This passage feels like it is premise of the article; the author eventually comes to terms with her tea-sipping and resting as recovery, and this doctor explains the reasoning behind the medical decision-making which is very clear (and mindful/thoughtful) I think.
“To paraphrase him [German anesthesiologist], he said: ‘Pain is a part of life. We cannot eliminate it nor do we want to. The pain will guide you. You will know when to rest more; you will know when you are healing. If I give you Vicodin, you will no longer feel the pain, yes, but you will no longer know what your body is telling you. You might overexert yourself because you are no longer feeling the pain signals. All you need is rest. And please be careful with ibuprofen. It’s not good for your kidneys. Only take it if you must. Your body will heal itself with rest.”’
In America you can buy topical antibiotics at convenience stores, but you get a lecture if you ask for something stronger. Painkillers are prescription only and there's very little stigma for something like Tylenol 3.
In Australia you can buy codeine over the counter, but you get a lecture if you ask for something stronger. Antibiotics are prescription only but have no stigma.
The undertreatment of pain in the US is affecting my grandparents in a huge way. My poor grandfather spends a week or more a month suffering from the rapid taper the doc is putting him through. We are trying to get him into pain management, apparently every doc in CA is scared of prosecution.
The irony is he would be just fine if they never rescheduled hydrocodone. When they did thst he had to be put on fentanyl and dilaudid, forcing us to seek out a pain specalist to get my grandfather the quality of life he needs to keep going.
The guy fell twice in two years and they just keep cutting him back, while abusers switch to heroin.
Genius tactic IMO. Deny those who need it, deny those who seek to abuse it, and force everyone to switch to heroin. Kidding of course- but thats where the abusers will go.
The legit QoL patients suffer with zero alternative. They cant take ibuprofen without shitting blood for a week.
Its like drm. The legit consumer is punished by those who abused the system.
Its more nuanced than that, but thats how it affects my life directly. Watching my grandparents in extreme pain because of crackdowns in all the wrong places. It makes me hurt and sick.
I'm not sure how amenable you are to alternatives, but after suffering myself with chronic pain in the past and discovering kratom to help with the pain in lieu of a narcotics prescription, I would suggest looking into this to improve your grandfather's quality of life. Years ago, my dad had surgery to "fix" a turn muscle that healed poorly, and was prescribed Tramadol for long-term pain management. After the docs started cutting everyone off, my dad suffered greatly from the pain, and I couldn't stand to see him like that, so I introduced him to kratom, as well. He takes it once in the evening before bed and he has also stopped getting regular migraines. The kratom subreddit is a good place to start looking for information. Just be aware that special interests have been spreading disinformation for a couple of years now, so take everything you read with a grain of salt. Do your own research and draw your own conclusions. There is a growing body of research available to help.
Highly controversial statement: you can still get Kratom legally online and in some states. There is an opiode like effect. It's worth looking into if your grandfather is suffering.
*edit: didn't see the comment right below this one! Thats +2 for Kratom!
I've read a few coherent accounts of what happened here in the US, and several of them blame changing Medicare/Medicaid quality-of-care guidelines. Specifically, that at one point one of the guidelines -- which factor into how much various entities in the system get paid -- changed from measuring whether pain was appropriately managed, to measuring whether pain was being eliminated. Which in turn led to an explosion of prescriptions of high-strength pain medications in order to hit the measure.
Having some experience with Medicare's version of the guidelines, most of them are sensible and do directly relate to whether someone's being treated in a way that will lead them to be healthy and happy in the long term. But it appears that one was a major mistake.
I wonder if that doctor has ever had major surgery himself and been told not to use painkillers?
Even if that is the case, pain seems to vary greatly in how it affects people. I would be very hesitant to tell someone that they should just let the pain "guide" them, because I have no idea what it is like for them.
My grandfather was an open-heart surgeon. In the days following surgery, he would always insist that his patients get up and take a short walk. They would not want to, but he insisted that this was an important and valuable part of recovery (in several dimension) and that they needed to push past resistance and force themselves to do it.
Later in life, he underwent a surgery requiring general anesthesia and found himself in the same position. He said, "If I had known it was like that, I would not have made them do it."
