Andrew Hagen

The lives of millions of Americans are altered for the worse by chronic pain, especially in the back and neck. A significant population suffers pain due to motor vehicle accidents. Regardless of the cause, however, a lifetime of terrible pain debilitates people’s lives. Doctors commonly prescribe pain pills. With chronic pain, however, any solution to the problem must be lifelong, not merely temporary. Whether the pain is extreme or less than extreme, people can become addicted to pain pills. Thus a great controversy over access to pain medication exists.

Richard Paey was injured in a car accident. After an unsuccessful surgery, Richard had chronic pain that he compared to being in a blast furnace. 60 Minutes told his story. (*) He and his family moved to Florida. There he couldn’t find a doctor willing to prescribe enough pain pills for him to make it through. He went back to his doctor in another state for the prescriptions, which he filled in Florida. Eventually, in desperation for more pain medication, authorities say, Richard forged prescriptions for himself. Now he will sit in prison for decades. Ironically, his prison doctor prescribed him a morphine pump and a wheelchair. Now Richard has the pain relief he needs.

The outlines of Richard’s story, from chronic pain to being accused of drug dependency, addiction, or even out-of-control behavior, is far from unique.

To allow doctors to prescribe the huge amounts of pain drugs necessary for chronic pain patients without fear of prosecution, the DEA drafted guidelines. In 2004, however, the DEA took back the guidelines. (†) Dr. Nora Volkow, director of the National Institute for Drug Abuse, is a strong advocate for fighting prescription drug abuse and addiction. She claims two million Americans abuse prescription drugs. (‡) Democrat Patrick Kennedy (chronic back pain) (§) and conservative Rush Limbaugh (ear pain) (**) are two prominent Americans who have faced a glaring public spotlight on their addictive behaviors and their pain problems.

The other side is respresented by Pain Relief Network, a group of patients, doctors, and others who see the grave harm that is done when palliative drugs are denied people who do suffer from debilitating chronic pain. (††) PRN aims to not let those who suffer such pain be forgotten.

As the debate goes forward, we should bear in mind the basic facts of pain. First, medicine has not yet devised a useful objective test for pain. There is no machine that they can hook you up to to get a reading on a “pain-ometer.” Pain is felt internally. We get the impression that another person is in pain when they cry out, complain, wince, or otherwise act as if they were in pain. This inability to directly experience another’s pain gives rise to many suspicions and accusations of faking. Indeed, faking pain is a problem. If a medical scientist came up with a device for measuring pain, it would be one of history’s great medical advances.

If technology remains unable to sense pain, as many believe, we will have to find ways to match our national goals with our actions. We want to defeat drug addiction, and we want to defeat chronic pain. Both are highly important national priorities. At this point, there might not be any obvious solution. Dialogue is called for. Those who experience the problem of pain and those who experience the problem of addiction need to share their experiences so that society can grow wiser. If citizens don’t get involved and tell their stories, all the important decisions will be made by bureaucrats.

Above all, however, all possible steps must be taken to prevent the onset of chronic pain. For example, in your car, don’t keep the headrest in the lowest position unless you are short. For most people, the headrest should be adjusted upward to help prevent a neck injury in the event you are rear-ended or in another collision. Perhaps auto manufacturers should be forced to increase the size of seatbacks to prevent this problem altogether. (‡‡) Post-market products (§§) might help.

Let’s hope Congress wakes up and takes action to prevent chronic pain relief, and that a dialogue can begin on the topic of chronic pain and its treatment.

The danger of a flu pandemic is highlighted by the recent discovery in Japan that influenza viruses are more resistant to key drugs than had been previously known. (*)

The influenza pandemic after World War I killed millions.

The Decadent West is a sharply written, interesting web log. If you haven’t seen it, I recommend you check it out. (*)

Decadent West is currently offering a condensed explanation of America’s obesity problem. Fatness now outweighs lung cancer as the leading cause of death. Americans are eating too much corn, says DW, especially in the form of corn syrup. (†)

Corn does have a lot of sugary calories. Eat prudently.

