You mention pain relief in low-income countries. And it does appear to be a direct and easy way to eliminate suffering, but it has a very interesting history. Have you ever read Dreamland by Sam Quinones? It's a history of the opioid crisis, and he lays some portion of the blame for it on precisely this sort of effort.
The book as a whole was largely concerned with the opioid epidemic in America, but part of the book had to do with the developing world, specifically Kenya. In 1980 Jan Stjernsward was made chief of the World Health Organization’s cancer program. As he approached this job he drew upon his time in Kenya years before being appointed to his new position. In particular he remembered the unnecessary pain experienced by people in Kenya who were dying of cancer. Pain that could have been completely alleviated by morphine. He was now in a position to do something about that, and, what’s more morphine is incredibly cheap, so there was no financial barrier. Accordingly, taking advantage of his role at the WHO he established some norms for treating dying cancer patients with opiates, particularly morphine. Essentially loosening the standards for their use. Then, to quote from the book:
"But then a strange thing happened. Use didn’t rise in the developing world, which might reasonably be viewed as the region in the most acute pain. Instead, the wealthiest countries, with 20 percent of the world’s population came to consume almost all–more than 90 percent–of the world’s morphine."
These standards and the broader ideology factored into pain being the fifth vital sign, and the development of oxycontin, and a bunch of other craziness like the idea that opioids weren't addictive as long as you were using them to treat actual pain. (For my money that last bit is the most fascinating bit of the whole story.)
In any case just about everything has weird second order effects. Including this.
I have not read the book, and I certainly agree that the second order effects have to be taken into account, but I do think that the first order effects of how bad pain, etc. really is is neglected in the discourse about the opioid crisis. In all the media and discussion around the harms of excess opioids (outside of EA circles), I don't think I've ever heard the obvious first-order point that pain really sucks and opioids alleviate pain. It is a difficult balance, of course, but the pendulum might be swinging to far in the direction against pharma pain relief. And thank you!
Good post as always! I didn't have a term for Type II fun before but I'll keep that in mind from now on. Also, your Boy Scout troop sounds waaay more intense than mine was.
Holy cow that backpacking trip musta been miserable. Btw, you were probably burning upwards of six to seven thousand calories per day, not just double regular intake.
You mention pain relief in low-income countries. And it does appear to be a direct and easy way to eliminate suffering, but it has a very interesting history. Have you ever read Dreamland by Sam Quinones? It's a history of the opioid crisis, and he lays some portion of the blame for it on precisely this sort of effort.
The book as a whole was largely concerned with the opioid epidemic in America, but part of the book had to do with the developing world, specifically Kenya. In 1980 Jan Stjernsward was made chief of the World Health Organization’s cancer program. As he approached this job he drew upon his time in Kenya years before being appointed to his new position. In particular he remembered the unnecessary pain experienced by people in Kenya who were dying of cancer. Pain that could have been completely alleviated by morphine. He was now in a position to do something about that, and, what’s more morphine is incredibly cheap, so there was no financial barrier. Accordingly, taking advantage of his role at the WHO he established some norms for treating dying cancer patients with opiates, particularly morphine. Essentially loosening the standards for their use. Then, to quote from the book:
"But then a strange thing happened. Use didn’t rise in the developing world, which might reasonably be viewed as the region in the most acute pain. Instead, the wealthiest countries, with 20 percent of the world’s population came to consume almost all–more than 90 percent–of the world’s morphine."
These standards and the broader ideology factored into pain being the fifth vital sign, and the development of oxycontin, and a bunch of other craziness like the idea that opioids weren't addictive as long as you were using them to treat actual pain. (For my money that last bit is the most fascinating bit of the whole story.)
In any case just about everything has weird second order effects. Including this.
But otherwise a great post!
I have not read the book, and I certainly agree that the second order effects have to be taken into account, but I do think that the first order effects of how bad pain, etc. really is is neglected in the discourse about the opioid crisis. In all the media and discussion around the harms of excess opioids (outside of EA circles), I don't think I've ever heard the obvious first-order point that pain really sucks and opioids alleviate pain. It is a difficult balance, of course, but the pendulum might be swinging to far in the direction against pharma pain relief. And thank you!
Good post as always! I didn't have a term for Type II fun before but I'll keep that in mind from now on. Also, your Boy Scout troop sounds waaay more intense than mine was.
Damn you're quick, and thanks! Hahaha, ride or die for Troop 204!
Holy cow that backpacking trip musta been miserable. Btw, you were probably burning upwards of six to seven thousand calories per day, not just double regular intake.
Thank you very much, that is very kind.