So I think the surgeon's personal experience of the situation is -- in fact -- highly relevant in practice, even if not in theory.
I'm not sure we should forgo pain management after major surgeries, but the benefit of getting up and walk even just 50m a few times a day is well documented. So no, it isn't fun, but it is a highly beneficial thing to do.
As human as that anecdote is, there are a long list of issues here. In particular, was the original idea that it would be a valuable part of the recovery in error?
It is easy for me to imagine a pain that I would never voluntarily experience or inflict (this isn't even a very profound level of pain, I don't like suffering even in small doses). This threshold is regularly breached and I often come out of it as an improved person.
Sometimes, and I'm thinking doctors and the military when I say this, people end up in situations where choices must be made. The situations are not emergencies and the choices affect other people in ways that the decider might not willingly accept for themselves. This is an unfortunate fact of the world not being a nice place.
I had my gallbladder removed a few years ago. It required a major incision and I was in the hospital for five days after surgery. I had to get up and walk a lap around the hallway a few times a day. I felt it get easier every day, but those first few times were excruciating.
It was good that they made me do it—by the last day, I was starting to develop nerve pain from so much sitting, propped up in the hospital bed. Walking was torture, but so was sitting.
I was reading "Dr. Mutter's Marvels" a while back. The eponymous surgeon was working around the time that anesthesia was being invented in the US, and it talks a bit about how some competing traditionalists believed that pain needed to be part of the actual bone-sawing surgery itself. (Also a natural part of all childbirth, with biblical overtones.)
Note that this is the exact opposite of the advice given in the article: you're told to ignore the pain and take walk, whereas the article states that the pain warns you to not disturb the healing process.
> I wonder if that doctor has ever had major surgery himself and been told not to use painkillers?
Since when is that a requirement for knowing what is best for your patients? The doctor is basing their judgement on current consensus within their field, which hopefully involves careful studies.
> The doctor is basing their judgement on current consensus within their field, which hopefully involves careful studies.
Medicine is unfortunately not nearly as scientific as you might wish - I worked for the British Medical Journal a while back and they are all about evidence-based medicine... unfortunately, there is still a lot of medicine that's based off of received knowledge or observational evidence, which may or may not be accurate. The situation is changing though as things get proper studies done, but it's not always easy to get decent results and so current consensus can and does change over time as research gets done.
Since the world stopped being completely black and white. (It never was.) And most definitely, medical science is not either.
With every medical decision there are trade-offs. Sure, it's best to walk soon after surgery... sometimes. Sometimes it's too early. And sometimes there are trade-offs like torturous pain that no person should have to bear. Many people might choose to forgo the day after walk knowing that their chances of a full recovery might be 0.01% lower.
It reminds me of the mantra that "breast feeding is best". Yes, according to some studies, there appears to be positive relationship. But what if continuing to breast feed causes a mother to stay clinically depressed. What if she can't handle the every 2 hours and it is driving her crazy and she wants to shake her crying baby. Maybe in this case, "formula is best".
A good medical practitioner works with their patients to communicate the risks and rewards clearly and help guide them to make the decisions that work best for them.
Anecdotally, I had a very intricate horizontal impacted wisdom tooth removal surgery done on barely any anesthesia because the thing was dangerously close to a nerve and I needed to be able to inform the dentist when he was getting too close to it (AR people: there is a market here for in-surgery diagnostic image overlays). It wasn't that bad (the healing process was more annoying), I was more focused on the ongoing procedure (but then again I was in med school before I decided to switch to computer science).
Slightly less anecdotally, I have a lot of doctor friends and while they may indulge in overwrought "look at how clever I am" medication schemes for ailments that do not really warrant it, I think that it's mostly because they feel that they don't have the time to rest like the author of the article (and this doesn't involve routine painkiller use either).
Some people argue that in my country (Italy) there is a cultural aversion to painkillers due to the historical influence of the Catholic Church, but it's hard to measure the effect.
I agree that there is no "one-size-fits-all" medical solution, but perhaps having this base-line allows building up when discussed with one's doctor - the article does not discuss this post-operation re-negotiation of how to manage the pain. Perhaps some HNers have experience with a similar situation that they could share.
