Clinical Anatomy 27:512–513 (2014)
Letter to the Editor A Proposal for Introducing a Requirement to Declare the Provenience of Cadavers in Anatomy Publications To the Editor, Clinical Anatomy: In a recent article, Jones and Whitaker (2012, p. 246) offered strong arguments in support of the proposal that “anatomists should cease using unclaimed bodies” for research and education. However, to introduce this proposal would be a daunting and difficult task; it could not be done quickly. A multipronged approach is needed with simultaneous action both locally and globally. Here, we propose a simple and technically easily implemented strategy that could have a global impact on the policy of cadaver sourcing. Human cadavers have played a key role in anatomy research and education for centuries. However, because of the ways in which cadavers were obtained and treated, the discipline of anatomy was—throughout its long and convoluted history—often perceived as emotionally dispassionate, morally dubious, and legally suspicious (Richardson, 2001; MacDonald, 2005; Jones and Whitaker, 2009). Cadavers were acquired in a variety of ways: initially, the bodies were mainly those of executed criminals; later, after the Anatomy Acts and similar regulations were introduced during the 19th century, unclaimed bodies from hospitals, asylums, and shelters for the poor were used in anatomy laboratories. As a rule, those bodies were of persons disadvantaged and disenfranchised while alive. However, recent decades have witnessed dramatic changes in the sourcing of human cadavers for anatomy laboratories in a number of countries. As a result, bodies are now acquired exclusively through donation programs and with informed consent. Even in counties in which there are strong cultural constraints against body donation, it is clear that carefully organized bequest programs enable anatomy laboratories to obtain sufficient numbers of bodies (Zhang et al., 2008, in press). However, this is still a far distant ideal in many other countries (Gangata et al., 2010). For example, the authors of a recent study in Nigeria noted with grave concern that “more than 72% of the [surveyed medical] schools reported that more than 90% of the cadavers were criminals that had been killed by shooting, less than 10% were unclaimed and unidentified corpses, and 0% originated from body bequest” (Anyanwu et al., 2011, p. 831). Even within the same country one finds dramatic differences in the way cadavers are obtained and treated. In China, elaborate activities at some institutions have resulted in the creation of successful body donation programs (Zhang et al., in press). However, at the same time, numerous concerns were expressed about the acquisition of cadavers that were plastinated in Dalian Medical University for the well-known public spectacle Bodies: The Exhibition (Bates, 2010). The strategy we suggest here focuses on publications— research articles, monographs, and textbooks. Publication
C V
2014 Wiley Periodicals, Inc.
productivity seems to be the most important contributor to success in academia. Relevant changes in publication policies could, therefore, have a considerable impact. We suggest that all anatomy journals, and indeed all medical and science journals that publish articles describing research based on human cadavers, should require that the provenience of cadavers be declared in such articles. We also propose that national and international associations of anatomy should adopt a similar policy, requiring the provenience of cadavers to be declared when abstracts of society meeting presentations are submitted and that this be made mandatory for all conference proceedings published in journals of anatomy or medical science. The same should be required for all images of human cadavers published in anatomy textbooks, atlases, and so forth. Institutionally, declarations should be included in all undergraduate and postgraduate research theses. These declarations would be similar to declarations of conflict of interests or statements that ethical approval (if needed) was granted. In addition, we would propose that no research or educational text be published if it utilized cadavers obtained in any way other than body donation. Depending on the level of acceptance, the proposed strategy could, at minimum, undermine the recognition of research, and educational materials utilizing bodies not obtained through donation; at maximum it could induce the abolition of such research and educational materials. Because of the intimate relationship between research and teaching in modern academia, the strategy could also have a positive effect on the acquisition and use of bodies for medical education. Support from professional organizations, publishing houses, editors, and leading researchers would be crucial for the success of the strategy. Introducing a declaration about the provenience of cadavers could be a step toward the global elimination of dubious practices in obtaining bodies for anatomy research and education.
