I’m not a regular reader of the Huffington Post, but I received a pointer to an article there that strikes me as worthy of comment.
From the title, you might expect a defense of animal-tested drugs, or at least a coherent explanation for why the author is taking them. However, what the article actually offers is condemnation of the use of animals in biomedical research, and even a claim that animal-tested drugs and medical interventions contributed to the author’s cancer.
The truth is that I don’t feel I’ve ultimately benefited from our healthcare system, despite some truly exceptional care and many amazingly compassionate practitioners. Just the opposite.
I first developed myelodysplastic syndrome (MDS) in 2004 from the chemo I was prescribed for breast cancer. In 2006, I underwent a stem cell transplant, which gave me two years of remission (albeit with many horrible side effects). This past July, I relapsed — this time with acute myeloid leukemia (AML). My prognosis is grim.
Ms. Chaitowitz sought treatment for her breast cancer. Presumably, before she consented to the chemotherapy, she was informed of the risks of this treatment, including the possibility of developing MDS. As well, before consenting to the stem cell transplant, she would have been informed by her physicians of the possible side effects, ranging from mild to horrible. That she describes her care as “truly exceptional” and her care providers as “amazingly compassionate” communicates that she regards these physicians as having lived up to their ethical responsibilities to her as their patient.
At which point, Chaitowitz had the information to make her own choices and, having made those choices, she needs to accept her share of responsibility for the outcomes. Our healthcare system did not hold her down and force her to accept chemo or a stem cell transplant. They were offered and she accepted them. Not only did she have the option not to pursue these treatments, she also had the option to forego medical care altogether. (I would hazard a guess that Chaitowitz had good enough health insurance that she had the choice to access the care options she did — many Americans do not.)
Throughout the past six years, I have felt terribly guilty about the drugs and procedures I’ve undergone because I know that so many animals have suffered in their development. …
The truth — mostly hidden from public view — is that animal research is horribly cruel. Despite what the research community claims, federal regulations are extremely weak and poorly enforced, and some species — mice, for example — are completely excluded from any protection. Many investigations have shown just how bad conditions are.
Chaitowitz makes claims here that are overly strong and that fail to draw important distinctions.
First off, she seems to be claiming that all animal research is horribly cruel. Possibly it could be viewed this way by a person committed to the idea that non-human animals have enforceable rights (making all human use of animals wrong), but most people fall closer to the view that animal welfare (which includes freedom from unnecessary suffering) is what ought to be protected. From that viewpoint, there are many types of animal research that are far from “horribly cruel,” and even in the studies where animals are exposed to diseases, surgery, or death, the research protocols build in measures to reduce the distress and discomfort of the animals. If cruelty were the goal, such steps would not be taken. Indeed, that such steps are required indicates that as a group, scientists who do animal research and the federal agencies that oversee animal use are committed to making that research as humane as possible.
Next, there is the question of whether the federal regulations are too weak. I’m guessing that most of Chaitowitz’s readers at HuffPo have never read those regulations (for which you can find links here) and thus have no way to assess their strength or weakness. That mice are
not covered species used in lab experiments does not, however, mean that they are treated more cruelly in labs than they are in kitchens and basements where they are poisoned, stuck on sticky-traps, or gravely wounded by snap-traps.
Note: as DrugMonkey and Laura point out in comments, I goofed here. Mice are indeed covered species. From Guide for the Care and Use of Laboratory Animals.:
In this Guide, laboratory animals include any vertebrate animal (e.g., traditional laboratory animals, farm animals, wildlife, and aquatic animals) used in research, teaching, or testing.
Mice, as vertebrates, are covered. (Edited to add: DrugMonkey provides regulatory chapter and verse.)
And no matter the strength of the regulations, how well or poorly they are enforced is a separate issue. To some extent, enforcement is a local issue that will depend on the efforts of the IACUC. Enforcement will also depend on the priorities and resources of federal agencies like the USDA. Good enforcement of prevailing regulations is a good way to ensure that they’re taken seriously. But poor enforcement doesn’t prima facie mean that the prevailing regulations are too weak.