I have had my teeth filled by a dentist that didn't "believe" in novocaine. Luckily, he died before I had any significant issues, and I had a later dentist that did it correctly. If you are doubtful of the usefulness of pain management while receiving a filling, you can try it yourself.
I'm perfectly understanding the concern for long term morpohine derivatives for treating post-surgical pain (although there are plenty of studies that show pain delays healing) so there is a bit of picking-n-choosing going on. Many nurses would recommend OTC acetaminophen in combination with ibuprofen as they work quite well and you're definitely still going to "feel it" if you're pulling out stitches with no risk of addiction. Since you aren't using a narcotic, you won't need a stool softener either.
I'm a bit concerned by the reliance on ibuprofen for pain (it's great for inflamation but prevents blood coagulation) since it can cause bleeding, although I'd note that she didn't even need that to sleep so her lapro-surgery was either extremely minor or she has high pain tolerance. Normally, combination with acetaminophen is preferred, because the dosage of each can be minimized.
Frankly, this all just sounds like German doctoring. I've also been told that you don't need decongestants (when flying) because your "nose should flow". It's normally acceptable (if inconvenient) advice, but if you're flying it could lead to eat infection and damage. It's not like your ear pain is going to get a pilot to turn a 747 around or help your cold pass faster. Suffering is not the answer to everything any more than a painless existence is.
> I have had my teeth filled by a dentist that didn't "believe" in novocaine. Luckily, he died before I had any significant issues, and I had a later dentist that did it correctly. If you are doubtful of the usefulness of pain management while receiving a filling, you can try it yourself.
I (German) openly prefer it, if the dentist gives the option whether to get a anaesthetic injection or not for dental fillings, not to get one, since I strongly prefer 5 to 10 somewhat inconvenient minutes over having a numb jaw for a whole day.
I am of course aware that there are really painful dental treatments such as dental root canal treatments - but in these cases no dentist will give you the choice whether to get a anaesthetic injection or not.
> Luckily, he died before I had any significant issues,
You're welcome to have your teeth drilled as you like. However, if you have a younger family member with more sensitive teeth you may understand that it's not for everyone. Imagine if your child jerked away for just and instant that caused the drill to cause more harm than good. The modern novacaine derivative my dentist uses lasts only about 30-60min after the appointment.
Because I was under the age of 18 and he was my parents dentist I didn't really have a choice. I didn't have any cavities as a child so my first negative dental experience was at 17 when he filled 4 molars "preventatively" (because he didn't know that epoxy capping was a thing). It didn't kill me, but it was an excruciating 30 min and an absolutely miserable day. The muscle tension pain from not moving took days to subside. Not a reasonable trade-off for me.
I had your experience at ages 6-9 in Alaska. The only available dentist had moral qualms about using novocaine.
The resulting aversion conditioning kept me away from dentists until I was 36, when my then-girlfriend coerced me to see a dentist. I needed lots of work, all of which was done using novocaine.
Pain control is part of good professional medical practice. If a practitioner puts you through gratuitous pain, find somebody else.
> Pain control is part of good professional medical practice. If a practitioner puts you through gratuitous pain, find somebody else.
I he has really "moral qualms" even when asked explicitly, I accept that you better look for another dentist. My claim is rather that it is as a dubious practise to just apply an anaesthetic injection by default.
That's interesting. My dad (half German) is the same way. After having gone to the dentist and seeing that, I though to myself, if he can do it, so can I. I now prefer it over having a numb mouth the whole day.
I've never had to to anything beyond simple fillings so I'd like to think that's the limit for me.
It depends on the procedure. I had a minor cavity filled when I was younger, and it really wasn't all that horrible. Something like a root canal would be unimaginable.
As I mentioned higher up the thread, pain thresholds vary dramatically. My father has had more than one root canal with no anesthetic because it was cheaper. He said the pain wasn't that bad. He just has a very high threshold for tooth pain, or lack of nerves there.
not all procedures are the same. my doctor also asks me if i want anaesthetics - but only if he thinks i can get away without one (i.e. minor work - he wouldn't ask if he expected the operation to last for more than a couple of minutes).
i've also skipped the anaesthetics on occasion without problems, but there were surgeries where this would have been madness where the doctor didn't ask.
