first opinion
Point / Counterpoint: Animals in medical research
CHRISTOPHE ARCHAMBAULT/AFP via Getty Images
Last month, the FDA announced it would phase out the use of animals in preclinical testing of monoclonal antibodies — and eventually other drugs — and instead rely on "more effective, human-relevant methods" like AI models. Is this a good idea? Will it work? Today, STAT is publishing two First Opinions with opposing perspectives on the decision.
On the one hand: Animal models are often flawed, offering incomplete representations of human disease. The FDA's plan is a roadmap that will help pharma move toward surrogate systems based on human biology — so argue a veterinarian and a virologist in one essay. It's time to disrupt a baked-in system that hasn't been serving the people who need it most, they write, and there are three main areas of challenge: policy, social, and technical.
On the other hand: Every lifesaving treatment and medical innovation we have has depended on animal research. Animals like mice, zebrafish, chickens, and frogs are the behind-the-scenes heroes of medical breakthroughs, argues a molecular biosciences professor in another essay. Researchers can't get the full picture from cells in a dish or computer models alone, she says.
Read both essays — for and against the FDA's decision — and let us know where you land.
reproductive health
ACOG updates pain recs for IUD insertions & more
Last week, the American College of Obstetricians and Gynecologists published long-awaited guidance on pain management for procedures like IUD insertion, endometrial biopsy, hysteroscopy, intrauterine imaging, and cervical biopsy. The move comes almost a year after the CDC updated its own recommendations on IUD insertion to include lidocaine, following years of media coverage pointing out how painful it can be, and even a viral trend where women posted close-up videos of their pained faces during the procedure.
ACOG also recommends local anesthetics like lidocaine spray or cream for IUD insertions, and varying options for other procedures including more topical or injected anesthetics, NSAIDs like aspirin and ibuprofen, and a nerve block. But the guidance also acknowledges that the existing evidence is often conflicting or limited — not every option will work for every patient, and it's hard to predict how much pain any given patient will experience. For these reasons, the guidance emphasizes the importance of shared decision-making between clinicians and patients.
cardiovascular health
Even more evidence against sedentary behavior (I typed this sitting down)
After someone is hospitalized for a heart attack or chest pain, they're at high risk for another cardiac event, even if they're receiving high quality medical treatment. A new study identifies sedentary behavior — generally bad for heart health — as a key, independent risk factor after hospitalization. In the study, published today in Circulation: Cardiovascular Quality and Outcomes, the least active people, who had a daily average of more than 15 sedentary hours, were two and a half times as likely to experience another cardiac event or die within a year of hospitalization than the most active group, who were sedentary for less than 12 hours a day.
Between 2016 and 2020, researchers recruited more than 600 patients who had a heart attack or chest pain from the emergency department at the Columbia University Medical Center. For 30 days after they went home, the patients wore wrist devices that tracked their movement. Researchers followed up on each patient one year later, either by contacting them or through electronic records.
According to the data, replacing 30 minutes of sedentary time with 30 minutes per day of either light activity, moderate to vigorous activity, or simply with sleep, reduced the risk of another cardiac event or death by 50%, 61%, and 15% respectively. For what it's worth: The data is based on patients from a single medical center. Also, the wrist devices couldn't differentiate between sitting and standing, only the intensity of any activity.
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