2014: Rat and Infant Massage

AWARDEES: Tiffany Field, Gary Evoniuk, Cynthia Kuhn, and Saul Schanberg

SCIENCE: Rat Massage Research Helps Premature Babies Thrive

FEDERAL FUNDING AGENCY: National Institutes of Health

A young scientist takes a small brush, the kind you would use to clean a camera lens, and rubs it briskly down the back of an infant rat – a rat pup. No, he’s not giving rat pups a massage to relieve boredom. He’s actually doing research, funded by the federal government. If this strikes you as frivolous or a waste of tax dollars, consider this: a discovery resulting from these experiments led to a momentous change in how premature babies are cared for that has saved lives and billions of dollars in health care costs. Because of this research, thousands of preemies have survived, grown stronger, thrived, and gone on to live healthy lives.

Premature birth is a serious health concern. One out of eight infants in the United States is born prematurely, and such births are associated with neurodevelopmental impairment that has been shown to persist into adolescence. Moreover, the annual health care costs associated with premature birth and long stays in the Neonatal Intensive Care Unit (NICU) were estimated to be at least $26.2 billion in the U.S. in 2005, nearly $52,000 per infant. This, of course, does not include the emotional toll it takes on thousands of families.

But in 1979, this was the farthest thing from the minds of Dr. Saul Schanberg, a Duke University neuroscientist and physician, Cynthia Kuhn, Ph.D., then a graduate student and now a faculty member, and Gary Evoniuk, their laboratory technician. Funded by the National Institutes of Health (NIH), they were working with rat pups to learn more about factors influencing two key growth markers: an enzyme called ornithine decarboxylase and growth hormone. In order to give the rat pups injections over a period of time, early experiments separated the pups from their very protective mothers, which the research group soon found led to declining levels of these growth markers.

Through a series of elegant experiments, the scientists ruled out the effects of nutrition, body temperature, pheromones, and other factors until it became clear that some other factor related to maternal absence was causing the negative impact on the pups’ growth. The researchers then made the critical observation that when they were present, the rat mothers spent a great deal of time grooming and vigorously licking the pups. Could the simple act of tactile stimulation, of touch, from the mother be making all the difference? Evoniuk picked up a tiny camera lens brush and, mimicking the mother’s licking pattern, stroked up and down the rats’ tiny backs. (Schanberg joked later, ‘”I couldn’t get the lab technicians to actually lick the pups.”) As one might imagine, this was a laborious task that needed to be repeated frequently. But the researchers observed, sure enough, that the enzyme levels rose, growth hormone rose, and the rat pups once again thrived.

Dr. Schanberg and Dr. Tiffany Martini Field, a psychologist at the University of Miami School of Medicine, met at an NIH study section later that year and shared their research. Dr. Field worked in pediatrics and was conducting research on stimulating premature infants to help them grow. She was interested in whether the Duke group’s results had implications for human infants, and she followed up with Dr. Schanberg’s team to better understand their work. Later that same year, Dr. Field, in a landmark study funded by NIH’s National Institute of Mental Health (NIMH), demonstrated that using similar tactile stimulation in human preterm infants, what is now called “infant massage,” also had immediate positive effects: greater growth rates, increased alertness, and a shorter hospital stay (an average of six days shorter), despite the fact that the massaged infants were not consuming more food than those not receiving the massage.

Dr. Field did not set out to develop infant massage as a national health care cost savings measure. Her goal was to help save and improve the lives of babies born too sick or too soon to face the world outside of the NICU, and she was very successful in that regard. Her success did, however, also result in enormous cost savings. A recent analysis estimates that these savings amount to about $10,000 per infant, resulting in a nationwide annual health care savings of $4.7 billion. Infant massage therapy is now used by close to 40 percent of NICU’s nationwide, a number that is steadily increasing.

Dr. Field went on to serve as director of the Touch Research Institute and Professor in the Department of Pediatrics, Psychology and Psychiatry at the University of Miami School of Medicine. Additional studies by her and others around the world have continued to show beneficial outcomes of infant massage as well as revealing the underlying physiological mechanisms involved. Dr. Schanberg and Dr. Kuhn collaborated with her, continuing to use insights from the animal work to explore potential physiological and hormonal mechanisms responsible for the benefits of touch in human infants. Her work has been funded by NIMH as well as the National Institute of Child Health and Human Development, the National Center for Complementary and Alternative Medicine, and Johnson and Johnson.

Drs. Kuhn and Evoniuk both earned Ph.D.’s at Duke. Dr. Kuhn is a professor of pharmacology and cancer biology at the Duke School of Medicine. Dr. Evoniuk is Director of Publication Practices for GlaxoSmithKline. Dr. Schanberg, who passed away in 2009, is fondly remembered by Drs. Field and Evoniuk and his other former graduate students – indeed, Dr. Kuhn had the privilege of being in his first group of graduate students and lab workers.

“Federal tax dollars fund rat massage” could easily have been a scandalous-sounding headline in the 1970’s. Today, it is yet another lesson in how odd-sounding research can lead to extraordinary benefits for society. These four scientists, instead of being criticized, are being honored with the Golden Goose Award.