1
1 Goran Strkalj and Nalini Pather2 Department of Chiropractic, Macquarie University Sydney, New South Wales, Australia 2 Department of Anatomy, School of Medical Sciences, The University of New South Wales, New South Wales, Sydney, Australia
*Correspondence to: Prof. Goran Strkalj, Department of Chiropractic, Macquarie University, Sydney, NSW 2109, Australia. E-mail: [email protected] Received 9 February 2014; Accepted 17 February 2014 Published online 13 March 2014 in Wiley Online Library (wileyonlinelibrary.com). DOI: 10.1002/ca.22390
Strkalj and Pather
REFERENCES Anyanwu GE, Udemezue OO, Obikili EN. 2011. Dark age of sourcing cadavers in developing countries: A Nigerian survey. Clin Anat 24:831–836. Bates S. 2010. Bodies impolitic? Reading cadavers. Int J Commun 4:198–219. Gangata H, Ntaba P, Akol P, Louw G. 2010. The reliance on unclaimed cadavers for anatomical teaching by medical schools in Africa. Anat Sci Educ 3:174–183. Jones GA, Whitaker MI. 2009. Speaking for the Dead: The Human Body in Biology and Medicine. 2nd Ed. Aldershot: Ashgate Publishing. p 296.
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Jones GA, Whitaker MI. 2012. Anatomy’s use of unclaimed bodies: Reasons against continued, dependence on an ethically dubious practice. Clin Anat 25:246–254. MacDonald, H. 2005. Human Remains: Episodes in Human Dissection. Melbourne: Melbourne University Press. p 220. Richardson R. 2001. Death, Dissection and the Destitute. Chicago, Illinois: University of Chicago Press. p 453. Zhang L, Wang Y, Xiao M, Han Q, Ding J. 2008. An ethical solution to the challenges in teaching anatomy with dissection in the Chinese culture. Anat Sci Educ 1:56–59. Zhang L, Xiao M, Gu M, Zhang Y, Jin J, Din J. An overview of the roles and responsibilities of Chinese medical colleges in body donation programs. Anat Sci Educ (in press), DOI: 10.1002/ase.1422.
Letter to the Editor A Proposal for Introducing a Requirement to Declare the Provenience of Cadavers in Anatomy Publications To the Editor, Clinical Anatomy: In a recent article, Jones and Whitaker (2012, p. 246) offered strong arguments in support of the proposal that “anatomists should cease using unclaimed bodies” for research and education. However, to introduce this proposal would be a daunting and difficult task; it could not be done quickly. A multipronged approach is needed with simultaneous action both locally and globally. Here, we propose a simple and technically easily implemented strategy that could have a global impact on the policy of cadaver sourcing. Human cadavers have played a key role in anatomy research and education for centuries. However, because of the ways in which cadavers were obtained and treated, the discipline of anatomy was—throughout its long and convoluted history—often perceived as emotionally dispassionate, morally dubious, and legally suspicious (Richardson, 2001; MacDonald, 2005; Jones and Whitaker, 2009). Cadavers were acquired in a variety of ways: initially, the bodies were mainly those of executed criminals; later, after the Anatomy Acts and similar regulations were introduced during the 19th century, unclaimed bodies from hospitals, asylums, and shelters for the poor were used in anatomy laboratories. As a rule, those bodies were of persons disadvantaged and disenfranchised while alive. However, recent decades have witnessed dramatic changes in the sourcing of human cadavers for anatomy laboratories in a number of countries. As a result, bodies are now acquired exclusively through donation programs and with informed consent. Even in counties in which there are strong cultural constraints against body donation, it is clear that carefully organized bequest programs enable anatomy laboratories to obtain sufficient numbers of bodies (Zhang et al., 2008, in press). However, this is still a far distant ideal in many other countries (Gangata et al., 2010). For example, the authors of a recent study in Nigeria noted with grave concern that “more than 72% of the [surveyed medical] schools reported that more than 90% of the cadavers were criminals that had been killed by shooting, less than 10% were unclaimed and unidentified corpses, and 0% originated from body bequest” (Anyanwu et al., 2011, p. 831). Even within the same country one finds dramatic differences in the way cadavers are obtained and treated. In China, elaborate activities at some institutions have resulted in the creation of successful body donation programs (Zhang et al., in press). However, at the same time, numerous concerns were expressed about the acquisition of cadavers that were plastinated in Dalian Medical University for the well-known public spectacle Bodies: The Exhibition (Bates, 2010). The strategy we suggest here focuses on publications— research articles, monographs, and textbooks. Publication
