Until recently, I worked as a physician at a primary care clinic one day a week in addition to my job as a science reporter for a newspaper. In two decades, I had only one patient taking opioids long term. She was in her 50s when I met her. She’d spent many years working in factories making cups, boxes, and other things, until they’d all closed down. She ended up at a commercial laundry, on her feet eight hours a day.
Of her many medical problems, the one that concerned her most was low-back pain. She eventually left her job and sought, and received, Social Security disability. By then she was taking Tylenol No. 3, a combination of acetaminophen and codeine, twice a day. Later, she graduated to Percocet—acetaminophen and oxycodone. When from …show more content…
It’s a Donald Trump kind of problem—dystopian, apocalyptic, and disproportionately affecting the white, underemployed people who voted for him in great numbers. If he does go searching for solutions, he might look backward. What he’ll see is that American medicine needs a dose of old-fashioned paternalism, something he might also appreciate.
“Paternalism” is a hoary concept in medicine. It has nothing in particular to do with men and fathers except, of course, that it arose at a time when few physicians were women. An essay in the AMA Journal of Ethics several years ago defined it as “an action performed with the intent of promoting another’s good but occurring against the other’s will or without the other’s consent. In medicine, it refers to acts of authority by the physician in directing care and distribution of resources to …show more content…
But just as the liberal use of opioids took hold, chronic pain was also on the rise, fueled by joint-grinding obesity, physical inactivity, diabetic neuropathy, sports injuries, and the graying of the population.
As important as those trends was a newfound respect for a phenomenon that had been held in contempt during the century-long rise of scientific medicine: the existence of symptoms without disease. The aches and pains that practitioners might once have attributed to hypochondria, psychosomatic causes, exaggeration, or fakery suddenly became worthy of attention because patients declared they were. This change in attitude happened nowhere more dramatically than in the strange phenomenon that came to be known as Gulf War
Of her many medical problems, the one that concerned her most was low-back pain. She eventually left her job and sought, and received, Social Security disability. By then she was taking Tylenol No. 3, a combination of acetaminophen and codeine, twice a day. Later, she graduated to Percocet—acetaminophen and oxycodone. When from …show more content…
It’s a Donald Trump kind of problem—dystopian, apocalyptic, and disproportionately affecting the white, underemployed people who voted for him in great numbers. If he does go searching for solutions, he might look backward. What he’ll see is that American medicine needs a dose of old-fashioned paternalism, something he might also appreciate.
“Paternalism” is a hoary concept in medicine. It has nothing in particular to do with men and fathers except, of course, that it arose at a time when few physicians were women. An essay in the AMA Journal of Ethics several years ago defined it as “an action performed with the intent of promoting another’s good but occurring against the other’s will or without the other’s consent. In medicine, it refers to acts of authority by the physician in directing care and distribution of resources to …show more content…
But just as the liberal use of opioids took hold, chronic pain was also on the rise, fueled by joint-grinding obesity, physical inactivity, diabetic neuropathy, sports injuries, and the graying of the population.
As important as those trends was a newfound respect for a phenomenon that had been held in contempt during the century-long rise of scientific medicine: the existence of symptoms without disease. The aches and pains that practitioners might once have attributed to hypochondria, psychosomatic causes, exaggeration, or fakery suddenly became worthy of attention because patients declared they were. This change in attitude happened nowhere more dramatically than in the strange phenomenon that came to be known as Gulf War