Up@dawn 2.0

Wednesday, April 26, 2017

Drug Dealer MD, Second Post

Over the past thousands of years, people have understood pain to serve at least two useful functions. Pain is a warning system which tells us what to avoid and what not. People also believe pain is an opportunity for spiritual growth: “what doesn’t kill you makes you stronger” “After darkness comes dawn,” etc. Today, modern American culture regards pain as anathema, and to be avoided at all cost. This new view of pain comes from the belief that pain can cause permanent neurological damage that lays the foundation for future pain. Dr. Lembke states in her book, “This new conception holds true for both mental and physical pain, and it has been a major contributor to the prescription drug epidemic.”[1] As for theories involving mental pain, these date the back the early 1900s. At least to Freud, whose idea was that the early childhood experiences can influence behavior in later life. Also, the idea that an experience in one’s past can have a lasting psychological and often unconscious effect on one’s behavior in the present. 

Now, the role of physical pain has also fallen into a similar transformation. 200 years ago, pain was considered a vital part of the healing process, especially during surgery to revitalize cardiovascular functioning and strengthen the immune response. By the mid-1850s, improved methods to treat pain were introduced, such as morphine and the hollow needle syringe used to administer this drug. This contributed to the changing views for treating pain. With an effective means of treating pain, more doctors began advocating for the use of opioid painkillers. By the 1950s, because of refined technology, opioids were able to be readily synthesized in the laboratory. Thus leading to very eager pharmaceutical companies whom couldn’t wait to sell the new products. Today, pain is considered an almost intolerable sensation for patients to bear. Doctors are expected not to simply lessen the pain, but to eliminate it altogether.

The pressure today, for doctors to treat pain, has become so overwhelming that doctors who leave pain untreated are not just demonstrating poor clinical skills; they are viewed as morally compromised. There is also the legal liability of malpractice doctors must consider. In regard to the views of physical pain causing potential future pain, pain researchers speculate that once the individual experiences pain, the brain can be sensitized for future pain created additional urgency to treat any pain immediately and completely. Our tolerance and threshold for pain are also much lower now than ever before. How much pain is too much pain for an individual to suffer? Because of the lower threshold we are now accustomed to, there is an increase in prescriptions and consumption of potentially addictive prescription drugs.

T-Rex added a great comment to my last post, “How did the medical community in general not realize the glaring consequences of having pharmaceuticals as a major for-profit market? Clearly, someone, somewhere in this food chain had to be aware that pushing all of these pills with a turbulence of misinformation had to be hurting the patients while lining the pockets of the pharma companies. Or perhaps this was such an institutionalized issue from the beginning that even if some doctors did realize what was going on that they couldn't fight it without risking their job and security…”

T-Rex…The medical community has been fed a series of false information about the addictive agents of opioids, such as Oxycontin. They have also been told that pain is something they should eliminate. The philosophy behind “what doesn’t kill you makes you stronger” has, over the years, been thrown out of the window. Now, we see pain as having no value. On top of this, as I mentioned in my presentation, patients receive surveys once they have been seen by any medical profession in a hospital. This survey asks patients if the physician did everything needed to eliminate their pain. If no, the doctor, as well as the hospital, will get flagged by the joint commission. If this happens too often, the joint commission will revoke the accreditation of the hospital. Thus putting tremendous amounts of pressure on doctors to not send those red flags to the joint commission. 

Truthfully, I do believe this is a very institutionalized issue. Purdue Pharma was responsible for the teaching material of opioids and was later found guilty of misbranding OxyContin, by misleading the risk of addiction and potential to be abused. I think because of this, as well as our current philosophy on pain, and the pressure hospitals place on doctors to eliminate pain are all contributing factors to this issue. 

[1]  Lembke, Ann. Drug Dealer, MD. 2016

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