Thursday, May 22, 2008

Pain and class

This from TIME magazine and CNN:

Millions of Americans in Chronic Pain
Friday, May. 02, 2008 By KATHLEEN KINGSBURY

Nursing a migraine today? New research shows you're not alone. More than a quarter of Americans suffer daily pain, a condition that costs the U.S. about $60 billion a year in lost productivity. And how often you're in pain depends largely on the size of your paycheck.

Americans in households making less than $30,000 a year spend nearly 20% of their lives in moderate to severe pain, compared with less than 8% of people in households earning above $100,000, according to a landmark study on how Americans experience in pain. The findings, published Thursday in the British journal The Lancet, also found that participants who hadn't finished high school reported feeling twice the amount of pain as college graduates. "To a significant extent, pain does separate the classes," says Princeton economist Alan Krueger, who authored the study along with Dr. Arthur Stone, a psychiatry professor at Stony Brook University.

Krueger notes that the type of pain people reported typically fell on either side of the rich-poor divide. "Those with higher incomes welcome pain almost by choice, usually through exercise," he says. "At lower incomes, pain comes as the result of work." Indeed, Krueger and Stone found that blue-collar workers felt more pain, from physical labor or repetitive motion, while on the job than off, which at least offers hope that the problem can be mitigated. This finding "emphasizes the need for pain preventing measures [in the workplace] such as better ergonomics," wrote Juha H.O. Turunen, a professor of social pharmacy at Finland's University of Kuopio, in an accompanying commentary to the report.

People with chronic pain also worked less, the new study found, costing U.S. businesses as much as $60 billion annually. These conclusions are in line with previous studies on productivity lost to common pain conditions, including a 2003 report finding that nearly 15% of the U.S. workforce's output was diminished by ailments such as headaches and arthritis. What's new in Kruger and Stone's study, however, is the level of detail with which the researchers were able to chronicle the lives of Americans in pain. With the help of the polling firm Gallup, they asked nearly 4,000 survey participants to diarize their daily activities over a 24-hour period. From these personal accounts, the researchers saw the impact pain had on people's emotional states. Though participants said interacting with a spouse or friend lowered their pain, those suffering chronic pain tended to socialize much less. They also spent a lot more time watching television�about 25% of their day compared with 16% for the average person.

Pain also appeared to be a major driver of healthcare costs. Krueger and Stone found that Americans spent about $2.6 billion in over-the-counter pain medications and another nearly $14 billion on outpatient analgesics in 2004, the most recent data available. But in these numbers, too, there may be a distinction between the haves and the have-nots. A 2005 study in Michigan showed that minorities and the poor have less access to such drugs than wealthier Americans because local pharmacies don't stock enough pain medications such as oxycodone or morphine.

"Those [pharmacies] in white ZIP codes were more than 13 times more likely to have sufficient supplies," says lead researcher Dr. Carmen Green, an anesthesiology professor at the University of Michigan. "I have patients who have to drive 30 miles or more just to get their pain medications."

One characteristic that pain doesn't seem to distinguish is gender: according to Krueger and Stone's study, men and women were nearly equally likely to find themselves in pain. Another is age. People reported more aches and pains as they got older, though surprisingly that pain tended to plateau from ages 45 to 75. "Maybe people reach a point in their career where they move up the ladder into a desk job," Krueger says. "Or maybe they've just learned how to cope with the pain."



Anonymous said...

Very interesting post. I dealt with chronic pain for several years preceding a cervical disk fusion. I was fortunate to have insurance and was able to go to a pain management clinic to receive both medications as well as several nerve blocks. I do have a question about pharmacies who do not carry an adequate stock of pain meds. Could this have anything to do with crime? I lost track of the number of times my local Walgreens was robbed specifically for meds such as those you mentioned. At one point, prior to my surgery, I was taking a very strong dose of oxycodone, and even though my pharmacy was in an upscale area they often had to special order my medication because even they were cautious about the level of narcotics they stocked.


Eric Livingston said...

Interesting data. I wonder if the study also looked at prescription pain medication addictions. I wonder if those who can afford such medications have higher rates of addiction.

Anonymous said...

people making less than a dollar a day in africa would kill to experience the pain of someone making 20 grand a year.

Larry James said...

Anon 2:38, two questions:
1) What does this have to do with inner city America where the wealth gap is as great or greater than in Africa and where the social dynamics of poverty or as severe? 2) Are you sugggesting that we should not care about or engage the poor in urban America?

Frank Bellizzi said...

Reading this just confirms what I have sensed many times; that my wealth makes it much easier for me to avoid or get over pain compared to someone who doesn't have the access I tend to take for granted. When I get a migraine, Imitrex is in the cabinet. I don't like its side effects, but they're much better than the headache. I don't like to think about how it would be to always have to ride out a migraine. But I know that millions of people do.

