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We think these features are neat and we think you'll enjoy them. Please visit the site today. Hello everybody, this is Marshall Poe, I'm the editor of the new books network. I want to tell you about a new book, public success private grief. An extraordinary personal account by Peter Cowley. It's about Peter's life of professional accomplishments alongside extreme personal tragedies, cancer, suicides among his closest family members, and alcoholism. Peter spoke about public success private grief on the NBN recently. Alas, Peter has been diagnosed with cancer and I urge you to read this compelling book. It's open, honest, and filled with life lessons. Visit ps-pg.com to learn more and buy the book. Hi, I'm Dr. Robert Pearl, former CEO of the Permanente Medical Group, Kaiser Permanente, a Stanford Medical and Business School professor, a Forbes contributor and best-selling author of the book Mistreated, while we think we're getting good healthcare and why we're usually wrong. And I am Jeremy Kor, host of the new books and medicine podcast. American healthcare is broken. Across the United States, there are over 200,000 patient deaths from medical error every year, growing physician burnout, outdated technology, and inconvenient and delayed care for patients. And on top of all of this, skyrocketing drug prices and increasingly unaffordable out-of-pocket patient expenses. For decades, our nation's political and medical leaders have talked about fixing the American healthcare system, and yet the problems are now greater than in the past. Every other industry that is inefficient and ineffective has experienced disruption. Healthcare will be no different. The question is whether the solutions will come from inside the healthcare system or be imposed on it. We'd like to invite you to listen to our new podcast, Fixing Healthcare with Dr. Robert Pearl and Jeremy Kor. Each episode will feature one of the top leaders and innovative thinkers in healthcare today. This shows format is simple. The guests will present their roadmap for fixing American healthcare's biggest problems. And from there, Jeremy and I will scrutinize the plan and help listeners separate fixes that have the potential to succeed from simply the hype. Our goal is that everyone from healthcare consumers to political and medical leaders will find value in the discussions on our show. You may not agree with the different solutions offered, but you will never again conclude that nothing can be done. We hope you will join us. Please subscribe via iTunes or your favorite podcast software. For more information, visit our website at www.fixinghealthcarepodcast.com. Welcome to New Books and Medicine on the New Books Network. I'm Monique Dufour. Thank you for listening. We're about to hear my interview with Keith Wailoo about his latest book, Pain, a Political History. It was published in 2014 by Johns Hopkins University Press. If you haven't yet read Keith's work, pain is an engaging place to start. As soon as I read it, I knew that I would assign it in my spring history of medicine course, and I look forward to the questions and discussions that this really well-written book will provoke. In 1997, Keith published his first book, Drawing Blood, Technology and Disease Identity in 20th century America, and followed up in 2001 with his second book, Dying in the City of the Blues, Sickle Cell anemia and the Politics of Race and Health. Taken together, these two books announced the arrival of a significant voice in the history of medicine, politics and culture. His subsequent works include, to name only a few, The Troubled Dream of Genetic Medicine, which he co-authored with Stephen Pemberton in 2006, and the 2011 book, How Cancer Crossed the Color Line. As you'll hear, Keith is a really fascinating speaker. As I listened to him, I was reminded of a recent controversy about the relevance of the history of medicine. Early this year, Richard Horton, the editor-in-chief of the medical journal The Lancet, accused historians of medicine of toiling what he called "a moribund field." According to Horton, most medical historians have nothing to say about important issues of the past as they might relate to the present, and fail to strengthen our ability to resist the adverse trends and demands of our age. Now, many scholars have since decisively refuted Horton so I won't pile on there, but I would suggest that Horton read Anything by Keith Waeloo, whose work lives up to the challenges of writing compelling historical work that also makes us see and grapple with the present in new and powerful ways. I hope you enjoy our interview. Welcome to New Books in Medicine. I'm your host Monique Duvour. Today we have a very special guest, Dr. Keith A. Waeloo. He's town's and Martin Professor of History and Public Affairs at Princeton University, where he is also Vice Dean of the Woodrow Wilson School of Public and International Affairs. Dr. Waeloo, thank you for joining us. Well, thank you for inviting me. Today we're going to talk primarily about your new book, Pain, a Political History, but you've written and edited many important books over your career. Could you tell us a little bit about how your interests have evolved over time? Well, I started my career after college as a science writer and I was really interested in new developments in science, medicine, and technology, but I've always also been interested in politics and the politics surrounding science, the way in which