> I strongly prefer 5 to 10 somewhat inconvenient minutes over having a numb jaw for a whole day.
I am not sure you'd say the same after 3-4 hours of treatment. I've done some root canal treatments here and there, which can take a long time. I'll take a numb jaw for a couple of hours afterwards over being in pain for 3 hours.
But I guess you're right, for 5-10 minutes of pain, it isn't worth it.
> If you are doubtful of the usefulness of pain management while receiving a filling, you can try it yourself.
What do you mean by a filling? Just for a minor cavity? I've never received local anesthetic for a minor plastic filling, just for root canals/crowns, and the pain has never been a problem. This seems to be common practice where I've gotten dental care (Sweden and Japan)
It varies by doctor. Usually, the more awful stuff they have to actually do, the less willing they are to issue pain pills for minor inconsequential things.
The guy who operated on my penis gave me a grab bag of pills that went right up to serious prescription pain killers and said just to call by if I needed more. I never even took the first day's pills, it barely hurt at all, but then he's a penis surgeon, it's not even essential to _have_ a penis, half the population don't have one so how important can that surgery be?
The guy who used to be my dentist before he retired was a Max Fac surgeon in his day job, dentist was how he relaxed before the weekend. So, normally he's putting back together ruined faces from car accidents and that sort of thing. Need a filling? "I can numb that, but it's in your lower jaw, and it's not touching the root, so I suggest we go without, then you won't drool for the rest of the day". "OK, but it will hurt?" "Barely at all, slight discomfort, weird sensation, no real pain". He was right, it was fine, definitely worth the small amount of discomfort to be in and out quickly and not drooling like an idiot.
On the other hand, when I was a kid I got hit by a car (my fault), they used Entonox (medical laughing gas) back then, I was high as a kite, and given the car smashed me good, that was probably the right call. So I'm not saying "I never use pain killers" but more like "I think pain killers are something to reserve for when it's really bad, not the first thing to reach for every time".
Well from experience 3 ops 2 minor 1 major in the UK last year they normally ask you to rate your pain on a 1 -10 scale and base meds partially on that.
I seem to be lucky and don't feel much pain so did not need any really strong painkillers after the first day or so and Tylenol made me nauseous so I stopped taking them.
Nationalistic swipes, which this crosses into, are not allowed on HN. They create flamewars and a nasty environment. I realize you may have meant it in good humor, but the communication channel here is much too poor for that to mitigate anything.
I laughed until I realized, wait you're right! I've noticed that the healing process seems to accelerate and inflammation is reduced when I put my attention on the pain (which takes practice, as the natural tendency is to try and escape it).
Reminds me of the commercials here. Back killing you while lifting pianos all day? Knees aching from gardening at age 80? Pop a pill and ignore the signals that you're damaging your body!
Without knowing your situation, plenty folks take (liberal amounts of) painkillers to numb the pain and thus never find out or work on the real cause of the pain.
Warmth and daily stretching, massage and exercise fixes most sore tight spots that, if left untreated, can escalate to chronic pain setting you up for an unending painkiller loop eventually making you a walking stiff.
Almost my whole body was a painful solid wreck until I started to work on it more or less every day. My lower back still has some tight achy spots but it's getting there. These days I can actually flex some muscles I had no idea I had or could control.
Herniated disc. During the worst weeks, I could hardly move inside the bed, let alone "work on it". Imagine you desperately need to pee but it takes you ten minutes to get out of bed.
It's much better now so I take smaller doeses, do physiotherapy and I can even use the bycicle to work again, but taking Ibuprofen is still necessary to be able to work on it in the first place. Plan is to be able to run again and Ibuprofen helps to get to that point.
A similar reasoning of a (military) Russian dentist refusing to apply even local anesthetic that a friend seen once - "I prefer to not lose contact with the patient"
My dentist in California said he had several patients from Eastern Europe and Russia who had dental treatment like this, and their teeth were all mangled from treatment without anesthesia. He had done numerous re-drilling’s and re-fillings and root canals on these patients to deal with decay in teeth that had already been treated in their home countries. They had decay underneath fillings because the original treatment had essentially only gone as deep as the patient could stand. The dentist would drill until the patient screamed stop and then fill the hole, even if that left continued decay underneath.
