2002 Winning Essays

In the fall of 1999, my mother was a healthy, active woman, working part time, taking care of three children and occasionally squeezing in time for exercise. One day after a vigorous workout at the gym, she developed a severe pain in her right hip. Some time after that, her index finger swelled up to double its size. A month later it became too painful for her to walk on the ball of her foot. A blood test revealed her problem: rheumatoid arthritis. She was only 46 years old.

The name of the disease terrified my whole family, perhaps because we really did not know just what this involved. I did not know it was possible for a person under the age of 60 to have rheumatoid arthritis. Our family pictured my mother bound to a wheelchair with deformed, useless hands and joints, unable to do simple, everyday tasks. Within a few weeks, it seemed as if that fate was imminent. All her joints were swollen, red and hot. She had difficulty getting out of bed in the morning. Just washing her hands was excruciating. She could not turn a key to open the front door or open a jar unassisted. Dressing herself was slow and painful. It appeared as though her role as a care giver was over.

Rheumatoid arthritis is a chronic inflammatory auto-immune disease in which the immune system produces antibodies that attack and damage cartilage and bone. Since there currently is no known cure and the cause of rheumatoid arthritis is also unknown, researchers do not know exactly what they are trying to battle (Badger, 427).

After trying a number of other drugs that either did not alleviate her symptoms or which had unbearable side effects, the rheumatologist prescribed Arava.

Arava, one of the ore recent and promising treatments, is the brand name of a drug called leflunomide, one of a class of drugs called disease-modifying anti-rheumatic drugs (DMARD). Arava slows the progress of rheumatoid arthritis while helping to decrease the inflammation caused by the disease (Eustice).

Significantly, leflunomide was initially discovered by observing its effect in a living arthritis rat model rather than in a test tube or computer model (Williams, 311-312). In models of arthritis in mice and rats where the disease has been established, leflunomide prevents or lessens the severity of joint inflammation. It also reduces auto-antibodies, which are the antibodies that attack the tissues of the body (Silva, 55). Because of these findings, further tests were made to determine leflunomide’s range of treatment.

While many new drugs are deemed unsuccessful because of the fact that they are not absorbed well, additional animal testing of leflunomide performed on rabbits and dogs determined the amount of the drug needed for adequate absorption (Silva, 56). Animal research is , therefore, necessary for the development and safety of all drugs because speculation and non-living models alone cannot determine what a drug will do in living beings (DeMonaco).

There are potential dangers with any new drug and animal testing is currently the best tool for assessing the risk in humans. It was observed, for example, that leflunomide caused poor development of some organs in rat fetuses when administered during pregnancy, as well as an increase in deaths of fetuses and decreased fetal body weight for fetuses that survived. Birth defects and decreased survival of fetuses were also noted in exposed rabbit fetuses. With this information, doctors learned that patients must not become pregnant while taking Arava (Arava).

A new drug may also cause malignancies, mutations or chromosome breaks. Various tests were performed on rats with Arava over a two-year period to determine if there was significant risk before moving on to tests on humans. (Arava) It was found, through animal testing, that leflunomide is an important drug for people with rheumatoid arthritis because of its effectiveness, relative safety and ease of tolerance (Portyansky, 21).

At first Arava did not seem to work for my mother as well as did the drug methotrexate, but after twelve weeks, her recovery equaled and eventually surpassed that of methotrexate. Because of Arava, my mother is back to taking care of me instead of my taking care of her. She still has her aches and pains and has had to modify some of her activities, but otherwise she is leading the life she had before the diagnosis of rheumatoid arthritis. On behalf of my mother and myself, thank you , animals.

As I get ready to return to school for my senior year in high school, I look back at my summer at the Mayo with satisfaction with what I accomplished and with regret at its coming to an end. It was a summer full of learning. I do spend nine months of the year learning at school, and some of my friends wonder how I could stand "wasting" my summer doing the same thing that I do the rest of the year, but it was not tiresome or monotonous. This summer at the Mayo, I took part in a different, better type of learning than that which usually takes place in high school.

High school has so much re-learning what I already know, teachers catering to the student who knows least and learning slowly so as not to lose anybody. There is a lot of jumping through hoops, busy-work and a great deal of other time-wasting activities. It is not all bad, but much of high school is frustrating.

At the Mayo, I learned interesting and valuable information as well as skills that will be useful to me in the future. I learned about the heart’s construction and function and much about mice, which will be useful to me since I plan to work in the research and/or medical fields. I learned about how to get along in a work environment, which will be useful in any job. Whether I was learning how to get a jammed copy machine running again or how to implant a transmitter into a mouse’s back, I always felt that I was accomplishing something. And that was quite satisfying.