health care is obviously highly politicized today. And so a lot of the writing that I've done is focused on topics where you see most glaringly the intersection of social, political, and cultural controversies in medicine and health care. The book that really led me towards this book on pain was a study I did on the history of sickle cell disease, a disorder associated with African Americans, higher prevalence in African Americans, and it was a study of how a disease could start 100 years ago as being virtually invisible, unrecognized clinically, unimportant scientifically, and how a disease could emerge slowly to become clinically diagnosable and observable, scientifically really important, and then socially and politically important, particularly in the context of the 1960s, as African Americans were moving towards and pushing for civil rights and proper recognition sickle cell disease, a disease associated with pain and suffering that was recurring, but not adequately treated became a kind of symbol of a quest for recognition and fair treatment. And it's that project that led me towards thinking about how pain is treated and how it's dealt with is not just a narrow scientific and clinical concern, but it's often always also a political and a social controversy. In addition to the shift toward pain as a new subject for you or as an evolving subject, the book itself seems to be pitched toward a broader audience. It's a little shorter than many academic books and in tone and in voice. It's very accessible without sacrificing any of the complexity of the story. Can you talk a little bit about the audience toward which you see this book being directed? Yes. I think I haven't ever lost track of my interest as a science writer in communicating as broadly as possible to patients, to people who are concerned about health and health care from whatever perspective. But I also spent nine years early in my career teaching in a medical school at University of North Carolina at Chapel Hill, teaching a course called Social Medicine and Society for medical students in their first and second year and teaching them about the importance of paying attention to social, cultural, political and economic concerns as they make their way into a new career. And I've increasingly thought of them as my audience as well and also the physicians that I taught with next to. Later, I worked in a health policy setting and I think the impulse behind my writing has always been to show experts as well as non-experts how their interests connect and how often they speak past one another around crucial issues in health and health care. So you might say that the way I write is an attempt to kind of communicate as broadly as possible while paying close attention to kind of expert understandings and how those expert understandings are translated into either patient care or public policy. I see. Well, many of our listeners are really fascinated by how good writing gets written and I tend to try to choose books that I admire yours among them. So I expect you're busy and you have many things to balance. How does the act of writing fit in your everyday life and how do you get from an idea to finishing your really excellent and accessible books? Well, that's a great question and I would say it's a continuing. What I learned I think about the discipline of writing from being a freelancer when I had to write to make a living is that I should take advantage of every available opportunity to jot things down. And I discovered about myself that I am a good writer but I'm a better editor of myself. And so the more I write this means the more opportunities I have to actually edit and refine and develop. Writing is an ongoing process and so what I realized at a certain point is that my writing style had adapted to the life of an academic that is to say often you're teaching and you're writing lectures and lectures have a very similar, a narrative quality to them. You're telling a story and then you're analyzing the story and encouraging students to think about their meaning across time as a historian. And what I realized I could do is treat drafting chapters or sections the same way I would treat writing a lecture. How to engage a student, a general reader, somebody who has some level of preparation but not is not an expert themselves. Into the key issues in the story. And then having done that I could find time during the next week perhaps to edit it and to refine it. I also tend to have a somewhat compartmentalized way of writing which is that I divide chapters into about four parts. So you have many stories inside of a larger narrative and that would mean that in a small space of time that's provided in a busy work week I might be able to pick up not a full chapter but maybe a section of a chapter to work on. So that's one of the ways that I continue to write and I also sort of learned early on that knowing who your main characters are in your writing can really help to organize what it is you're trying to do. So in many of my books a disease is my main character. And then the history of how that disease or health problem unfolds is the central to the plot development. And that often gives you an opportunity to pick up pieces of the book here and there and you know where you are in your plot. You know where you are in your storyline. So there are all these kinds of you might say narrative gains that you play with yourself to both get you motivated to write and to remind you of the importance of like