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My father died of cancer. The doctors gave him as much Demerol (a synthetic opiate) as he wanted to keep him out of pain. They gave my mom big boxes of the drug and syringes so she could inject him regularly. Of course he got addicted to the stuff, but what of that? There was no chance whatever of him recovering, and it kept him comfortable during his final months. The addiction was a medical non-issue. I'm glad it happened that way. That was 1971. About ten years later things had changed. The father of a friend of mine also died of cancer, but for him he would only be given a shot if he complained loudly and had his wife drive him to the doctor's office. Then they'd give him one shot which might last six hours, after which the pain would return. What changed during that time? The War on Drugs. The Nixon administration decided to get tough on drug addiction and clamped down. One of the myths going around was the idea of doctors being legal drug peddlers and writing prescriptions for addicts, so they imposed all sorts of paperwork on doctors. Whenever a schedule 1 drug was prescribed, the doctor had to fill out forms to justify it, and if it was found that the doctor was wrong then the doctor could lose his license to practice and perhaps even face criminal charges. This covered, in particular, the use of opiates for pain relief. So if a doctor under-treated pain, then all that happened was that one patient suffered. If he over-treated pain, he could lose his license and perhaps even his liberty. Which side would you err on? Yup, so did they. Easily the most egregious example of this is a medical procedure called debriding. In burn patients, there is dead tissue at the site of the burn and it must be removed; otherwise gangrene can set in and the patient can die. But this is an unbelievably painful process, because it means that the burn area has to be vigorously scrubbed to make the dead tissue come off. And we're talking open raw flesh here; all of us have had minor burns and we know how sensitive they are; that's nothing compared to a 3rd degree burn which may be several inches in size or may cover most of the patient's body. And in the 1980's this operation was routinely done without anesthetic. (Indeed, the result differs little from a Dark Ages torture called flaying which was one of their favorites because it was so effective at inducing pain in the victim.) I don't understand why such people weren't juiced with Morphine first. I find it nearly inconceivable that medical technicians could do that to people without feeling bad. I think part of the problem is that medical workers get used to being around pain in others -- it is, after all, a daily occurrence for them. And it's easy to rationalize: debriding a wound really does save the life of the patient. You have to be cruel to be kind, and all that. Moreover, except in cases of shock pain itself doesn't kill. It's a symptom, not directly a problem; fixing the problem will make the pain go away -- eventually. I think they get inured to it. So I can't say I'm surprised to learn that the same attitude has filtered down to treatment of children. And the American Academy of Pediatrics (and the American Pain Society) have now come out with a new policy stating that pain in children, even minor pain, should be treated more aggressively. I fully agree. It isn't possible to prevent pain entirely (a shot of anesthetic itself hurts) but it can be reduced in many cases. But it would help if Congress were to reduce the regulatory burden on doctors trying to use opiates. Doctors would use Morphine more (as they should) if they didn't fear the consequences of doing so quite as much. The evil of doctor-pushers is much less than the evil of unnecessary pain in innocent victims of injury. (discussion in progress) |
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