Utilitarianism, Science, and Public Policy

One of the things that you hear over and over again from the anti-science crowd is that public policy should not “sacrifice” the life of one person for the good of the population. In the case of vaccines, many of the people who are convinced that vaccines cause autism will tell you that we should not “sacrifice” a child to autism even if it means preventing a whole lot of death and disability from vaccine-preventable diseases. Mind you, autism does not equal death for a child. But such is the mentality of the fanatic.

I wish that I could live in a fantasy world where there were no sacrifices for the good of the population, where no one in the absolute would have a reaction to a vaccine (no matter how mild). Unfortunately, such a world does not exist. However, there is this thing called science, and it prescribes the tools we can use to minimize the amount of suffering in humanity. With it, we’ve been able to cure diseases that used to kill people by the thousands (maybe millions) in centuries past. Sadly, there are those who have not benefited from the science and may have even been hurt by it. But such is life. Continue reading

You’re supposed to feel pain

You hear it time and time again. The patient goes in to see their provider, complaining of some ailment – or ailments – that is causing pain. The provider prescribes some sort of pain killer in order, well, kill the pain. The patient then tells the doctor that the pain killer is no good, that they’re allergic to it or something like that, and that they need something “stronger”. The provider just goes ahead and gives the patient what they ask, maybe because they don’t want to deal with the issues of a potential drug seeker.

I don’t know exactly when it happened, but pain was declared a “vital sign” at some point recently. Upon being triaged, patients are now being asked to rate their pain on a scale of some sort. In my experience, the scale is 1 to 10. One is for a dull feeling, like when you get poked. Ten is the worst pain imaginable – think of having your limbs torn from your body as someone pours hot lead onto the stumps. (I think.)

Of course, people with a strained back that just won’t heal began to report their back pain as a 10, though it was clearly not that bad. Like any other vital sign, pain had to be reduced or brought under control. After all, you don’t let someone with an incredibly high blood glucose level or blood pressure walk out of your emergency department, do you? But the problem was that these folks with simple injuries being reported as a 10 had developed a tolerance to pain. So newer and stronger drugs were developed.

The problem with those newer and stronger drugs is that the human body is a wonderful piece of machinery. This wonderful machine can adapt to almost anything, pain being one of those things. The more a pain killer was administered, the more the pain receptors in the body adapted. The pain receptors became more sensitized, “scanning” more deeply for any signs of injury. Pain, after all, is how our body notifies all pertinent body systems that something has been injured and needs to be repaired.

So the person gets better and stronger pain killers and the pain receptors are still picking up pain. That, and the injury that caused the pain is not properly addressed because, hey, it just hurts too much to go to physical therapy or to have a surgery. The surgery itself may even bring about more pain. They are cutting into you, after all, and your pain receptors are cross-wired. And all this started at the beginning, when the pain from the initial injury was quickly and swiftly treated with a pill or two.

Now, many of you who are lurking this blog have claimed that I’m a shill for the pharmaceutical industry. If I am, then why am I right now stating that the medical field would be much better off if drugs for pain didn’t exist? There’s a lot of money to be lost if alternatives for drug medications were developed. Yet, no, I’m not talking about acupuncture.

I’m talking about telling someone who comes in with a busted hand from punching a wall that, yes, it’s going to hurt. It will probably hurt for a while as it heals. Tell the person in the car accident that they will be sore for a bit being as how they have just been in a car accident. Explain to the 450-lb man that his knee is not going to get better on pain medication alone until he loses, say, 5 stone.

Yes, maybe techniques such as relaxing and realizing that pain is a part of the healing process could be used instead of right off the bat dropping the opiates. Maybe some aspirin? Maybe?

Then again, I’m not a health care provider, and maybe the standard of care has evolved to the point where pain medication is always indicated for any kind of pain regardless of the place on the VERY SUBJECTIVE scale where that pain may land. It’s a scary proposition, though. The body will continue to adapt, and this arms race of sorts will continue.

No arms race ends in peace.