C V
2014 Wiley Periodicals, Inc.
productivity seems to be the most important contributor to success in academia. Relevant changes in publication policies could, therefore, have a considerable impact. We suggest that all anatomy journals, and indeed all medical and science journals that publish articles describing research based on human cadavers, should require that the provenience of cadavers be declared in such articles. We also propose that national and international associations of anatomy should adopt a similar policy, requiring the provenience of cadavers to be declared when abstracts of society meeting presentations are submitted and that this be made mandatory for all conference proceedings published in journals of anatomy or medical science. The same should be required for all images of human cadavers published in anatomy textbooks, atlases, and so forth. Institutionally, declarations should be included in all undergraduate and postgraduate research theses. These declarations would be similar to declarations of conflict of interests or statements that ethical approval (if needed) was granted. In addition, we would propose that no research or educational text be published if it utilized cadavers obtained in any way other than body donation. Depending on the level of acceptance, the proposed strategy could, at minimum, undermine the recognition of research, and educational materials utilizing bodies not obtained through donation; at maximum it could induce the abolition of such research and educational materials. Because of the intimate relationship between research and teaching in modern academia, the strategy could also have a positive effect on the acquisition and use of bodies for medical education. Support from professional organizations, publishing houses, editors, and leading researchers would be crucial for the success of the strategy. Introducing a declaration about the provenience of cadavers could be a step toward the global elimination of dubious practices in obtaining bodies for anatomy research and education.
1
1 Goran Strkalj and Nalini Pather2 Department of Chiropractic, Macquarie University Sydney, New South Wales, Australia 2 Department of Anatomy, School of Medical Sciences, The University of New South Wales, New South Wales, Sydney, Australia
*Correspondence to: Prof. Goran Strkalj, Department of Chiropractic, Macquarie University, Sydney, NSW 2109, Australia. E-mail: [email protected] Received 9 February 2014; Accepted 17 February 2014 Published online 13 March 2014 in Wiley Online Library (wileyonlinelibrary.com). DOI: 10.1002/ca.22390
Strkalj and Pather
REFERENCES Anyanwu GE, Udemezue OO, Obikili EN. 2011. Dark age of sourcing cadavers in developing countries: A Nigerian survey. Clin Anat 24:831–836. Bates S. 2010. Bodies impolitic? Reading cadavers. Int J Commun 4:198–219. Gangata H, Ntaba P, Akol P, Louw G. 2010. The reliance on unclaimed cadavers for anatomical teaching by medical schools in Africa. Anat Sci Educ 3:174–183. Jones GA, Whitaker MI. 2009. Speaking for the Dead: The Human Body in Biology and Medicine. 2nd Ed. Aldershot: Ashgate Publishing. p 296.
513
Jones GA, Whitaker MI. 2012. Anatomy’s use of unclaimed bodies: Reasons against continued, dependence on an ethically dubious practice. Clin Anat 25:246–254. MacDonald, H. 2005. Human Remains: Episodes in Human Dissection. Melbourne: Melbourne University Press. p 220. Richardson R. 2001. Death, Dissection and the Destitute. Chicago, Illinois: University of Chicago Press. p 453. Zhang L, Wang Y, Xiao M, Han Q, Ding J. 2008. An ethical solution to the challenges in teaching anatomy with dissection in the Chinese culture. Anat Sci Educ 1:56–59. Zhang L, Xiao M, Gu M, Zhang Y, Jin J, Din J. An overview of the roles and responsibilities of Chinese medical colleges in body donation programs. Anat Sci Educ (in press), DOI: 10.1002/ase.1422.
