The government doesn't feel your pain

By Scott Sumner. Excerpt:

"Bill Clinton famously told voters:  “I feel your pain.”  Although I now look back on the Clinton years rather fondly, I suspect that even his strongest supporters would not view his soulful empathy as anything more than an act.  The government does not feel your pain.  The FDA does not feel your pain.  Doctors and nurses do not feel your pain.

You feel your pain.

Consider this recent FT story:

But when the procedure began, Czar was still alert and gripped by intense pain. “I remember saying ‘I feel everything’ and nobody believed me.”

The new podcast The Retrievals hears from a dozen women who had the same procedure at the Yale Fertility Center and who all reported extreme pain throughout. At the time they were told by staff they had been given the maximum amount of pain relief, meaning they couldn’t have more. However, it later transpired that a nurse at the clinic had been stealing fentanyl and replacing it with saline solution. It is thought that 200 patients had been denied pain relief during egg retrievals over a period of five months. . . .

I doubt there will be a woman listening who does not recognise elements of this story: of medical professionals underplaying their pain, or rushing them as they explain symptoms, or being made to feel weak, hysterical or unreliable witnesses to their own experience.

Nobody believed them?  All 200 patients?  I’d be really annoyed.

There’s a perception that people have different tolerances for pain.  And yet I’ve never seen a shred of evidence for that claim.  No one can truly know what another person is feeling.  There are lots of things that other people find painful that don’t bother me at all.  But that doesn’t mean I have a high tolerance for pain.  There are other things that bother me more than they bother other people.  We’re all wired differently; we experience the world in different ways.  I have no idea what it feels like to be you.

Here’s Scott Alexander, criticizing the fact that our medical establishment refuses to take reports of pain seriously:

 This paper lists signs of drug-seeking behavior that doctors should watch out for, like:

– Aggressively complaining about a need for a drug
– Requesting to have the dose increased
– Asking for specific drugs by name
– Taking a few extra, unauthorised doses on occasion
– Frequently calling the clinic
– Unwilling to consider other drugs or non-drug treatments
– Frequent unauthorised dose escalations after being told that it is inappropriate
– Consistently disruptive behaviour when arriving at the clinic

You might notice that all of these are things people might do if they actually need the drug. . . .

Greene & Chambers present this as some kind of exotic novel hypothesis, but think about this for a second like a normal human being. You have a kid with a very painful form of cancer. His doctor guesses at what the right dose of painkillers should be. After getting this dose of painkillers, the kid continues to “engage in pain behaviors ie moaning, crying, grimacing, and complaining about various aches and pains”, and begs for a higher dose of painkillers.

I maintain that the normal human thought process is “Since this kid is screaming in pain, looks like I guessed wrong about the right amount of painkillers for him, I should give him more.”

The official medical-system approved thought process, which Greene & Chambers are defending in this paper, is “Since he is displaying signs of drug-seeking behavior, he must be an addict trying to con you into giving him his next fix.”

Here’s the NYT:

How does it feel to suffer from debilitating pain but not be able to get your hands on the medication that could help? In the Opinion video above, we hear from Americans who have had to endure this nightmare.

They are among the countless people with chronic pain who have been the unintended victims of the national crackdown on opioid prescribing. In response to the deadly opioid crisis, the Centers for Disease Control and Prevention issued guidelines intended to limit opioid prescriptions. That advice soon became enshrined in state laws across the country. Suddenly, many pain patients lost the drugs that made their lives bearable. Some sought relief in suicide.

Last year the C.D.C. issued new prescription guidelines intended, in part, to induce a course correction. But facing a confusing mess of federal and state laws, many physicians are still afraid to prescribe opioids to genuine pain sufferers.

Critics of utilitarianism often point to thought experiments:  “What if a certain social goal could only be achieved by torturing thousands of innocent people.”  I guess the idea is to show that the policy in question is obviously abhorrent, even if it were to pass some sort of utilitarian cost-benefit test.

In this case, you cannot even justify these rules by pointing to gains in other areas.  The crackdown on pain relief had a negative effect even if you put zero weight on all of the suffering of people denied pain relief by doctors.  That’s because the crackdown on opioid prescriptions in the early 2010s led to an enormous surge in the use of illegal alternatives such as fentanyl.  The annual death toll from these illegal substitutes is now an order of magnitude higher than a decade ago.

The ideology of paternalism is based on the idea that the government understands your interests better than you do.  There are undoubtedly cases where that assumption is correct.  But on average?  When children suffering from cancer are screaming in pain, are most of them just faking it?  Would you want a government bureaucrat in the DEA to make that decision for you and your child’s doctor?

I don’t agree with the government policy that denies people the right to take certain drugs.  But I understand the logic behind these laws.  I understand why some people would disagree with me.

I don’t agree with the government policy that denies people the right to practice medicine without going through an absurdly long training program, often in areas that have no relationship to their future work.  But I understand the logic behind these laws.  I understand why some people would disagree with me.

I don’t agree with the government policy that denies licensed doctors the right to determine appropriate pain relief.  I do not even understand the logic behind these policies.  I do not understand why anyone would disagree with me."