First Opinion is STAT’s platform for interesting, illuminating, and provocative articles about the life sciences writ large, written by biotech insiders, health care workers, researchers, and others.
To encourage robust, good-faith discussion about issues raised in First Opinion essays, STAT publishes selected Letters to the Editor received in response to them. You can submit a Letter to the Editor here, or find the submission form at the end of any First Opinion essay.
The story
“The end to animal testing marks the beginning of better biomedicine,” by Ellen P. Carlin and Jason Paragas
The response
Animal models have long provided answers to the most pressing biomedical questions, from the development of the polio vaccine to more recent Nobel Prize-winning discoveries in cancer treatment. “The end to animal testing marks the beginning of better biomedicine” presents a false dichotomy, arguing that novel cell- and computer-based methods are and should be a replacement for animal models in biomedical research. This argument ignores the reality that medical research relies on both animal models and newer technologies.
I am a practicing veterinarian and biomedical researcher in the field of pediatrics who uses both animal and cell models to answer questions about diseases that impact preterm babies. Like many of my colleagues, I have experienced the benefits of using an integrated approach both in my research and veterinary practice. Integration of cell- and computer-based technologies in concert with animal models provides all the promise of increased innovation without compromising the safety and scientific integrity of biomedical research.
The most concerning proposal described by the authors is that drug candidates will be tested at “subtherapeutic levels” in humans, bypassing standard toxicity trials in animals. Giving a person a candidate compound without an idea of how that compound will interact with the 80-plus organs and more than 200 cell types that make up a human being could be disastrous. Additionally, not all patients are going to react to a pharmaceutical agent the same way as a “healthy volunteer,” which is why biomedical researchers have developed specific animal models of different medical conditions. For example, a compound recently tested in my laboratory worked beautifully in cell models, was effective and nontoxic in healthy adults in preliminary trials, but proved to be incredibly toxic in an animal model of a preterm infant. Should this drug have bypassed the animal model and moved directly to clinical trials in preterm infants, babies would have likely died.
Cell- and computer-based models are valuable contributors to biomedical research, but as they currently exist, they fail to fully recapitulate the complexity of human physiology. Animal models remain vital facets of biomedical research because they represent the complexity of human physiology. These approaches work best in concert, and arguments that present these approaches in opposition are fundamentally flawed.
— Caitlin Vonderohe, Federation of American Societies for Experimental Biology
The story
“There is no replacement (yet) for animal models in medical research,” by Carole LaBonne
The response
While I started my career obtaining a DPhil in biochemistry from Oxford University in 1975, most of my subsequent activities have involved promoting the development of alternatives to the use of laboratory animals. Laboratory animal use in Great Britain peaked in 1975 and has declined around 70% since then, yet British laboratories have continued to churn out biomedical innovations and Nobel Prize winners. LaBonne supports her argument that animal research needs to continue invoking the discovery of insulin and the development of the polio vaccine (and the Nobel Prizes awarded to some of the scientists involved who did animal research). However, the history of the Nobel Prize for the discovery of insulin is not one of heroic animal research, as Michael Bliss’ superb history of insulin’s discovery recounts. Similarly, the polio vaccine story involved not just research on monkeys but groundbreaking cell culture work, which also received a Nobel Prize. Three recent NIH directors have either alluded directly to the problem of an overreliance on animal models or have predicted that drug discovery and safety testing will soon be based primarily on so-called alternative research models not involving animals. LaBonne is looking backward, whereas Carlin and Paragas in their opinion essay are correctly predicting the non-animal future of biomedical research, drug development, and chemical safety testing.
— Andrew Rowan, WellBeing International
The story
“A broken system forces parents to DIY hospital-level care for their medically complex children,” by Jules Sherman
The response
A sad but true commentary on the current health care crisis. It’s unfortunate that our most vulnerable and precious patients and their families are left to fend for themselves. If this type of substandard care was given in a hospital, people would be outraged and rightfully so. We shouldn’t accept this as the standard for discharge, either. Our responsibility to provide life-sustaining care doesn’t end at discharge. We need changes to make this situation better for all involved.
— Cynthia DeMott
The story
“A medical forensic nurse’s concerns about at-home sexual assault kits,” by Rachell A. Ekroos
The response
With due respect for my colleague, we authored research that challenged her current position. Consider this: Patients bring evidence from home to the nurse, and informal surveys of forensic nurses almost always result in acceptance of the items. So, if what Dr. Ekroos holds now is true, acceptance of evidence from home must now be refused. For example, washcloth, underwear, cotton-tipped applicators, tissue, and other items as they do not meet the standard for collection of samples from the patient by the nurse as stated in the decisions, new legislation, or opinions. There is opportunity to explore the value of items brought to the forensic nurse and the nursing assessment and interventions to support the patient during a very difficult time.
— Patricia M. Speck, D.N.Sc.
The story
“The ironic origin story behind Sloan Kettering,” by Daniel Stone
The response
Excellent piece that makes the connection so many do not want to see between industrial progress and harm to public health. We need not revile Sloan or Kettering for doing so much to promote disease, for the culture in which they lived and we still live prizes commercial success too much. They were not evil men but successful within that culture. But we must grow up. To value things we make, and money, more than the primary directive of valuing life itself above all, is simply evidence of a society and culture that needs to mature.
— Richard Reibstein, Boston University