I can only assume that the second round of treatment in their home countries would be either another round of drill torture or tooth extraction.
> They had decay underneath fillings because the original treatment had essentially only gone as deep as the patient could stand.
In the middle of a root-canal my anesthetic completely wore off. I was able to feel the nerve root in my tooth being twisted up into a metal file and snapped out, along with all the canal filing and packing that happens afterwards. White-hot all-encompassing pain. There's no way any of those patients got a proper job done.
Why not ask for more anesthetic? When a friend went to a dentist for a procedure, she repeatedly asked for more anesthetic until she couldn't feel the pain. I think it took two or three additional injections after the first one before that happened. (It's hard for anesthetics to make their way into the jaw bone, I believe.)
I’ve had a root canal where the anesthesia didn’t wear off but simply wasn’t complete. It was still the most painful thing I’ve experienced. If I needed a root canal without anesthesia I’d just ask for an extraction. No way I’d even attempt a root canal without anesthesia.
Different concept. Anesthesia for an operation leads to better outcome and more comfortable for the patient. Sucicide was common in people who needed a surgery prior to the advent of anesthesia.
I had a tooth taken out without any anesthetic before. It was bad but the pain was so severe I barely remembered it even later that day. It’s almost like I remember it happening to someone else, not me.
My suspicion is that paracetamol / acetaminophen and ibuprofen are so incredibly not-good for you, and this anaesthesiologist knows this, that he covering his ass by minimising how much he doles out.
Both of them (Acetaminophen is the US name for Paracetamol) are highly dangerous, even in small dosages. Paracetamol poisoning can kill within a day, and the lethal dosage is equivalent to about 20 pills. Ibuprofen is proven to cause heart attacks & stroke.
Your suggestion is the perfect example of why over the counter drugs as so dangerous: a Dr or a pharmacist is aware of the dangers, that we (being the public) may not know about, and should not dispense those without taking them into account.
The problem is you can't make over the counter drugs illegal in the US, not only because of the medical-industrial complex lobbying, but also because of the cost of getting a Rx. Had the US had a public health system…
I am a practicing doctor and I don't know where this is coming from.
Paracetamol and Ibuprofen while they have potentially lethal side effects are incredibly safe and effective in daily practice and consequently are very widely used. Every known drug has side effects and if you ever read a drug insert you would never pop a pill again. In the case of ibuprofen/paracetamol we are careful to avoid use in patients with ulcers, elevated blood pressure, liver or kidney disease, alcoholics or allergy to either drug.
Unlike opioids they don't cause dependence and their anti-inflammatory effect is very useful post trauma. Most patients self regulate their dosage and usually taper down within a few days. Used in combination a more nuanced effect can be achieved with lower doses.
Paracetamol toxicity in particular frequently occurs in the context of attempted suicide, alcohol abuse or mental impairment and requires a huge pill burden 20 - 24 pills ingested at once or about a 6 - 12 pills in repeated doses over multiple days. This is not as common as you would assume.
Surgery without anaesthesia is cruel and abusive. NSAIDS are not always the right call,but given a choice they are a good alternative.
Tldr: they are dangerous in theory but safe in practice.
would you recommend a patient take any drugs regularly without regular follow ups?
that's the danger of 1000ct over-the-counter. taking a couple of ibuprofens when you have a headache is one thing. taking enough to need 100s of them, without a professional recommendation is another.
I'm fortunate enough to never had need to take either, except after having my wisdom teeth out I took a few paracetamol with hydrocodone tablets.
I'm not suggesting that taking a few doses here and there is anything to be concerned about.
What worries me is that some people are consuming probably too much over probably too long and having subclinical negative health outcomes as a result.
Recommended dosage, which most people take more of – take two every couple of hours, and you're going to need a new liver. And when you're in pain, it's easy to loose count.