Update: 24 March 2004. The Corn Refiners Association says that high fructose corn syrup “is not the cause of obesity.” (‡)

How can we “cut the occurrence of chronic diseases by half within a decade?”

Democratic presidential candidate Joe Lieberman has made an interesting health policy proposal: the creation of an “American Center for Cures.” (*) By investing $150 billion (over several years) the federal government can spur science and innovation and entice to market cures that private industry alone does not have the profit motive to develop. (†)

What a great new idea.

Several years ago, researchers devised a new diagnosis called “Munchausen Syndrome By Proxy” (MSBP). According to the diagnosis, parents harmed their children in order to draw attention to themselves. By advocating medical care for their children, parents could come under suspicion of MSBP. The diagnosis resulted in hundreds of British parents and thousands of parents worldwide losing custody of their children. Now controversy rages over whether the diagnosis has validity. (*)

The seconds of your life are ticking away. The Deathclock tells you how many more you have left. (*)

Update. Linked by Legal Memo-Random. (†)

Lynn S of Reflections in d minor informs about stevia, a natural herb that works as a non-fattening sweetener. For some reason no one has heard of it. (*) (†)

Nutrasweet is a brand name for a sweetener that contains aspartame. Aspartame has been criticized as being a neurotoxin. (‡) (§) (**)

I do not know if the criticism of aspartame is accurate. Perhaps it should be compared with sugar and with stevia.

Jim Wooten informs his readership of how the prescription drug bill, recently passed by Congress, has one interesting, new, but little-remarked upon provision, health savings accounts. (*) Like IRAs, they are tax-free savings accounts that allow Americans under 65 to actually save dollars for their own health care, and then actually retain control over their own savings. These accounts should allow consumers to make better health care decisions, and enjoy more freedom of choice in the health market.

To put on my amateur economist’s hat, they should increase the elasticity of demand for many medical services, and therefore just might put a small dent in ruinous medical cost inflation.

Real liberals should approve, and I say bravo.

This may be the most controversial thing I’ve ever written: eating bread will not kill you. Apparently, thanks to the faddish Atkins diet, bread sales in the US are falling through the floor.

Consumption of bread plummeted in America in the past year with an estimated 40 per cent of Americans eating less than in 2002.… The average American eats 54lbs of bread a year, barely a third of the quantity consumed by the French and Italians. But the Italians and the French are not notably obese, Mr [Patrick] Davis [of the National Bread Leadership Council] said.

(*) There is nothing wrong with bread. (†) The obesity problem in America is due to our habit of gorging ourselves with all kinds of food. You can’t wolf down boxes of Krispy Kreme doughnuts, gallons of sugar water, pounds and pounds of bacon, and then cut back on the bread and expect you’ll suddenly get fit.

An epidemic of obesity is affecting not just America, but the entire globe. (*) About 1.7 billion people suffer from obesity. The condition causes diabetes, cardiovascular disease, hypertension, and cancer. Annually, the condition causes more than 2.5 million deaths, including over 300,000 in each of the United States and Europe.

Michael Fumento (†) (‡) and Gary Taubes (§) have a sharp disagreement over low carbohydrate diets, said to help in achieving weight loss, in Reason. This is the diet pioneered by Robert Atkins, who died this week of injuries related to a fall on ice. (**)

Without knowing anything about nutritional science, to me the argument that is most compelling is that obesity is caused not just by an imbalance of certain kinds of food—for example, too many carbohydrates and too few proteins—but is caused primarily by the consumption of too many calories of any kind. Simply put, people are eating too much.

The stakes of the debate are indeed higher than just the proper treatment of obesity. Atkins’s research runs counter to the standard food pyramid promoted by the US government, which suggests a high carbohydrate diet. (††) This is not just a scientific argument; it is a deeply cultural issue.

Update: 26 November 2004. The CDC no longer stands by the figure of “400,000″ deaths per year in the US. That was statistically inflated, they say. (‡) New data will be submitted to JAMA.

After this update, I plan to refrain from covering any news about this statistic on this web site.