Another positive outcome from my internship from Mayo is I learned of another interesting field of medicine that I might like to try. The investigators in my lab at the Mayo taught me a number of minor surgical procedures on mice. I learned to intubate a mouse, cut down to and insert a catheter into its carotid artery, implant a transmitter under its skin and suture the mouse closed again. These are procedures that I would not have had the chance to learn until medical school, if not for my summer at the Mayo, and thanks to the Mayo, I have another job to add to the list of one hundred things that I want to do: surgery.

The Mayo allowed me to learn things that I never knew before, but even better than that, I learned some things that possibly no one else knows in the world, besides the investigators in the lab. The research project allowed me to be one of the first people to learn the unique way that a mouse’s cardiovascular system works. I also was a part of the work that will lead to the knowledge of the average heart rate of a mouse. This was not a known fact previously.

The Mayo was one of the greatest learning experiences that I have ever had and I hope to have the chance to work there again. I want to thank Carlos , Terri , Suresh, Rhonda and my fellow summer students Saylee and Ryan for allowing me to do so much and for making a wonderful experience. I would also like to thank everyone at SwAEBR for giving me such an excellent opportunity.

We go to school each day and say goodbye to our parents assuming that they will be there when we get back. Then one day you come home from school, everything seems normal except that your father is laying on his bed in discomfort. Before you know it things suddenly change in your life. FEAR overcomes the moment!!! You hear your sister calling 9-1-1. Before you know it in a glaze of confusion the flashing red lights arrive at your home. Everything around you becomes tinted red as the color of pain flickers. You watch as your father who always there with strength to protect you is taken away on a stretcher to a place where lives are changed. You go to the hospital and wait to see a smile and fear the tears. Your father is rolled away quickly as he states, "I love you."

My father suffered a myocardial infarction. The cardiologist who took care of him explained to us that he was about to perform either angioplasty and the placement of a stent in the damaged coronary artery, or if needed a coronary bypass operation. Cardiologists were regularly inserting these mesh tubes into patient’s arteries by 1997 (1). The stents were placed and have kept my Dad’s heart functioning normally since.

Coronary stent placement became a common procedure in the nineties after being introduced and tested in porcine arteries (8) and successfully performed on patients by 1986 (9). The procedure continues to undergo numerous technological refinements. Cardiologists continue to cite that stents improve the safety of artery-clearing procedures and increase the percentage of blood vessels that stay open afterwards. The technique of coronary stent placement has rapidly become an alternative and adjunct to angioplasty to prevent acute occlusion and late restenosis after angioplasty. In this procedure a small, mesh, stainless steel tube is mounted on the end of the catheter used in balloon angioplasty and then threaded through the artery. When it reaches the blockage, the balloon is inflated, expanding the stent and lodging it firmly in the artery. This not only pushes the blockage or atherosclerotic plaque out of the way but also props the artery open like a scaffold and discourages new deposits from forming. Epithelial cells then grow over the stent.

In a study conducted by the Jefferson Medical College of Thomas Jefferson University in Philadelphia researchers reported that coronary stents carried the same risks as angioplasty, but were more effective in most patients; the stent kept arteries open wider and reduced the rate of recurring blockages. As a result patients underwent fewer repeat procedures than with angioplasty (10). A Dutch study reported the same results (8). In another study using national registries, David O. Williams of Brown University, R.I. compared records for 1,559 people who underwent angioplasty with stent placement in 1997 or 1998 with the outcomes of 2,431 people with angioplasty alone. They found within a year three times as many people of the 1985 or 1986 group developed further artery blockage or restenosis as the 1997 or 1998 group (1).

Stents have come a long way since their initial introduction. The most recent developments are undergoing animal and clinical trials now. These include stents coated with such drugs or agents as Sirolimus, an immunosuppressive drug made by Johnson & Johnson (6), and Paclitaxel, a chemotherapeutic agent, made by Boston Scientific Corp. (7). The animal trials on the sirolumus coated stent tests the duration of the drug in the vessel to inhibit restenosis. Of even greater interest are stents, which are coated with genes that are released to the arterial wall where they inhibit cell growth and thereby help control blood vessel damage. The initial study conducted suing genes transferred to the artery wall was done in pigs and in cell cultures at the Children’s Hospital of Philadelphia, Pennsylvania (5). Also under investigation in animals are biodegradable stents. These would degrade after a few months, after the artery healed from an angioplasty.

