarter of the studies in biomedicine involve animals (and more than 90 percent of those are rats and mice), but anyone working in the field will tell you that such animal studies are indispensable. One cannot develop an understanding of a chemical or a gene, then try to ascertain its role in a complex human organism with billions of cells and dozens of organs, without first knowing how it works in the biological systems of animals. The animal model enables a scientist to understand what is happening at a level of detail that could not be reached in humans.8

The great kidney transplant pioneer, Dr. Thomas E. Starzl, when asked why he used dogs in his work, explained as follows. In his first series of operations, he had transplanted kidneys into a number of subjects; the majority of them died. After figuring out what had enabled a few to survive, he revised his techniques and operated on a similar group of subjects; a majority of them survived. In his third group of subjects, only one or two died; and in his fourth group all survived. The important point, said Starzl, was that the first three groups of subjects were dogs; the fourth group were human babies. Had Starzl begun his series of experimental operations on humans, he would have killed at least 15 people. Yet there are activists who believe, in the name of “animal rights,” that that is what Starzl should have done.

MORAL CONFUSION

To understand the animal rights movement, we must distinguish its objectives from those of animal welfare organizations such as local societies for the prevention of cruelty to animals, which have a time-honored place in our culture. Typically these organizations work to reduce animal cruelty, care for stray animals, teach good animal care, run neutering programs, and build animal shelters. Acting as the stewards of animals, especially those not in a position to care for themselves, these organizations uphold our traditional values of humane, caring treatment of sentient creatures.

Animal rights organizations, on the other hand, invest their energies in campaigning against various uses of animals, including research. They start with a completely different philosophy, summed up by Singer, who has argued that sentient creatures—all those capable of feeling pain— must essentially be considered as moral equivalents to humans, certainly as equivalent to severely brain-damaged humans and human infants before the age of reasoning. Anyone who dismisses any sentient creature as merely an animal to be used for human benefit is guilty of “speciesism,” a prejudice morally equivalent to racism and sexism.9 On the political front, PETA director Newkirk has asserted that “Animal liberationists do not separate out the human animal, so there is no rational basis for saying that a human being has special rights. A rat is a pig is a dog is a boy. They’re all mammals.”10 She has also said: “Six million Jews died in concentration camps, but six billion broiler chickens will die this year in slaughterhouses.” Chris DeRose, who heads the organization In Defense of Animals, says that even if the death of one rat would cure all disease, that death still would not be right, because we are all equal.11

The healthiest generation in history is a ripe target for the anti-science nonsense pushed by the animal-rights movement.

Many factors have contributed to the climate of moral confusion surrounding the use of animals in research and to the willingness of so many people to credit the bizarre ideas of the “animal rights” activists:

We are victims of our own health care successes. We have enjoyed such a victory over infectious diseases that baby boomers and subsequent generations do not even remember polio and other dreaded infectious diseases, and have little sense of how amazing it was when antibiotics were first developed. With the eradication of so many deadly infectious diseases, antibiotics have become something that you take for incidental minor infection. The healthiest generation in history is a ripe target for the anti-science nonsense pushed by the animal-rights movement.

America has sustained a steady, devastating decline in scientific literacy. Our high-school students consistently rank below those of other developed countries.12 As a result, most people, especially young people, do not understand what the scientific method is really about.

Today Americans spend little time around animals other than house pets. It is worth remembering that just before World War II one in four of us lived on a farm; now it is one in 50. What do most suburban and urban kids know about animals, other than what they see in talking, animated animal cartoons? The animal-rights movement works hard to attract these young people, directing propaganda particularly at the very young.13

In a broader sense, science itself may have contributed, at least indirectly, to the intellectual climate of confusion over values. Many philosophers have interpreted modern science as proving that nothing exists except that which we can measure empirically. If you add to this the premise that science is the path to truth, then moral values appear to lose their foundation. This has made science seem to endorse the moral, cultural, and intellectual relativism that infuses the “post-modern” thought in our most prestigious universities. (Singer was recently appointed to an endowed professorship at Princeton University.) This issue is complex, of course, but it is worth emphasizing that science absolutely depends on the concept that there is such a thing as truth, and there are systematic ways to distinguish it from falsehoods.