picking up a piece and working with it. That's fantastic. I could hear you talk about that for a lot more but let's turn to your most recent book, Pain, a Political History. Just to get our readers oriented could you give us a sense of the broad narrative suite of the story chronologically and just in terms of the larger arc of the narrative? Yeah. So the book starts after World War II when soldiers return from the war and physicians and others are perplexed by the problem of soldiers who have been horribly wounded who are experiencing pain. And the question that emerges for many physicians is is pain a disability. That is should soldiers, we know what physical disabilities look like but what if a soldier is complaining about chronic pain, how should we treat that? And that begins a long debate in American society about whether we should create disability benefits for people in pain, whether chronic pain is worth a kind of compensation that we are providing starting in the 1950s and 1960s, who is in pain? Pain is one of these problems where there's a large element of trust and subjectivity. It can't be measured in the same way that temperature can be measured or blood pressure. So the question about whether pain is real and how we should deal with it became not just the problem for clinicians sitting at someone's bedside but increasingly for society and for government. As in in 1956 Eisenhower signs reluctantly a disability law that allows, that recognizes disability in the social security system and very shortly thereafter the question before the health education and welfare department and disability judges is the question is pain a compensable disability? So my story starts in the 1950s but it really tells the story of a growing liberal society where the commitment to taking care of people who are in pain and doing so liberally by creating disability benefits for them, showing compassion, creating things like patient controlled analgesia as in putting the morphine drip into someone's hand, allowing them to determine how much relief they would like to have becomes part of a society committed to compassion and the broadest definition of social welfare and how by the 1980s this runs up against skepticism, concern about whether we are in serving people in pain, in relieving them of their suffering, not also creating an indulgent society. And one of the hallmarks, the central moment in the book, the central chapter is when Ronald Reagan comes into office and his administration argues that the social security disability roles is filled with people who are using subjective complaints to become welfare cases. And so there's a kind of a conservative backlash against the idea that pain is real and ought to be relieved in such an expansive way. So the book really then is the story of how the debate about who's in pain and how much relief they deserve may start off as a soldier story or as the story of an elderly people seeking health care. But it ultimately becomes a highly politicized story about deservingness, about entitlement, about citizenship, and about the debate between liberals and conservatives about what kind of society we wish to build. And so in a funny way, I started the story, I started the book thinking that it was going to be a kind of a politics of how people get care at the bedside and quickly realized that it was really touching some of the major political controversies of our time. Well, I was thinking before I talked to you, the thing that I noticed the most about the book is I was reading it and going through it was I was at first surprised to see that neither physicians nor people in pain were the primary protagonists in the story. Of course, they appear in the story. You choose to focus on those who judge pain, who try to adjudicate questions of pain. Similarly, medicine isn't the central context for the story. So could you preview a bit for our listeners who the important actors are in this story and what the important venues are and the important contexts in which this story takes place? Well, it takes place in a number of different venues, but it and the venues do ship, but you're right to say that it's not patients and it's not doctors who are at the center of it. So for instance, the moment in the 1960s when a Republican judge named John Brown, who was appointed by Eisenhower, has to weigh this question. A woman in Texas is denied disability benefits mostly on the basis of pain. And this case comes before John Brown. And Brown issues of verdict, which says if pain is real to the patient, the Secretary of Health and Education Welfare cannot be allowed to just dismiss it out of hand. They must really grapple with this question of subjective experience as the source of disability. Now, that is a judge, not a physician, making a deliberation on what pains should matter and how government and disability deciding on disability benefits should respond. Well, what's surprising to me is the extent to which it is judges. It's literally court appointed officials who were drawn into the debate on how we should measure pain in citizens and how we should properly and compassionately relieve those pain. So surprisingly, for me, it's judges. And when I say judges, I don't mean just court officials, but back in the 1950s, there was a commission that was created in the Veterans Administration where physicians, about 150 of them, were asked the question, you know, we do rate different forms of disability as warranting different forms of compensation for