Getting closer to poverty and reading this blog have helped me to not be so oblivious. Thanks for your efforts, Larry, to help others to think and to live better.

Anonymous said...

I'm saying, sure, people who have less their life isn't going to be as pain free as someone who has more. I wonder if our call to seek justice in the world might not always look like making the poor in the richest country in the world, look more like the richest people in the richest country in the world, rather, have christians of all socio economic statuses living amongst the poor, befriending them, and helping them when need arises, sharing what they have, etc. Poverty is such a relative thing... in the not too distant past, even the wealthiest of wealthy in the world didn't have indoor plumbing, something that even the majority of poor have in todays society.

We can point out all day long how life isn't as easy for those that have less money that someone else, but is that what we're supposed to be doing? Should we constantly be comparing lifestyles? Which is why I bring up the point that the vast majority of the world would kill to be homeless in this country.

Maybe we should stop trying to classify, and determine who deserves what, and be arms of healing to those who are hurting, and sometimes, those that are hurting are the wealthy, and those that are rich are the poor.

Frank Bellizzi said...

To the previous anonymous:

So, if the millions of hungry children in this country start eating healthy food on a regular basis, we're in danger of spoiling them as though they were Wall Street hot shots? Sounds to me like that's what you're saying.

You can always point to someone else who has it as bad or worse. But when does "poor and hungry and in pain" ever become the standard for self? Never.

Justin said...

I don't eat healthy, and I'm not poor (well, the government did discount my health care the other day... I didn't know that 3200 a month in gross income counted as poor in this country for a family of two) My life is wonderful. Do I have to deal with being sick sometimes cause my insurance has a 5000 dollar deductible? Yep. Do I eat sandwiches more often than meals with veggies? Yep. Do I do without a lot of stuff that I had growing up with parents who make considerably more money than I do? Sure do. But I'm content. My wife deals with headaches that almost knock her out of commission, and has for her whole life, cause her parents weren't great with money and couldn't afford health insurance or drs visits. She could probably get a constant prescription to deal with it, but she doesn't. She deals and moves on. She doesn't expect to get the same kinda of care that someone with more money gets. She doesn't sit around and complain that there's no justice, cause she would much rather be where she is than be in a place where food is scarce, and rebel groups roam the streets killing innocent civilians. And I know that too.

That being said, when someone comes up to me in my neighborhood (one of the poorest in my city) and is in need, I help them where I can. But is the answer to have someone, the government or otherwise, provide for every possible thing they could need? Whose standard of living do we base our justice on? Is it just that a family making 100,000 dollars a year can't afford the same luxuries as someone making a million a year? Life is not as black and white as many of you would like to think. And the standard of living you and I have is better than almost all that have come before us. We have luxuries that make life SO much easier than even kings had just 150 years ago.

Think about that.

Larry James said...

Justin, you and I just don't agree on health care. In my view, health care should not be treated as a commodity to be bought and sold like pork bellies (bad example!) or wheat futures. If the capacity exists, health care should be regarded as a basic human right--and not just here, but everywhere. I care about your wife's headaches, as I know you must. She shouldn't have to suffer with them. If you want to keep it in market terms, I wonder how much productivity she loses due to this problem? I find it morally objectionable for there to be a remedy that she cannot have simply because you can't afford to pay the insurance premiums that are far too high because we insist on making health care a commodity to be bought and sold like refrigerators or Chevrolets.

Frank Bellizzi said...

Larry's expression, "if the capacity exists" puts it clearly. And it does exist.

belinda said...

Larry -- AMEN!

Justin said...

The whole reason we have the cures is because it is profitable to create them. Without that profit incentive, our medical technology would pale in comparison to the one we have now. 60 years ago we didn't have antibiotics. People would not be able to put the correct capital investment in finding new drugs without a capitalist system. If you nationalize the system, and the profit is taken away, innovation will come to a stand still. Profit potential is what gives people the umpth to take risks which yield great reward to those you oppose (those wealthier than you) and those you support.

Anonymous said...

So, let's see, Justin. We have cures because we have it set up so that people make money off of serious illness. And, if you can afford to pay, you have access to the "best health care system in the world." If you can't, well, no sweat. You're part of a system that serves the rich. . .and almost 50M of us can go begging. Your myopic perspective makes Larry's points better than he does!

Justin said...

You lack nuance in your understanding of what an economy is when you think of things only in terms of "making money". Money is just a representation of the value of your production. When you, through sacrifice and sweat create value where there once was none, ie find cures to diseases or create any other thing that makes life easier, you receive a medium of exchange in order to make life easier for yourself... which in turn, allows for others the opportunity to provide some sort of service to you for that medium of exchange of your previous labor.