Notice that the animal rights activists decided early on to target scientific researchers, not farmers, although more than 99 percent of the animals used by humans are for food and just a fraction of one percent for research. Singer has said that the strategic decision to level protests against science was made because farmers are organized and politically powerful (and live in rural areas, which makes them hard to get at). In contrast, scientists are not politically organized, live in urban areas, and can be hard put to explain their work in lay language. As the strength and funding of the animal rights movement have grown, however, it has turned its attention to additional groups of animal users.

THE FATEFUL LOGIC OF APPEASEMENT

Scientists have, alas, proved easy targets, in part because we made a disastrous tactical error at the outset. Accustomed to dealing with others by reason, and eager to meet the activists halfway, the research community adopted “The Three Rs” described by W. Russell and R. Birch.14 We pledged again and again to reduce the number of animals used, refine our techniques, and replace animals whenever possible. In truth, of course, scientists are always looking for ways to refine, replace, and reduce animal use. It makes sense from the point of view of humane treatment, the economics of research and, often, science. But, as our primary response to a radical attack, it came across as a confession of guilt. We should recognize and clearly state that, although we accept high standards for the use and care of research animals, we are not engaged in some kind of “necessary evil.” We have had to relearn the costly lesson that appeasement is a losing game. To make concessions on a matter of principle is to concede the principle itself. Then defeat is only a matter of time, as our opponents demand complete consistency with their own principle.

“Rights,” the concept that the activists are working so hard to suborn, are a moral concept. Rights stem from the uniquely human capacity to choose our values and principles, then act on our choices and judgment. Within that context, rights are moral principles stating that, as human beings with the ability to develop and act on moral judgments, we must leave each other free to do so. That is the basis of our claim to political and personal freedom. Rattlesnakes and rats, tigers and sheep, and even our closest animal-kingdom relatives, chimpanzees, exhibit no ability to comprehend, respect, or act upon rights. The “law of the jungle” is no law at all. Indeed, the concept of rights is profoundly incoherent when applied to animals. It is worse than mistaken; it dangerously subverts the concept of rights itself at a time when human rights worldwide are in need of clear articulation and defense.

Focusing on the Three Rs without exposing and refuting the underlying philosophy of animal rights proved a public relations catastrophe. Our basic position should have been that human beings have a right to use animals for human purposes, but also have a responsibility to use animals humanely. The more we emphasized the Three Rs, the stronger the animal rights movement became, and the more money the radical activists raised. This was occurring at the very same time that science was demonstrating noticeable improvements in the handling of laboratory animals.

The fundamental principle is the same with respect to the wearing of fur, another choice target of the animal rights movement. People may choose not to buy or wear fur, and that is fine with us. But philosophically, a principle is a principle. We should not concede that it is unethical to use animals humanely for any legally sanctioned purpose. Too many scientists have tried to separate themselves from fellow citizens using animals in other ways.

ANSWERING THE ARGUMENTS

It is not sufficient for the medical-scientific community to expose the fundamental flaws in the philosophy of animal rights. We must be able to respond to the movement’s other, more utilitarian arguments against the usefulness of animals in research:15

  • They assert that animal research is cruel. This argument misses the point that experimenters usually want to disturb the animal as little as possible, since their goal is to study its natural response to whatever is being tested. An estimated seven percent of research does employ procedures causing pain in order to understand pain mechanisms in the central nervous system. This kind of experimentation has enabled us to develop effective painkillers, for example.
  • They say animal experiments are duplicative. The reality is that today only one out of four grant requests is funded, a highly competitive situation in which duplicative research is scarcely likely. But research does have to be replicated before the results are accepted; and progress usually arises from a series of small discoveries, all elaborating on or overlapping one another. When activists talk about duplication, they betray a fundamental misunderstanding of how science progresses. Nor do they understand scientists. What highly trained, creative individual wants to do exactly what someone has already demonstrated?
  • They urge prevention, not treatment. The activists say we should urge people to adopt measures such as an altered diet or increased exercise to prevent major illness, so that we would not need so many new treatments. But much of what we have discovered about preventive measures has itself resulted from animal research. You cannot get most cancers to grow in a test tube; you need whole animal studies.
  • They argue that we should use alternatives to animal research. A favorite example is computer simulations. We wonder where they think the data comes from that is entered into computers. We have to feed our machines real physiological data to get real answers. One activist we know keeps arguing we should use PET scans, which can provide an image of how a living human organ is functioning, as a way of avoiding the use of animals. Please note that it took Lou Sokoloff at the National Institute of Mental Health eight years of animal research to evolve the PET scan methodology. 

