A World of Hurt

Washington — As a primary human drive, not even the pursuit of prolonged pleasure can compete with the avoidance of pain. That is why the sudden emergence of the painkiller issue strikes home to so many who are afflicted with pain ranging from splitting headache to crippling arthritis.

In recent weeks, people seeking relief have been afflicted by the overreaction to reports that several new pain alleviators, taken in large doses by especially vulnerable patients, may increase the risk of heart problems. These new, expensive medicines were developed to reduce pain without the risk of side effects like ulcers that were associated with established painkillers. Within days, other studies surfaced to generate worry about the side effects of sustained high doses of those familiar medicines - naproxen, ibuprofen, even century-old aspirin.

At a stroke, trial lawyers advertised for clients who would sue; publicity-famished politicians demanded tighter regulation by the Food and Drug Administration; editorialists inveighed against the pharmaceutical industry for putting profits before safety; many doctors wondered what drugs were reasonably safe to prescribe to patients in pain.

A true "miracle drug" would be one without any side effect, no matter how much you took or for how long - and that miracle has not yet happened. Before joining the patellar reflex (better known as the knee-jerk reaction), consider some of the panicked ideas being bruited about and the risks they entail:

1. Shake up the F.D.A. Make it much tougher for new drugs to be approved; require more and longer studies because side effects may not show up for years. Risk: people in pain, angry at bureaucrats frozen by potential criticism, will steal or buy the relief from profiteers here and abroad. How many pain-induced depressions and suicides may occur if tomorrow's painkillers are withheld from the public for years?

2. Remember the mantra "First do no harm." Risk: fearful overreaction harms research that could do great good. The Washington Post reports that "the spate of bad news about painkillers has dealt a major blow to what had been a highly promising effort to use the drugs to prevent a host of leading killers, including many types of cancer, Alzheimer's and other forms of dementia."

3. Prohibit all drug advertising, because it needlessly stimulates demand; the pious "ask your doctor" line is a shameful dodge. True enough, but the huge investment in developing major medicines is recouped by mass sales through advertising; if there was no profit in discovery, research would wither, much human misery would be prolonged, and the cost to the public of treating diseases that go uncured would skyrocket. (And who's for prohibiting the tort bar from advertising?)

4. Socialize science; merge the F.D.A. with the National Institutes of Health to finance and control all medical research and provide free prescription drugs to all. Risk: under monolith medicine, too many taxpayers would die waiting.

Nobody affected by the recent diet-drug fiasco doubts that independent and expert drug traffic cops are needed. What, then, is to be done to give doctors and patients enough information to intelligently balance the risk of taking a tentatively approved drug against the risk or pain of doing without it?

Rather than terrorize the F.D.A. into a cover-your-posterior paralysis, beef up its staff and expand the role of independent review panels to initiate as well as speedily review trials. Require practicing physicians to attend teleconference and Internet briefings about new drugs by those independent panels so that patients can depend on up-to-date personal guidance.

Call on the pharmaceutical industry to curtail its 25 percent-a-year increase of hard-sell advertising; instead, it should relate ad budgets to research costs and treat doctors as judicious students, not sales targets. In reciprocation, Congress should pass tort reform before painkiller-killers drive offshore the U.S. industry that leads the world in curbing suffering and saving lives.

I own some stock in four drug companies and want the managers to do this: Explain the risk-benefit ratio to patients, pundits and politicians forthrightly and in plain English. Use larger containers and print big, clear warnings on them.

I have a bottle in my medicine chest marked "poison" with a skull and crossbones on the label. It's old-fashioned iodine and stings a little but is good for cuts. I never drink it.

Uncertainty is more frightening than a sure death.

I think the big deficiency of our education and conditioning is this lack of familiarity with risk and uncertainty. Teachers make their pronouncements as though they are absolute certainties -- because they are passed on down high, presumably from the top educators in the system, and thereby, everybody else is relieved from the responsibility and freedom of thinking for themselves and accepting the consequences of their choices -- as long as they remain safely within the confines of political correctness of thought.

Thus, demagogues (I won't name names) can promise, "Vote for our presidential candidate and the lame will walk, plenty of money will always be everyone's Social Security entitlement, no Americans will ever die in wars, the foolish will not be discriminated from the wise, your jobs will never become obsolete or outsourced, and we won't raise your taxes to pay for all this, etc."

I recall talking to a person wasting away dramatically, for which the doctors had given up and pronounced, "There's 'clinically' nothing wrong with you." Yet this person knew they were wasting away and dying with each day, and each moment. I said, "One of the products that people use to build their bodies up is andro; the Nazis even proved its effectiveness among concentration camp detainees in their program to produce a superior human." Maybe you should try it. Their response, "I'm worried about the long-term side-effects." That person was gone in a matter of weeks.

There are people suffering from mind-numbing migraines that make them feel that death might be preferable; the same for bodily pains -- yet their lives are transformed by aspirin, naproxen, ibuprofen, guaifenesin, steroids, whatever. If they don't have these pain-relievers this moment -- their next might be their long-term prognosis.

There are two "conservatives" at the NY Times: Safire and Brooks. They sure let us down a lot! I'd prefer one solid one! (It's only the very odd column by Safire or Brooks that is of any real use. Brooks did a great one on conservative professors at wacko-leftist colleges. But he followed it up later by urging conservatives to "insist" on gay marriage!)

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