I will admit that I often times see the world too myopically, but to assume that only I see things that way, and you don't anon, is in itself myopic. You can't have your cake and eat it too. Until the Kingdom comes in full, the system we have is broken to some extent. We've developed a system that has, at least in many places around the world, made what is ultimately the natural state of man, poverty and pain, less of a factor. Is it still a factor? Of course. And we should do all we can with our resources to help where we can. But we should never join together the message of the Kingdom with having riches, and I think there's a tendency within the social justice movement, of which I consider myself apart, to do just that. Should we be trying to make everything "equal" in some way, or should we realize that things will never be equal in the way we desire, yet still continue to act justly towards those we can with what we have, but not complain that someone has something better? I just don't believe Jesus's goal was to give everyone in the world the same resources that the richest in the United States have. His goal is to change the lifestyle of those that follow him to represent the life of Christ and to be content whatever the circumstances knowing, or having faith, that one day things will be made right. We can do what small things we can to change things, and absolutely should. But our hope is not in universal health care, or a government that claims to provide an abstract notion of equality, but in the resurrection of Christ, which is the promise that the world will once again be made right. We aren't working to build the Kingdom, but we are working for the Kingdom. That difference, I believe, is what seperates those that have faith from those that think we as humans can end suffering. We can't. There are forces beyond our control that have been spinning the world out of control for a long time. We choose to live out that different ethic as a witness to those around us that another age is breaking in, and will soon lift all our burdens.

My original point was just this. While we're working for a select group of people, who, in the grand scheme of things have a life much better than the rest of the world does, and by doing so, making the rich in the US richer, while the poor in the rest of the world continue to struggle.

I think we need to think of justice in terms that aren't just about quality of life, moreso about respect for life. No matter how much money someone has, they are still going to suffer, and as long as the prescription we offer them is only throwing more money their way, they will continue to trust in mannah rather than the Lord.

Anonymous said...

I agree that we can do better on health care. But part of the problem is that our health care system has spun out of control. Almost no thought is given to cost/benefit. We just demand more and more treatment, regardless of whether it makes any real sense. A recent study confirmed that patients reported the same or better outcomes when given relatively low tech, less expensive treatment when compared to those whose doctors "pulled out all the stops." I am all for reasonable access to reasonable health care. I am not for any universal system that just opens the door to extraordinary measures with no limits on cost. It will just spin the system even farther out of control and eventually even the US won't be able to afford it.

Larry James said...

Justin, the first line in your last post seems to contradict what you wrote in the post just before it--the one about profit motive, take a look. Your health shouldn't be mediated by any profit to make money. And, that same desire to make money drives much of the practice of medicine that is addressed by Anon 6:49 p.m. We lag far behind other industrialized naitons because we continue to regard health and health care as something to be traded on the open market, like corn, cars or oil futures. Other nations bury us in overall national health outcomes across the board. That is undeniable. Everyone is recognizing this truth.

Justin said...

I don't think there's a contradiction at all. Profit and making money are different. You may think otherwise, but I think there's a distinguishable difference. When I hear someone say "make money" there are many ways that can happen. Gifts, government stimulus, counterfeiting. These are ways to make money that have nothing to do with profit. Profit is merely a higher return of resources in some sort of trade. Now, in our economy, it is almost always in getting a higher return of dollars than the dollars and time invested. But in a barter economy, it looks different than that. Is it wrong for a blacksmith to trade horseshoes for eggs? Each person in the party there determines how much said task is worth in whatever trade they participate in in order to barter. For the blacksmith, maybe in order tomake his work worthwhile, he needs 4 dozen eggs. The chicken farmer needs horseshoes, and he determines that he can expend 4 dozen eggs for a set of horseshoes. Each profited in the transaction, but no money exchanged hands.

IE, "making money" and profit are not synonymous.

Anonymous said...


Huh? Aren't we more than a little off-topic? Are you suggesting I trade my doctor eggs for a checkup? Why do discussions with you always seem to get bogged down in detailed, nit-picking semantics?

Daniel Gray said...

So instead of making money, they made "eggs"... That was totally out in left field (in fact, maybe completely outside the ballpark). Like Anon 11:28 said... you're arguing semantics, and it makes no sense in the current discussion.

PBS Frontline had a great episode a few months ago regarding "universal" healthcare in several different countres. (It's available to watch on their website.)

Switzerland offers the most interesting example, because it had a similar healthcare economy to ours 20 years ago, but almost all Swiss healthcare co's. are now non-profit. Swiss health care operates effectively, but profits are reinvested in technology/innovation rather becoming the black hole of corporate wealth.

The Japanese system (government regulated prices) has actually increased innovation, because it has forced companies like Toshiba to develop low-cost technology to maintain profits.

Every system has its flaws, especially our own, but to assume that universal healthcare stifles innovation is simply not true.

Most countries have seen drastic improvements in labor force production that offset the increased costs of healthcare. But unfortunately, corporate America is too focused on the short-term bottom line to see the long-term benefit of healthcare to the U.S. economy.