Anand Testimony

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and international committees and consulted with many corpora-
tions, not-for-profit organizations and consumer organizations.
Dr. Caplan is the recipient of many awards and honors and holds
six honorary degrees from colleges and medical schools. He is the
fellow of the Hastings Center, the New York Academy of Medicine,
College of Physicians of Philadelphia, and the American Associa-
tion For the Advancement of Science. And we welcome you here as
well, Dr. Caplan.
Our final witness is Professor Teresa Stanton Collett. From 1990
through 2003, Professor Collett was a professor of law at South
Texas College of Law, where she taught various legal courses.
Since 2003, she has served as professor of law at University of St.
Thomas College of Law, teaching bioethics, property, and profes-
sional responsibility. Professor Collett has also served as a visiting
professor at Notre Dame Law School; Washington University
School of Law in St. Louis, Missouri; the University of Texas
School of Law; the University of Houston Law Center; and the Uni-
versity of Oklahoma College of Law.
Prior to joining South Texas College of Law, Professor Collett
was affiliated with the law firm of Crowe & Dunleavy in Oklahoma
City, Oklahoma. And we welcome you here as well, Professor.
I want to thank all the witnesses for being here this afternoon,
and we want to make sure that you are aware that your testimony
will be permitted for 5 minutes, and we actually have a lighting
system. When the red light comes on, that means your 5 minutes
is up. I won’t gavel you down immediately, but we would ask you
to keep within that as much as possible. A yellow light will come
on letting you know you have a minute to wrap up, and the green
light will be on for 4 minutes.
It is also the practice of the Committee to swear in all witnesses
appearing before it, so if you would each please stand and raise
your right hand.
[Witnesses sworn.]
Mr. CHABOT. All witnesses have indicated in the affirmative.
Without objection, all Members will have 5 legislative days with-
in which to submit additional materials for the record.
And, Dr. Anand, you are recognized for 5 minutes.
TESTIMONY OF SUNNY ANAND, DIRECTOR, PAIN NEUROBIOL-
OGY LABORATORY, ARKANSAS CHILDREN’S HOSPITAL RE-
SEARCH INSTITUTE, AND PROFESSOR OF PEDIATRICS, AN-
ESTHESIOLOGY, PHARMACOLOGY, AND NEUROBIOLOGY,
UNIVERSITY OF ARKANSAS COLLEGE OF MEDICINE
Dr. ANAND. Thank you. I appreciate the invitation to testify be-
fore this Committee. I come to you as a researcher in the develop-
ment of the brain, particularly as it relates to pain perception dur-
ing fetal and neonatal life. I am not here as a practitioner for pro-
cedures required for termination of pregnancy or anesthetic prac-
tices related to those procedures.
I think the evidence for and against fetal pain is very uncertain
at the present time. There has been a recent attention on this
based on a review article that was published in the Journal of the
American Medical Association on August 24th. And I will first try
to bring up some points to critique that article.

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6

That article was published by Susan Lee and her colleagues at
the University of California, San Francisco, and they have done a
systematic review of the published literature related to this subject.
First of all, they present pain as a hard-wired system, whereby
pain impulses are conducted from receptors through nerves and
nerve pathways until so-called perception occurs in the sensory cor-
tex. This is an incorrect view of pain, which is rather outdated. For
the last 40 years, medical research has shown, beginning from the
gate control theory of pain, that pain reception occurs within a
multilayered system with numerous elements of nerve fibers and
cells, the functions and the characteristics of which will change de-
pending on the type of pain, the context in which it occurs, as well
as other cognitive and behavioral demands at that time, so that the
processing of pain and indeed perception of pain doesn’t simply
occur in the sensory cortex. It can occur at various different levels
within the nervous system.
Second, Lee and colleagues presume that the structures used for
pain perception in adults are the very same structures used during
fetal and neonatal life. The lack of development of these structures
is then taken as proof that the fetus does not—or the preterm
neonate—would not feel pain until 29 to 30 weeks period of gesta-
tion. This is again a flawed line of reasoning.
Many years of careful research in which I have participated has
shown that the neonate, or the fetus, is not a little adult;that the
mechanisms and structures used for pain processing are very dif-
ferent at different stages of development. Indeed the nervous sys-
tem will use the elements available at that time, at a particular
stage of development, to transduce external and internal stimuli,
and pain is an inherent, innate part of this system.
These neural elements during development may not survive, may
not be maintained until maturity. They may have only a transient
role in conducting pain or pain-related information from the pe-
riphery to the central nervous system.
Lastly, I beg to differ with the contention that the perception of
pain occurs only in the sensory or the somatosensory cortex. For
example, in conscious adults, if you stimulate the sensory cortex,
or if you cut it out completely, it will not alter pain perception.
Stimulation does not produce pain perception; removing the sen-
sory cortex does not block pain perception.
So if the viability of the sensory cortex is not a necessary cri-
terion for pain perception in adults, why should that be a criterion
for fetus and preterm infants and neonates?
Despite this caveat, more recent research shows that there is, in-
deed, alteration in the activity of cortical centers related to sensory
perception, but this may have more to do with the content, but not
the context, of the pain experience that is being transduced.
Lastly, I would like to identify that there was ambiguous meth-
odology followed in this review whereby 2,100 articles were ob-
tained from PubMed through a detailed search strategy. And the
subsequent disconnect of selecting what evidence to include in the
data synthesis did not follow the methods of a systematic review.
If I were to review this systematic review, it cannot be replicated,
and therefore it calls into question the scientific validity of this ap-
proach.


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I appreciate the opportunity to present my views.
Mr. CHABOT. Thank you very much, Doctor, and we can get more
information in the questioning period, of course.
[The prepared statement of Dr. Anand follows:]
PREPARED STATEMENT OF SUNNY ANAND

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