February 14, 2015
In 2000, the United States declared that the measles virus had been eradicated. Yet, within the first week of 2015, there were approximately 121 cases reported in 17 different states. This trend is closely linked to parents choosing not to vaccinate their children. Anti-vaxxers have many reasons for choosing not to vaccinate their children, especially the high prices of vaccines and the potential health and safety hazards for... // Read More »
February 12, 2015
Yesterday, Steve Phillips echoed my support for Dr. Atul Gawande’s book, Being Mortal. One of Dr. Gawande’s key points is how difficult it can be for doctors to talk with their patients about care at the end of life, when the doctor cannot “fix” the problem. Steve also raised the difficulty of these discussions in his January 28 post on this blog. This past Tuesday,... // Read More »
February 11, 2015
I just finished reading Atul Gawande’s book Being Mortal and would recommend it to anyone interested in the issues surrounding death and dying. In the book Gawande comes across as both a caring physician and an engaging author. He weaves together the things he has learned about how we die and stories of the lives of a number of people as the live out the... // Read More »
February 10, 2015
The other day I was speaking to another physician about grace. This was at church, not surprisingly, but later I wondered why such discussions don’t occur in the hospital. When I recall the more remarkable physician-patient encounters I have seen, the word that comes to mind as the common theme is grace. We can see it in the physician calmly and pleasantly treating the irascible... // Read More »
February 9, 2015
The ways to make a baby have been expanded once again. While the ways to bring a baby into this world can be the source of much bioethical debate, it was generally accepted that two people would be part of the process. After a recent decision in the British House of Commons, this given has changed – three parent in vitro fertilization (IVF) has been... // Read More »
February 8, 2015
Sen. Feinstein of the U.S. Senate released a committee report two months ago on the use of torture by CIA interrogators in the 2000s. While some have expressed outrage, many have been silent on the matter. I think ethicists are obligated to speak on this issue, and Christian ethicists should be able to articulate the moral high ground regarding the treatment of prisoners or the... // Read More »
February 7, 2015
In his recent State of the Union address, the President made the following statement: “As Americans, we respect human dignity… We do these things not only because they’re right, but because they make us safer.” Human dignity is a concept rich in significance and riddled with controversy. While you would be hard pressed to find someone who would disagree with the President that human dignity... // Read More »
February 7, 2015
Chronic Pain -- The Invisible Public Health Crises
A Call for Moral Leadership“I am an invisible man. No I am not a spook like those who haunted Edgar Allen Poe: Nor am I one of your Hollywood movie ectoplasms. I am a man of substance, of flesh and bone, fiber and liquids- and I might even be said to possess a mind. I am invisible, simply because people refuse to see me.”
- Ralph Ellison
Ralph Ellison’s famous novel, The Invisible Man
, starts with this passage, which also reminds me of the problem of chronic pain. The Institute of Medicine (IOM) report, Relieving Pain in America, documented the more than 100 million Americans (almost 1 in 3 and surely someone whom you know and love) suffers from chronic pain, at an economic cost of $6 billion and an incalculable psychological cost. We named pain as a “disease” because of its profound effects on the brain and its interference with multiple domains of the quality of life of sufferers. The committee identified chronic pain as a public health problem, given the sheer numbers affected, and the opportunities to intervene to prevent acute pain from becoming chronic pain. However, the report is now almost four years old, and it is fair to say has not really moved the needle in doing what we implored in the IOM report—“changing the way in which pain is judged, managed and perceived.” Why is that?
Because pain is subjective -- and therefore difficult to measure by the usual medical tests -- it is often doubted. As someone once said, my pain is real, your pain is in doubt. Also, we live in profound cultural ambivalence about pain. Cultural icons such as Julius Caesar and Albert Schweitzer have been quoted as saying that pain is worse than death, but there is also an ethos of “no pain, no gain.” Medical interventions, particularly powerful opioid drugs such as morphine and oxycodone, although essential to manage acute and persistent pain, come with a cost of many side effects and may induce psychological dependence in some. Persons in pain and their doctors fear addiction, although we do not truly know the risk of addiction in persons taking opioids who have not abused recreational or illicit drugs. For these and other reasons, on an individual and societal level, we prefer to ignore the problem of chronic pain
, unless confronted by it in our personal lives.
So how do we advance the moral imperative to address pain and suffering in contemporary medical practice, as required by our ethical codes and professional oaths? How do we bring the invisible suffering of so many to light and work to alleviate it? I think we commit ourselves to five big goals:
1. We advocate for more and better science to understand the underlying neuroscience of pain production and modulation. This requires advocacy at the NIH and other federal agencies to fund worthy science related to pain mechanisms and clinical trials of pain treatments.
2. We advocate for more and better drug development, including the creation of abuse deterrent opioid formulations and novel non-opioid based analgesics. This will require advocacy for effective public-private partnerships between the pharmaceutical industry, academia and federal agencies.
3. We advocate and demand better education of health care professionals to live up to their obligations to be competent and to attend to pain and suffering in their patients. We also advocate for better public education so that persons suffering with chronic pain understand that this is a disease, and not subject to quick fixes.
4. We advocate and demand better policy solutions to provide sustainable and patient-centric interdisciplinary pain treatment programs that truly address patient and provider needs.
5. Finally, we need effective collaboration on a shared policy agenda between pain specialists and substance abuse specialists to advocate for comprehensive, rehabilitation-focused care for chronic pain
, and greater access to substance abuse treatment for those persons who have a dual diagnosis of chronic pain and addiction.
These are my thoughts. What do you think?Richard Payne, MDJohn B. Francis Chair, Bioethics
Center for Practical Bioethics
Esther Colliflower Professor of Medicine and Divinty
February 5, 2015
On January 8, I wrote about increasing physician support for physician-assisted suicide (PAS)—up from 46% of surveyed MDs in 2010 to 54% now. Only 31% were flatly against it. The remaining 15% give qualified support—“it depends.” Now, Medscape sends a follow up (registration required), regarding the reasons their surveyed physicians gave for their answer. The title of this report: “Is religion why docs are against... // Read More »
February 5, 2015
This morning the Presidential Commission for the Study of Bioethical Issues (Bioethics Commission) resumed consideration of U.S. engagement in the global response to the current Ebola epidemic by examining ethical issues that arise when conducting research during a public health emergency. As experts move to accelerate development of drugs and vaccines against Ebola, a debate […]