...more than 90 percent of the animals used in research are rodents. At the same time, more than 5 million unwanted cats and dogs are killed in shelters every year, which comes to about 50 animals killed in shelters for every one that must be sacrificed in research.

We hear other arguments. Activists say animal research diverts funds from medical treatment; but the United States spends only 37¢ on animal studies for every $100 we spend on treatment. We could divert all our research funds into treatment, and it would have no impact on treating sick people. Activists say that pets are at risk, but more than 90 percent of the animals used in research are rodents. At the same time, about five million unwanted cats and dogs are killed in shelters every year, which comes to about 50 animals killed in shelters for every one that must be sacrificed in research. One reason is that animal rights organizations have attracted much of the funding away from animal welfare organizations, so they cannot run adoption or neutering programs as well as they could with more funds.

THE MOUNTING TOLL

Despite the weakness of their arguments, the “animal rights” activists have taken their toll on research progress. Nothing infects creativity like fear. Today, scientists who work with animals are often segregated in high security buildings, like bunkers, separated from their colleagues. In effect, biomedical research budgets are reduced by the costs of increased security and compliance with new regulations. The public should be informed what is at stake in this controversy before costs mount higher.

In the earlier mentioned case of an individual granted standing in court to sue on behalf of animals, the precedent, if upheld, can obviously lead to mischief by those who would impede research. A “plant” in a laboratory need only claim distress at the way animals are being treated to bring a nuisance lawsuit against the laboratory. Even now, of course, an accusation of wrongdoing, no matter how trumped-up, will lead to weeks or months of work stoppage while the laboratory is being investigated by government agencies.

The case mentioned earlier of the inclusion of rats and mice (as well as birds) under the Animal Welfare Act is more complicated. Viewed superficially, the proposal is not unreasonable. Rats and mice are animals, after all, and deserving of appropriate care. Their exclusion from oversight by the Department of Agriculture reflects the department’s decision to focus available funds on monitoring the well-being of more preferred animals: primates, dogs, and cats. But one need not be overly cynical to suggest that the real motive behind the push for inclusion is not one of welfare so much as it is a wish to impede research by all means possible. Bureaucracy costs money and is enervating. The fact that the person leading this effort once offered brain-dead humans as a substitute for animals as research subjects speaks volumes about the real agenda here. Is there a proven problem concerning the welfare of these animals? The Association for the Assessment and Accreditation of Laboratory Animal Care International (AAALAC), the extra-governmental organization that intensively examines animal care programs at institutions striving to receive AAALAC’s highly desirable seal of approval, has estimated that 90% of the rats and mice used in research are already overseen by either AAALAC inspections or those required by the Public Health Service of its grantees.16 Many non-academic institutions, such as pharmaceutical companies and commercial breeders, are covered by AAALAC inspections of their programs. Thus, the USDA would needlessly duplicate oversight programs already in place.

A CALL TO ACTION

We live in an age of moral self-doubt. Some scientists and other individuals associated with biomedical research in supportive roles have begun to feel that their use of animals is somehow wrong, a kind of “necessary evil.” This feeling has spawned a group calling itself the “troubled middle” (a rather presumptuous phrase, suggesting that only they care about the issues raised by animal research). Indeed, a whole industry has grown up around this sense of guilt, with constant, somewhat repetitive conferences focusing on how to oversee research, how to be the perfect member of an Institutional Animal Care and Use Committee (IACUC), and how to find alternatives to using animals. It is not that any of these topics is unworthy of consideration. We simply note that the process is over done, and usually happens without consulting actual, working scientists. A working scientist, one without significant administrative responsibilities, is rarely a major speaker on these programs.

It is time for scientists to get back in the fray. Distinguished scientists in Europe have been threatened and attacked for years and, after a brief hiatus, animal-rights violence is on the rise again in the United States. Public attitudes toward animals and their use in science have been changing under the animal activist barrage. Bureaucracy and regulation tend to take on a life of their own, growing if they are not actively opposed.