Which is why in some countries, the maximum amount allowed over the counter is 16ct or so (sometimes a bit more when bought from a pharmacist who can make sure the buyer is aware of the dangers). It is irresponsible to sell a 1,000 ct bottle of pills, yet the grocery store near my house does, over the counter even.
I just looked at my ibuprofen bottle and it says to take one 200mg tablet every 4-6 hours. That's 800-1200mg per day, which is not something to worry about.
Certainly if you ignore that and take a higher dose or take it more frequently you can have problems, but assuming you don't have existing liver issues and aren't drunk all the time, you need to take like 5x (or more) the recommended dose to run into any trouble. If you're that stupid, you deserve what's coming to you.
the idea is to reduce risk, not eliminate it. thinking is, if you need 1000ct of any drug, you should probably see a health professional first; if you're going through the effort (and extra cost) of buying 63 packs of it, then there's probably nothing that could be done to stop you from whatever you are trying to do.
Lots of people take 2 Extra Strength Tylenol at at time. If you do that every 4 hours (instead of 6), you're looking at 12 pills a day. Add to that a few doses of Nyquil or some other multi-medicine that has Tylenol in it, and it's possible to get up to a toxic dose.
> I have noticed the need to "take something" with a lot of American friends when they have problem. It's almost like a reflex.
I have a friend who was in an accident and required emergency surgery. She happens to be a drug addict who is no longer involved in drugs (we do not say 'former' drug addict as there is no such thing). Even though she put in her intake form "DRUG ADDICT" in bold letters and told them, they still insisted on trying to give opiate-based pain killers to her. It is almost like they are telemarketers going off a script to sell something, which is in this case to push opiate drug painkillers.
It's such a strange bimodal distribution, among people I know - there are those who take preposterous numbers of painkillers on a semi-regular basis, and those who won't take an OTC painkiller except under duress when they're on the edge of blacking out from the pain.
I do think a great many people either overprescribe or are overly dependent on painkillers, opioid and otherwise, but there's also many different kinds of pain. I have a fairly high pain tolerance for most things, but certain kinds of acute pain, mouth pain or the warning pain of a migraine immediately disrupt my ability to concentrate usefully, which can be problematic when you need to concentrate to resolve the source of the pain.
There's also a weird thing where a good number of people I've known have regularly taken well in excess of the maximum safe dosage (even for Rx) of painkillers for days or weeks every month, and not think this is something they should bring up with their doctor. If this were "I talked to the doctor and made this choice based on X information," I wouldn't be as surprised, but it just never crossed their minds that it was abnormal to have crippling pain on a recurring basis.
In the US, I recently had two teeth removed that had horrendous infections (the swelling was tremendous); after the surgery, I asked them about painkillers, and they told me I wouldn't need them, just take ibuprofen if the pain gets bad and it'll go away in a day or so. I was skeptical but listened, and much to my surprise, the pain did almost magically vanish after I went to sleep that night.
AIUI the reason they still tried opiate painkillers is that there aren't really many non-opioid alternatives available other than the OTC stuff - and the effectiveness of both types varies wildly by person, but since the distribution is wider for the opioids, on average you're more likely to get pain relief from it. (My brother, for example, gets almost no benefit from any non-IV opioid painkiller, whereas if I take a single hydrocodone I'm both pain-free and borderline asleep.)
It'd be nice if we could find ways of relieving crippling pain without risk of physiological addiction, but so far, I don't think I've seen much compelling research toward that.
This study showed that a Tylenol ibuprofen combo was as effective as opioids (and with zero chance of addiction). If course it's likely to vary in effectiveness by patient and depend on the type of pain. I can't help but feel that pharmaceutical companies probably don't want a lot more studies like this coming out.
This study is so bad I don't know where to start. Apart from its small size, the other major things is there was no ibuprofen control or ibuprofen with codeine control. There is a vast difference in the effectiveness of ibuprofen over acetaminophen.
It is studies like this that have caused us Australians to lose access to OTC codeine this week.
Codeine at the dose available over the counter is not very addictive. On top of this the pharmacists record your details so that anyone addicted is picked up and helped. As far as I can determine there has not been a problem with OTC codeine in Australia.