Stents are proving to be with continued refinement the preferred treatment for many who would otherwise undergo open-heart surgery. My Dad was lucky he benefited from the research on animals in the design of a small piece of metal mesh that allowed him to forgo open-heart surgery. I have a first hand appreciation for the animal and human research that gave my Dad a quality lifestyle and more time with me.

Follow Up Essay by Elizabeth, Internship completed at Barrow Neurological Institute

My experience this summer taught me about the research aspect of medicine. I participated in a research project to learn more about the learning process of the brain. The research with Dr. Vu, who provided an educational environment, was done on zebra finches, Australian birds. It was hypothesized that certain areas of the brain, known as HVC, Uva, and mMAN played major roles in song production of these birds. By lesioning certain areas of the brain and recording the songs of these birds, it can be determined whether each section is effected. The recorded songs would then be analyzed by a certain computer program to see the attempts of its singing and relearning process. Part of the experiment dealt with tracking a certain protein in the brain that is associated with learning. I assisted in recording the birds and taking care of the colony. I made sure that the birds mated and injected them with testosterone because they sing as a part of their courtship rituals; thus, the testosterone would incite them to sing. I assisted during surgery, deskulled bird brains, and mounted slides, all the while learning much about birds. The experience was amazing!

Animal testing benefits humans and animals in many ways. Every day millions of people and their pets are protected against disease, cured of poison, or recover from a severe injury because of research preformed on animals. Medical researchers provide good living conditions for the animals, as well as medical attention when needed. They are well fed and often care for by the researchers themselves. When experiments are conducted, it is in the most humane way possible, utilizing anesthetics when needed. Even when an animal dies during these studies, it is not in vain, because its death will provide a clue to a cure.

Animal testing has benefited research in many fields, including diabetes research. Diabetes is the lack of sufficient insulin, a hormone made by the pancreas that allows the body to absorb sugar. In the United States alone, 15.7 million people have been diagnosed with diabetes with two thousand more being diagnosed daily. This disease is personal for me because my aunt is diabetic. I recently lost my uncle due to complications associated with the disease. There are two types of diabetes; Type I and Type II. Type I diabetes (common among children) occurs when the pancreas does not produce insulin at all. Type II occurs when insulin is produced, but not in large enough quantities to maintain life. Either type may cause blindness, kidney and heart disorders, nerve and brain disorders, and poor blood circulation in the limbs. The poor circulation may result in the loss of the legs or arms, and even death. My aunt and uncle have relied on regular shots of insulin and careful control of their diets to remain healthy. When asked if this constant monitoring of blood sugar and diet ever annoyed them, they said that having a fairly normal life was better than no life at all.

Research on diabetes and the pancreas though unsuccessful, was conducted years before 1921. However, it was the research of Sir Fredrick Banting that put it all together. While in Canada, Banting became intrigued by diabetes and the protein structure of insulin. Previous studies indicated that insulin was produced in areas of the pancreas known as the Islets of Langerhans. However, it was discovered that Acinar, an associated type of pancreatic tissue, could not be present when Islet cells were ground or the substances they contained would destroy the insulin’s structure, causing it not to function. Banting formed a hypothesis that ligation (sealing) the pancreatic ducts would degrade the Acinar but not the Islets, making it easier to produce usable insulin. He approached Dr. Miller, professor of physiology at the University of Western Ontario with this theory. Lacking the facilities, Dr. Miller referred him to Professor J.J.R. MacLeod of the University of Toronto. MacLeod reluctantly provided Banting with facilities and the assistance of Mr. Charles Best, an undergraduate summer student. They furnished the lab with whatever equipments and dogs they could find. They began by sealing the pancreatic ducts of the dogs to degrade the acinar tissue, but they were met with poor ligations and infections. Ten dogs were tested and ten died before they successfully achieved the degradation desired. Using the produced insulin, they kept Marjorie (a dog with her pancreas removed) alive for seventy days. The two men had created the first refined insulin. They refined their research so that the pancreases of slaughtered pigs and cattle could be used to produce this vital substance.

The pancreas of animals are no longer used now to produce insulin the genetic engineering of E. coli bacteria has allowed us to create chemically identical insulin. This may have never been possible if Banting and Best did not prove that insulin could be refined and given intravenously. It is important to know that Banting and Best took in stray dogs for their research, and even though they died, they were well taken care of. Thanks to animal research, millions of people almost never worry about death from lack of insulin and diabetes complications. Present and future research may eventually find a cure that will make diabetes a term only used in medical history books. I know from experience that at least two of the 15.7 million Americans are glad that research is done so they could live.

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