returning veterans. What about pain? And what about suffering? And what about mental anguish? Do those belong as disabilities that ought to be rated and compensated? And the physicians were largely kind of abhorred to this idea that they were going to be dragged into this issue in an area where they felt fundamentally unprepared to deal with the subjective phenomena. So in a funny way, by over the course of time, given the ambiguities and anxieties of doctors and scientists over this question of what is pain, who should judge, and how should it be relieved? Increasingly, it's been also politicians and judges. So some of the major debates of our time really arrive at places like the Supreme Court to decide. So I stopped earlier by telling you the story up until Reagan. Well, since Reagan, you've seen a kind of a new politicization of pain. And you might say, blue states, the concerns are things like became physician-assisted suicide in Oregon, and the proper compassionate treatment of pain at the end of life, which could blur over into some views, into euthanasia, or even murder, as Jack Cravorkian was accused of in Michigan. So the question of where proper compassionate pain relief ends, and euthanasia or murder begin, were topics that physicians had to understand, but ultimately, those lines had to be marked and defined in the law. And so, it's once again not surprising that in the 1990s, when the case of Washington v. Glutsberg arrives at the Supreme Court, the question of physician-assisted suicide and whether people have a right to relief, a right to die at the end of life, it is San Antonio Conner who is weighing this question of who's in pain and what constitutes proper relief given the kind of intense moral and political concerns circulating around the management of pain. So what I'm particularly drawn to in this book is this relentless concern, and the judges themselves have to kind of draw on what do they draw upon in making deliberations on these issues. I think one of the ways that you track that so successfully is by tracking what you call different theories of pain that circulate, and you especially get going on this in chapter two, opening the gates of relief. And you start here to really bring theories of pain to the fore. What in the 1960s were some of the important emergent theories of pain, and what roles did these theories play in these evolving debates? Well, that's a great question. I mean, unquestionably, the central theory was a new idea of pain that was developed by psychologist Ronald Melzak and a physiologist named Patrick Wall. They collaborated on the development of something called the gate control theory of pain. And that theory emerges in the early 1960s and really takes off. And all it suggests is this, that it's a criticism of surgeons, pharmacologists, and psychiatrists. Surgeons thought pain is located somewhere in the brain. And if you remove part of that brain that is associated with pain perception, like the frontal cortex, then pain experiences are diminished. Psychiatrists weren't quite sure what to do with pain. In many ways, they thought that people in chronic pain were more maladjusted and should not be taken at face value. And of course, in the emerging world of drugs and pharmacology after World War II, you have new drugs like Percadine and Demerol promising fast relief at no consequences. And into this context, Melzak and Wall come in and they say, "Well, if you really want to understand pain, you have to understand that pain is transmitted, not through the nervous system, through long nerve fibers. But what they theorized is that there were these gates, like an electrical gate that would open and inhibit the passage of pain impulses or clothes, and that many things could shape how pain was transmitted to become pain perception. They thought that your history, your background, the cultural context, yes, neurophysiology, yes drugs, all of these. So what they did was they expanded the definition of why pain was perceived in the way it was. And one of the things that this theory did is it opened up practitioners to experiment with different forms of pain relief. That is to say, rather than just using surgery or drugs or dismissing pain patients as psychologically maladjusted, how about if you try, oh hypnosis? And in some cases, it works. How about if you tried these electrical stimulation in some cases, it worked? What if you tried by the 1970s acupuncture? So this theory ended up being incredibly productive for opening up, and you might say liberalizing. So when I talk about pain in the 1960s in the context of a liberal society, what I mean is not just liberal political trends, but a kind of liberalization, a new trend pushing back against medical conventions, embracing new ways, perhaps alternative ways of dealing with this phenomenon called pain. And it's also in this time period that you see the rise of things like patient-controlled analgesia, as in, rather than having physicians decide who's in pain or who's not, if you allow people to have a morphine drip in their hand and let them decide how much pain they're in and how much relief they need, those are some of the ways in which gate control theory, new theories of pain, not the theories of pain as now adjustment, but theories of pain as real and working a wider array of approaches because, of course, everybody's pain is different. That's a kind of a nutrism that emerges in the context of the 1960s and 1970s. By the time we get to the 1980s in the chapter