If rats could talk…

I have long maintained that rats are the thinking man’s pet. Intelligent, capable, social, expedient and adaptable. In essence all the very best of humankind’s strengths, put together in a few hundred grams of fur and a tail. To be truthful, I think the tail puts a lot of people off. Amazing really that such a small feature should put off so many potential owners. For some reason we adore squirrels (essentially a rat with a bushy tail) but are not attracted to rats, their bald cousins.

Yet we live side-by-side, cheek by jowl with rats. It’s said that in urban contexts, we are never more than 5 m from a rat. That’s nonsense – it’s nearer 2 m. Rats live on what we discard. If we want to contain their populations we should be more efficient and throw away less. But that’s not really the point I want to make. Stick with me.

For several years I taught biological psychology with the Open University (OU). Incidentally for those of you who do not know of the OU, let me briefly sing its praises. Modular courses based around self tuition with a handful of face-to-face tutorials. The students are typically middle-aged, often unfulfilled housewives thwarted by feckless children and couch potato husbands. Having also previously taught in medical school where our next generation of doctors are truculent 18-year-olds, oozing privilege and entitlement but lacking interest or understanding, the contrast could not be more illuminating. Unlike the arrogant new generation of future doctors, barely shaving. (no, hanging a stethoscope ever so casually over your shoulders does not make you a doctor). Fulfilling their parents’ social aspirations with barely disguised disinterest they are a travesty of learning. The OU students are hungry for knowledge, hanging on every word a tutor speaks. Absorbing, admiring, appealing. The acme of what learning should be. There is simply no better group of people to teach than those who have been deprived of learning. I loved my time teaching oU students.

Okay, back to the rats. One of the ideas I tried, in order to teach my OU students was the notion of how behaviour manifested itself in animals and how we could learn from this. I had a simple routine – I would ask students who had a pet. Most did. Going round the class I would try to establish who had the most interesting pets for instance. Monitor lizards, bejewelled tree frogs and chameleons obviously trumped cats and dogs and mice. Typically, I chose one student and had them come up to the front and face the others. I stood by the blackboard with chalk. I gave them a minute to describe their pet. As they began to talk, I wrote keywords on the blackboard, in particular those that described behaviour or personality.

We, as a class, would then discuss how these might be assessed. For instance, Cuthbert the chameleon might be “quite nervous” according to his owner. How would we measure that? What would tell us if Cuthbert was more or less nervous after a given treatment for instance. How would we tell?

The students thoroughly engaged with this idea and were soon thinking up complex and elaborate ways of finding out whether Roland the rat, Gordon the guinea pig or Cuthbert the chameleon was anxious.

But why would we want to know if Gordon was anxious? Well without going into the whole pro/anti-animal experiment trope, this is the basis of how we learn about drug side-effects for instance. Or, if you are interested in anxiolytic drugs, this might be used to find which new molecules might be effective.

It’s still a roundabout way of finding out about drugs. If rats or guinea pigs could only talk, we would save ourselves a whole load of trouble. We would love to hear what the rats thought. All that information at our fingertips. Imagine that!

And here is where I get to the point. Imagine the rats and guinea pigs could speak and that humans, specifically clinical trial designers, were more or less wilfully ignoring what they were saying. Ridiculous. Obviously. Yet exactly this situation occurs in so many of our clinical trials. The guinea pigs (the patients) are speaking loud and clear yet so often without any indication of being heard. We are desperate to know what the rats might tell us yet completely oblivious to the very real information being offered by the patients.

It’s hard to believe, more than 20 years into our third millennium, that clinical trials devoid of patient input in terms of design, thinking, logistics or outcomes still exist. A trial designed in the absence of patient input is almost doomed to failure. And so it should be. It is the sound of one hand clapping.

Lucien Engelen of Radboud University, some time ago, initiated the scheme whereby a positive “Patients Involved” seal of approval could be applied to conferences. Why not trials too? Studies that involve patients in very real and practical non-tokenistic ways. I say it’s time to take the next step. It’s time to name and shame those trials that do not.

Because the rats can talk after all and it’s time we listened to them.