Neuroscientists can engage the issue in several ways. They must first recognize that this is a struggle for minds. Thus, their own minds must be clear on what justifies what they do with animals. Articles by Cohen17 and Vance18 are excellent primers on the ethical issues. Researchers must appreciate the value of their work for humanity and be able to talk about it in readily understandable terms. When given an opportunity to speak or write about neuroscience research, scientists cannot shy away from stating how invaluable animal research is. On the home front, they should offer to sit on IACUCs to provide the expertise on neuroscience research that may well be lacking on their particular committee.

Don’t just grumble!  Speak in schools, attend conferences on animal care issues sponsored by NIH and other organizations so that administrators and regulators have a better understanding of life in the trenches. And contribute some money to the biomedical research organizations working for science, so woefully— shamefully really—under funded when compared to the opposition.

We who work with animals have made a moral choice. Obviously, we believe that humans are special, which justifies to us the use of animals when necessary. Scientists must be comfortable in stating unequivocally and publicly that human life comes first. The rational layman has no problem accepting this, especially when he or she understands something of the process of science thanks to the efforts of scientists active in public education.  

 

References

  1. Singer, P. 1990. Animal Liberation, 2nd ed., New York: Random House.
  2. Ingrid Newkirk speaking in Rosenberg, J., “Animal Rites,” The Village Voice (March 6, 1990): 33.
  3. Hoge, W. “British Researchers on Animal Rights Death List,” The New York Times (January 10, 1999).
  4. Jones, EG. and Mendell, LM. 1999. “Assessing the Decade of the Brain.” Science 284: 739.
  5. Cavalieri, P. and Singer, P. 1993. The Great Ape Project. New York: St. Martin’s Press.
  6. Anonymous, 1999. Nature 397:461.
  7. Comroe, J and Dripps, R, 1976.  Scientific basis for the support of biomedical research. Science 192: 105-111.
  8. Botting, J and Morrison, AR. 1997. Animal research is vital to medicine. Scientific American. February: 83-85.
  9. Singer, P. 1990. Animal Liberation, 2nd ed. New York: Random House.
  10. These remarkable views of Ingrid Newkirk, cofounder of PETA, were reported in a November 13, 1983, Washington Post article by Chip Brown when PETA was just becoming a household word and biomedical research was only beginning to recognize that it had a real problem with which to deal.
  11. DeRose, C, leader of Last Chance  for Animals, as quoted in “Biting Back” by E. Venant and D. Treadwell, Los Angeles Times, April 12, 1998: E12.
  12. Goodwin, FK. 1991. The price of progress.      In D.C. Harrison and M. Osterweis (eds.). Preparing for Science in the 21st Century. Washington, DC: Association of Academic Health Centers, pp. 86-96.
  13. Morrison, AR. 1994. Understanding (and misunderstanding) the animal rights movement in the United States. In P.P. DeDeyn (Ed.). Ethics of Animal and Human Experimentation. London: John Libbey Co., pp. 93-106.
  14. Russell, W and Birch, R. 1959. The Principles of Humane Experimental Technique. London: Metheun.
  15. Goodwin, FK. 1992. Animal research, animal rights and human health: The Stephen Paget Memorial Lecture. Conquest—Journal of the Research Defence Society No. 181, August: 1-10.
  16. Personal communication from John Miller, executive director.
  17. Cohen, C. The case for the use of animals in biomedical research. New England Journal of Medicine. 315:865-870, 1986.
  18. Vance, RP. An Introduction to the Philosophical Presuppositions of the Animal Liberation/Rights Movement, Journal of the American Medical Association 268:1715-1719, 1992.



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Carolyn Asbury, Ph.D., consultant

Scientific Advisory Board
Joseph T. Coyle, M.D., Harvard Medical School
Kay Redfield Jamison, Ph.D., The Johns Hopkins University School of Medicine
Pierre J. Magistretti, M.D., Ph.D., University of Lausanne Medical School and Hospital
Robert Malenka, M.D., Ph.D., Stanford University School of Medicine
Bruce S. McEwen, Ph.D., The Rockefeller University
Donald Price, M.D., The Johns Hopkins University School of Medicine

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