that you call the conservative case against learned helplessness, you find that pain has become a decisive and divisive wedge issue, and that it emerges as an index of America's welfare problem. How did this happen? How did we get here by the 1880s and what were some of the important implications of this development of this as a wedge issue? Yeah, and I think we got there for a number of reasons. Some of it had to do with the cost as in the part of the conservative critique of the great society and the social programs that had been created in the 1960s and the commitments of the 1960s was that somehow what had been created was a society that did not prize hard work but actually prized welfare and government dependence. They pointed to the rise of those very disability programs which had grown 20-fold over the course of the 20 years since the 1960s and already by the 1970s, even liberals in government like Jimmy Carter were worried about whether the growth of those programs were sustainable and whether or not they had created what conservatives came to call perverse incentives. If you create incentives for people to say they're disabled, then aren't you creating disability? So part of the critique of pain and subjective pain is real pain in the Reagan administration. It's something that had already begun in the Carter administration was a really broad critique on some of the crucial issues that defined kind of liberal judgment in the 1960s. That in the name of knowing the pain of others, right, Bill Clinton later said, "I feel your pain." It was that kind of liberal claim that people conservatives felt were sort of suspicious and they regarded with a great deal of skepticism. But they also were concerned about the cost, the fact that disability costs had skyrocketed and they were fundamentally concerned about things like wedge issues like welfare and entitlements. And so for all of those reasons when Reagan came into office, literally in his second month after taking office in the papers at the Reagan archives, you could find people in his office of policy development debating how we are going to scale back this liberal commitment to disability and remove these so-called subjective problems that have become so central to government and get people back to work and reduce the size of government at the same time. So that chapter really tells the story of Reagan's attempt to remove and they ultimately removed almost half a million people from the Social Security Disability roles, claiming that their complaints were illegitimate. And this was followed by pushback from Congress. Many of these cases went to court in major class action suits and it made pain even more of a political and a legal debate. It's not less. The response of the Reagan administration was that in legal settlements and in congressional law, you find politicians and judges again trying to write rules and guidelines for how pain should be measured, what made pain legitimate, when pain was illegitimate and what the responsibility of government was to people in various kinds of distress. During this period, a very special kind of pain becomes important, that of fetal pain. Why does fetal pain emerge as an important kind of pain that conservatives in particular want to pay attention to and to focus on? Well, that's also a wonderful question. I would say that through Reagan's first term, he really takes a beating politically and in the public debate as sort of being in the embodiment of a kind of a harsh and a callous conservative that's not concerned with the pain of people truly suffering and need. In the early 1980s, you also see the emergence of the religious right as having a significant influence in the Republican Party. And right towards the end of his first term, as he's turning towards, excuse me, reelection, it becomes clear that the battle against abortion rights is figuring very prominently for the religious right. They want to champion the rights and the personhood of fetuses. And they find a way to do that in a couple of different ways. One is that there's a film that emerges in the 1980s called The Silent Screen, which is supposed to embody the figure of the fetus that is being aborted and the pain that's caused. But they also begin to talk explicitly about something that, well, neurologists would say, don't exist because there's no neurological development that would say that a first trimester fetus or a second trimester fetus might be in pain. But they say there's this thing called fetal pain. And so for them, what's interesting, in Reagan adopts this language, that what I say is like, fetal pain is the pain that Republicans could organize themselves around. They might not trust the pain of the person seeking disability benefits, but they surely wanted to speak on behalf of fetal pain because it did a new kind of political work for them coinciding with their political and moral agendas as they emerged in the mid-1980s. So that's where fetal pain came from. And it's still around, of course. The red states are keen about passing fetal pain regulations, reminding women seeking abortions that there is such a thing as fetal pain in their view in order to kind of stem the tide of abortions in their states. So that this is a real phenomenon in American cultural politics today, and its origins really lay in that conservative term that you see in the Reagan administration. As we turn to the 1990s then, how do we get from fetal pain to a new locus of the debate's physician-assisted