I wonder if science would have found a cure for my leukemia by now if they weren’t sidetracked by misleading animal tests. I wonder if the chemo that I took for breast cancer would have been safer it hadn’t been tested in species that are so unlike our own.
The truth is that using animals to develop and test drugs is a system that doesn’t work very well. It’s an old paradigm, one that is fortunately beginning to change, however slowly. A growing number of scientists are developing some exciting (and more effective) non-animal alternatives.
It’s true that a mouse is not exactly like a human, so treatments that prove extremely effective in mice may not be effective in humans. However, for most of the questions we would like biomedical science to answer, we are not at a point where we could just substitute computer models for animals — you can’t build a good computer model of a phenomenon you don’t understand fully, and we cannot work out all the mysteries of physiology, whether in humans or in mice, from first principles. Since Chaitowitz doesn’t really enumerate the “non-animal alternatives” she mentions, it’s hard to know what else she has in mind.
Of course, the best fit from experiment to human treatment would come from experimenting on humans. However, biomedical experiments with human subjects cannot be conducted unless appropriate studies in animals have been performed first. This is the current state of regulations in force as far as human trials go, and it’s not clear that the public wants to drop animal experimentation in favor of becoming guinea pigs themselves. Indeed, given Chaitowitz’s anger at the medical treatments she received that didn’t work as well as had been hoped, I get the feeling that not even she would cheerfully embrace being an experimental subject. I daresay that patients without a commitment to the rights of mice would be even less enthusiastic about removing the preliminary animal studies.
If you wonder how I can justify taking the drugs, the truth is that like all living beings (“lab animals” included) I desperately want to live. And because of government regulations, I don’t have a choice.
The current drug approval system doesn’t yet acknowledge the superiority of human-focused, nonanimal research methods (such as microdosing) and all pharmaceutical companies must use animals to get their drugs approved. Hopefully, this situation will soon change.
In fact, as discussed above, Chaitowitz did have a choice — to opt out of these treatments. As it happened, her desire to avoid treatments tested on animals was in conflict with her desire to live, and she went with the desire that was stronger.
How could this conflict have been avoided? Presumably, if there were drugs that were never tested on animals but only on humans. However, to use these with a clear conscience, Chaitowitz would have to be able to accept the suffering of humans in the experiments required to develop these treatments. In the absence of the preliminary testing in animals, experimenters might have much less information to start with, and the harm to human subjects might be much more extreme.
But this is a choice that Chaitowitz thinks we should have?
If the chemo drugs I’m trying now don’t work, I do have one last option. I could try a Phase One trial. That’s when a drug looks promising in animals and is first tested in humans. My doctor started to tell me why so many participants die in Phase One trials — but it turned out I already knew the answer. Drugs that work in animals, he explained, usually don’t work in humans.
This claim shows a fundamental confusion about what Phase I drug trials are for. Such trials are meant to establish what kind of dose can be safely administered and tolerated, to uncover side effects, and to assess the pharmacokinetics and pharmacodynamics of the drug. There is not any expectation that a human subject in a Phase I trial will receive a direct benefit from the treatment being administered. Generally, if it is possible, Phase I trials will be conducted on a relatively small group of healthy volunteers. However, Phase I trials may also enroll patients with end-stage diseases for whom the available treatment options have not been successful. This bears repeating: enrollment in a Phase I drug trial does not constitute treatment. Many participants in Phase I trials die because they are in the last stages of a terminal illness.
Cancer is no one’s idea of a good time, and coming to grips with our own mortality is on the verge of impossible. Undoubtedly, our desire to overcome disease and to avert death (at least until we’ve done most of the things we wanted to do) is a strong motivator to many of our medical advances. But given that our biomedical knowledge depends on data drawn from actually functioning whole organisms, getting the data makes some amount of suffering unavoidable. And given that most of the humans with whom Chaitowitz shares a government and regulatory environment seem to feel that there’s a morally relevant line between humans and non-human animals, while some of the suffering on the path to cures will be human suffering, animal studies will be an integral part of the research, reducing the amount of human suffering both in the research and in the treatment of patients in the world.