A life without pain?

@giles_fraser writes

I have no fondness for pain per se. And I can even imagine taking a draught of something myself one day, were some pain to become utterly intolerable. I do understand. And, yes, even understand that helping others to do it can sometimes be an act of mercy.

But it is also right to push back against the general assumption that pain reduction is unproblematic. For pain is so much a part of life that its suppression can also be a suppression of a great deal of that which is valuable. Constantly anaesthetising ourselves against pain is also a way to reduce our exposure to so much that is wonderful about life.

Yet too many of us make a Faustian pact with pharmacology, welcoming its obvious benefits, but ignoring the fact that drugs also can demand your soul. That's perhaps why we speak of the overly drugged-up as zombies.

 Giles Fraser, My Problem With Euthanasia (Guardian 3 May 2013)

I have written before on this blog about the biological function of pain. In Cycle of Pain Relief, I discussed how pain relief becomes the problem, illustrated by the last 48 hours of Kurt Cobain. And in Back Pain, while sympathizing with Scott (Dilbert) Adams, who had complained about his own back pain and suggested that his back was evil, I suggested that sometimes it was the painkillers that were evil - especially the casual use of painkillers - because they interfere with the natural communication between the mind and the body, and the natural balance of work, rest and play. See also my post on The Purpose of Labour Pains.

Anti-Psychotic Drugs

Doctors are continuing to prescribe anti-psychotic drugs (such as olanzapine and risperidone) to control the behaviour of elderly and confused patients, especially in hospitals and care homes, despite strong guidelines indicating that they are inappropriate for this purpose and carry dangerous side-effects.

• BBC News: Doctors 'ignoring drugs warning'
• BBC File on 4: 'What did they give my mother?'

A typical pretext for prescribing these drugs is that the patient is agitated or upset - assertiveness framed as aggression. In other words, if an old person complains about the quality of care, the easiest way to fix the problem is to slip some olanzapine into the cocoa. If there is any psychosis here, it is in the system and not in the individual.

Drugs may be justified if they provide some therapeutic benefit for the patient, but not if their purpose is merely to compensate for the inadequate care offered to old people. The BBC has found cases where the patient's life appears to have been significantly degraded or shortened by these drugs, simply to make things easier for the carers. The use of these drugs for this purpose is deeply unethical.

Meanwhile, there is a much better and cheaper remedy for agitation among demented patients: drinking more water.

• BBC News: How care home keeps elderly healthy

Unfortunately, drinking water has a well-known side-effect, possibly resulting in more work for the care home staff, so we may see some resistance to this remedy among the less caring care homes. (Some schools also discourage water-drinking, to prevent the pupils needing to go during lessons.) When you are checking out a home for an elderly relative (or a school for a younger one), small details like the provision of water can provide good clues about the real purpose of the institution.

Statins and Supplements

Why do some people take vitamin and mineral supplements? Why do some people (usually on the advice of their doctor) take statins?

Both are thought to improve health. Supplements such as Vitamins A, C and E, together with beta-carotene and selenium, are thought to have an antioxidant effect, attacking so-called free radicals; meanwhile statins are supposed to reduce levels of cholesterol. Both free radicals and cholesterol are commonly blamed for various causes of ill-health and premature death.

Huge amounts of money are spent on both supplements and statins. In Britain, the NHS apparently sees statins as some kind of wonder-drug; Professor Roger Boyle, National Director for Heart Disease in England, hopes to increase the number of people on statins from roughly 3 million at the moment to around 6 or 7 million people. [BBC News, 2 April 2008]

Howeve, there seems to be no evidence that either supplements or statins actually increase life expectancy for the general population, although statins do appear to improve life expectancy for a small number of men (generally those who have already had heart attacks). Some research suggests that vitamins 'may shorten your life' [BBC News, 16 April 2008].

Advocates of both supplements and statins tend to shift their ground at this point. Even if it doesn't increase the length of life, which of course they don't necessarily concede, then it certainly improves the quality of life. (This is of course a much more difficult claim to disprove, since quality of life is more difficult to measure objectively, and the data are harder to come by.)

For my part, I can't see much difference between the supplement debate and the statin debate. I don't understand how people can be strongly in favour of one kind of pill, and strongly against another kind of pill, when they are produced in the same kind of factories and sold on the same kind of logic.

Perhaps we shouldn't be surprised if the benefits of supplements and statins aren't easy to prove. After all, free radicals and cholesterol occur naturally in the human body, and are necessary for life. The idea that you can improve health by simply taking some pill that will reduce the level of a naturally occurring substance seems to conflict with the idea of the human body as a complex, interconnected, largely self-regulating system. I am particularly astonished that many people who think of themselves as "holistic" either don't seem to appreciate the consequences of meddling with this complexity, or they imagine that popping pills can establish a better all-round balance than the body can achieve on its own.

Sources

Wikipedia on Cholesterol: Cholesterol is a lipid found in the cell membranes of all animal tissues. ... Most of the cholesterol in the body is synthesized by the body and some has dietary origin. ... Biosynthesis of cholesterol is directly regulated by the cholesterol levels present, though the homeostatic mechanisms involved are only partly understood.

Wikipedia on Free Radicals: Free radicals play an important role in a number of biological processes, some of which are necessary for life. ... The body has a number of mechanisms to minimize free radical induced damage and to repair damage which does occur.

Wikipedia on the Statin Controversy: Some scientists take a skeptical view of the need for many people to require statin treatment. Given the wide indications for which statins are prescribed, and the declining benefit in groups at lower baseline risk of cardiovascular events, the evidence base for expanded statin use has been questioned by some researchers. A much smaller minority ... question the "lipid hypothesis" itself and argue that elevated cholesterol has not been adequately linked to heart disease. These groups claim that statins are not as beneficial or safe as suggested.

Wikipedia on Antioxidants: Despite the clear role of oxidative stress in cardiovascular disease, controlled studies using antioxidant vitamins have observed no reduction in either the risk of developing heart disease, or the rate of progression of existing disease. This suggests that other substances in fruit and vegetables (possibly flavonoids), or a complex mix of substances, may contribute to the better cardiovascular health of those who consume more fruit and vegetables.

[all articles accessed 16 April 2008]

Update

Antioxidants prevent health-promoting effects of physical exercise in humans (May 2009). hahahahahaaa says Ben Goldacre

Pharma Self-Justification

Big Pharma has a great POSIWID argument. Yes, we know prescription drugs are expensive, but that just shows two things.

1. How valuable they are.

2. How much it costs us to develop them.

Marcia Angell, The Truth About the Drug Companies, New York Review July 15 2004