suicide and what you call ultimate relief of pain, which is, you know, people who advocate that they may choose to die? So in the pain by the 1980s and early 1990s is now clearly become a kind of a contentious, highly politicized cultural problem. And at the same time, it's a real personal issue that is to say, and it manifests himself at the bedside. It has always been the case that the question of how to appropriately take care of people at the end of life was a source of concern. The rise of physician-assisted suicide, particularly in a state like Oregon, which passes its first, passes its legislation in 1994 and then again in 1997, really signals a new moment in which progressive states like Oregon are trying to kind of push the boundaries of, you know, what they consider to be compassionate relief far. In Michigan people like Jack Kravorkin are doing it in a much more kind of flamboyant and sort of circus atmosphere, you know, giving people access to his suicide machine. But all of these become examples of physicians asking the question, how should we properly and compassionately give people relief for pain at the end of life? And those issues kind of gradually move into the courts and become the flashpoint of conservative as well as liberal tensions once again, as you might say, the religious-minded conservatives and also religious liberals object to this, and they don't see this as a role that's consistent with their view of what a doctor should be, whereas other doctors feel that this is exactly consistent with what a doctor should be providing at the end of life. And it's these issues that gradually as well make their way, and it won't be surprising because I'm saying like a broken record, into the courts. It's the courts that need to decide, you know, what the nature of relief at the end of life is. And what the courts ultimately decide is that there is no such thing as the right to die, but it's fundamentally supportive of the idea that there is something called the right to paleiation and the right to relief at the end of life, even if using morphine reduces blood pressure and is part of hesening death, that this is still consistent with compassionate care at the end of life. So here you have another example of how it's the courts that are trying to decide where is the line between, even though the line is fundamentally blurry, where's the line between compassion and euthanasia? I want to turn to the last body chapter of the book, which you call OxyContin Unleashed. And I could read that chapter as sort of the denouement in the story of marketplace logic in pain treatment, which was by this point widely, the marketplace was widely deregulated and it was pro-business, and it created a competitive and unstable medical marketplace. And so you tell the story in this chapter of how both liberals and conservatives alike had to contend with this marketplace condition that they had created. What were some of the important implications of that marketplace and the debates that it gave rise to? Yeah, so the last chapter OxyContin Unleashed is takes a drug that is now kind of widely known as an example. It's one of the leading forms of prescription drug abuse today and it's created all kinds of regulatory worries. And one of the things I point out is that that drug and its wide use didn't come out of nowhere. It emerges, its origins also lay in the 1980s in the embrace of a market-friendly approach to drug regulation, the rise of direct-to-consumer drug advertising, it starts in that era. And the belief that the market should be deregulated to an extent that its drug companies that have the tools that provide relief for society in pain. And what I track is the rise and fall of many different drugs that are market booms and market busts that are the byproduct of that way of thinking about how we relieve the pain of society and the role of pharmaceuticals in doing so. And I see that as a kind of a natural byproduct of a new philosophy. One of the central characters in that chapter is Rush Limbaugh who in the about ten years ago is arrested for what's called doctor shopping and that is having hired a Latina housekeeper to acquire lots of OxyContin. And to me his case is a kind of an important example of how on one hand a conservative spokesperson who believes in the power of the market and who was very much part of the critique of liberal regulation and the importance and also a champion for the free market, you could see him both as a proponent of these conservative beliefs but he's also therefore a victim having become addicted to OxyContin. And so to me the story of OxyContin and the story of Rush Limbaugh go hand in hand in that final chapter as reflections of the society that conservatism and the deregulation of the drug industry has created. So that's but at the same time I point out that in that chapter that we have two problems in American society, right? The time period from the 80s to the today also shows is a time period in which prescription drugs become the major form of drug abuse in this country, partly as a result of those trends. But the other problem that we have is we have a problem of overconsumption and over medication alongside under treatment that is to say the story of OxyContin also mimics the kind of story of overconsumption, the haves and the have-nots, the sort of divides that also afflict other areas of the American economy and society. You see it played out in the story about over treatment of pain and under treatment of pain, too