care. Thus it is obviously not enough for scientific medicine to do well on double-blind clinical trials. It must also meet socio-ethical demand for empathy, and control of pain and suffering. And this, of course, means that it must abandon scientific ideology’s ignoring or bracketing subjective states as irrelevant! It does not mean, in my opinion, trying uneasily to coexist with non-evidence-based alternative medicine!
One final issue needs to be discussed. It will be recalled that the federal laboratory animal laws that forced what we have called the “reappropriation of common sense” on pain also contained a proviso mandating control of “distress.” Beginning in 1985, however, the USDA, in writing regulations interpreting the Act, focused exclusively on pain, thereby upsetting many activists. In my view, this was extremely wise, though not necessarily intentionally so. The point is that now USDA has begun to look at distress, but is doing so after the acceptance of pain has become axiomatic. Had they demanded control of pain and distress from the beginning, little progress would have been made on either category, the dual task appearing far too formidable to allow for progress on either front!
The situation is quite different now. I recently attended a conference of experts on how to deal with “distress.” The preliminary discussion illuminated a fascinating leitmotif common to many participants. “While pain is tangible, real easy to get hold of,” the argument went, “distress is far more amorphous and opaque.” I was genuinely amused by this, and altered my keynote address to acknowledge the source of my amusement. “Almost 25 years ago exactly,” I said, “I attended a very similar conference on pain, sponsored by the same people. At that time, I argued that animals felt pain, and that that pain could be known to us and controlled. An NIH official was there and said nothing, but called the Dean of my school to tell him that I was a viper in the bosom of biomedicine, and students should not be exposed to my ideas! The point is that felt pain was as remote and outlandish to scientific ideology then as distress seems to be today.” I also pointed out that if 500 million dollars were made available for distress research, it would not go begging and unclaimed! The distress issue, too, is simply reappropriating ordinary common sense on negative mental states or emotions in animals, such as fear, boredom, loneliness, social isolation, anxiety, etc, and then providing science-based clarification of these concepts and their operational meaning and criteria for identifying them. I am morally certain that in 25 years, in retrospect, distress will look as transparent as pain!
FILENAME \p A:\Chapter 9.doc
See for example, B. Rollin, The Unheeded Cry
D. Callahan, “Death and the Research Imperative”
R.M. Markes and E.S. Sacher, “Undertreatment of Medical Impatients with Narcotic Analgesics”
J. Liebeskind and R. Melzack, “Meeting a Need for Education in Pain Management”
B.R. Ferrell and M. Rhiner, “High-tech Comfort: Ethical Issues in Cancer Pain Management for the 1990s”
E. Gray, “Do Respiratory Patients Receive Adequate Analgesia?”
M. Pernick, A Calculus of Suffering: Pain, Professionalism and Anesthesia in Nineteenth Century America
G.A. Walco et.al., “Pain, Hurt, and Harm: The Ethics of Pain Control in Infants and Children”
D.K. Cope, “Neonatal Pain: The Evolution of an Idea”
CIRP, “Pain of Circumcisision and Pain Control”
K.J.S. Anand and P.R. Hickey, “Pain and its Effects in the Human Neonate and Fetus”
K.J.S. Anand and P.R. Hickey, “Halothane-Morphine Compared with High Dose Sufentanil for Anesthesia and Post-Operative Analgesia in Neonatal Cardiac Surgery”
Walco et.al., op. cit.
B.H. Lee, “Managing Pain in Human Neonates: Implications for Animals”
S. Beggs, “Postnatal Development of Pain Pathwayss and Consequence of Early Injury”
Walco et.al., op. cit.
L. Robins et.al., “Drug Use in U.S. Army Enlisted Men in Vietman: A Follow-up on their Return Home”