much pain relief and also places where there's too little pain relief in places where because of anxieties about addiction people have lack of access to pain relief. So I try to tell the story not just of over medication which is what OxyContin is usually associated with but also of persistent under medication as well. And to some extent our challenge today is to sort of deal with the problem of drugs and OxyContin not with one policy concern but with both that is to say we have two problems that coexist at the same time. And as people who are interested as I am in health policy and in drug policy we need a better way of dealing with what is in fact a very complicated problem of pain. Well since we've arrived at the present moment by way of conclusion I wanted to ask you given the care with which you wrote the book and the way that it does attempt to reach general readers about an issue that still very much thrives on all kinds of political and health levels today. What do you hope will be the afterlife of this book? How do you hope that it might affect readers and their understanding of pain and the attendant policies with which we define and address it? Well I think that in some ways I have a view about books that is not unlike one's views about your kids when they grow up. You let them go and define their own way in the world and you hope they'll amount to something good and you give them all the support you possibly can. But at the same time they might get into trouble and it's up to you to kind of help them out. So there's a little bit of letting go but in the period since the book has been published I've talked to you know to physician groups like at the Cleveland Clinic and I've talked to universities and I've given interviews like this and I've also been talking to groups that are involved in reforming the way we deal with pain in DC and elsewhere and I'm hopeful that a book like this by kind of you know in a way I think the way I think about pain is that the actors in my story, many of them only know the small issues that they've been dealing with. In the written administration they only thought about it as a kind of a problem of like liberalism and the growth of disability. They didn't necessarily think about the way in which the marketplace reforms that they were setting in motion would create the phenomenon like OxyContin. So part of what I try to do is to show that it's important to have a broad view of the politics of pain from the bedside all the way through American society so that we actually might have a maybe a unified vision of what the challenge is going forward. So I guess that's all I'd say is that you know I would like to be part of the conversation about how we reform our thinking about pain and adequately take care of people who are experiencing pain and the last thing I want to say is that I end the book by talking about judges who judge the people who judge pain and the reason I end there is because I think there's all too much kind of critical judgment of whether people in pain are faking it or not and how much relief they deserve. I don't think we spend enough time thinking about the problems of those who judge others and the way in which ideology filters into our thinking from all sides of the political spectrum and that's one of the things that I want to put on stage in this book as well. Kind of a critical look at the society that would judge people in pain and their problems. Well we're out of time and I think that that's a great place to end. Thank you so much for joining us today. I thoroughly enjoyed listening to you. Thank you Monique. This is wonderful. Thank you very much. [Music] [BLANK_AUDIO]
Is pain real? Is pain relief a right? Who decides? In Pain: A Political History (Johns Hopkins University Press, 2014),Keith Wailoo investigates how people have interpreted and judged the suffering of others in the US from the mid-1940s to the present. While doctors and patients figure in his story, the primary protagonists are politicians, judges, and ideologues, who variously understood the ambiguities of pain as political problems to be settled in legislatures and in courts of law and public opinion alike. For instance, in the 1940s and 1950s, the “pain complaint” of ailing World War II veterans became the locus of debates about manhood, federal disability benefits, and pharmaceutical interventions. Although physicians faced complex problems about adjudicating the pain of their patients, Wailoo shows that pain was also a deeply cultural problem, especially as new, competing theories of pain emerged to explain not only the experience of suffering, but the character, motives, and rights and responsibilities of the sufferer. In the Reagan administration-era, debates about pain were an index of America’s welfare problem, and in late 20thcentury, controversies over fetal pain and the “ultimate relief” of physician-assisted suicide reflected the polarized landscape of “liberal” and “conservative” positions. The last chapter, “OxyContin Unleashed,” compellingly shows how a de-regulated and pro-business pain policy led to the pain drug boom in a competitive and unstable medical marketplace. Ultimately, Wailoo claims that “we have a cultural problem understanding people’s pain.” Pain shows us how that has taken place throughout our recent history, and challenges us to acknowledge and attend to the way that we politicize the pain of others without regard for their suffering.
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