As for why to not make it prescription only is we have universal healthcare in Australia. Shifting low dose codeine to prescription only will cause a massive increase in doctor visits at a huge increase in the cost to the Australian tax payer. I use OTC codeine to treat and catch my migraines before they become major. I maybe take codeine once a month and never visit the doctor. I will now have to visit at least once or twice a year for no reason other than to get a script for something I have been buying over the counter for the last 30 years.
If it's sufficiently low dose and it's tracked at a level that can detect and alert about potential abuse, that makes a lot of sense to me; thank you for the (much better) explanation.
Basically like lots of things in Australia we are getting caught up in the US hysteria about opioid addiction.
Yes opioids are powerful and potentially dangerous drugs, but used wisely they are very useful and effective. If there is a problem then the solution is to solve the problem, not just ban everything because there might be a problem.
On the topic of the US opioid addiction the way it has been handled is appalling. Getting millions hooked on powerful prescription opioids and then cutting them off cold turkey with effectively zero help so they end turning to really dangerous drugs like fentanyl is criminal.
When I was a kid you could purchase codeine cough medicine OTC in my U.S. state (it was same deal as you describe for Australia -- the patient would have to sign a register so the pharmacist could make sure you weren't buying five bottles a day or whatever).
Nothing works as well for a nagging cough as codeine and terpin hydrate. Nothing.
Unfortunately, you've got to go to a doctor to get it nowadays.
Instead, most people use OTC stuff with DXM (which doesn't work as well, is an abusable drug in its own right, and is quite likely more toxic than the codeine).
The question should be is their a compelling reason to make it Rx Only, and people that support making it Prescription only have the requirement to provide evidence to support making it RX only.
The fact that is "addictive" is also not enough IMO
People are neither medically qualified to evaluate opioid use nor, when in a situation where they may be necessary, personally capable of evaluating their situation. This is why trained professionals exist. This is literally why.
Asking whether there is an argument for an addictive opiate with significant health impacts and the opiate-consistent tolerance growth that leads to self-medication and increased dosage to be available without medical consultation is the "wrong question"--to somebody whose posts throughout this thread are unempathic, pull-the-ladder-up-behind-us, so-brave stances that project personal (theoretical and probably wrong) resistance to addiction onto societal policy.
>>This is why trained professionals exist. This is literally why.
Trained Professional exist to advise and recommend. Even in healthcare doctors are not dictators, they advise their patients on the best course of action it is then up to the individual to either follow that advice or not. I assume you oppose that, and believe doctors should have legal authority over their patients who should not be given any choices and should be compelled to do anything the doctor orders
So my question to you is why to you hate individualism and individual freedom? Following that how far does that extend, to you believe in a pure technocracy where decisions and public policy are selected on the basis of "trained professionals " in their areas of responsibility, particularly scientific knowledge with out considerations for personal liberty, rights or choices?
> I assume you oppose that, and believe doctors should have legal authority over their patients
This is a weakly constructed strawman. The gulf between doctors compelling behavior and society not enabling obviously self-destructive ones is wide.
Which you should know. And yet, the disingenuity is p. strong in here, so I'm gonna go with do know rather than should know.
> So my question to you is why to you hate individualism and individual freedom?
I "hate" individualism because I find selfishness to be base; in my experience the proportion of people who crow about "individualism" and who aren't in it to hurt those with fewer advantages than they have is a rounding error. And the freedom to ramp yourself into opioid dependence is not a meaningful freedom.
> with out considerations for personal liberty, rights or choices?
This degree of oh so you must believe silliness is some /r/iamverysmart stuff. C'mon.
>>And the freedom to ramp yourself into opioid dependence is not a meaningful freedom.
Nor is that a freedom I am speaking of, however the idea it should be a crime to "ramp yourself into opioid dependence" is unethical on its face as that is more of a medical and mental health problem not one that should be solved with criminality
I do however think it is a "meaningful freedom" for one to be allowed to judge for themselves what medication and/or pain management they should use in a given situation.
Further the War on Drugs as a directly result of prohibitionist policies have directly lead to more suffering and lose of "meaningful freedoms" for non-drug users than the abuse of the drug ever did.
I think it selfish is prohibitionist to not look at the big picture, to not see the Failure that the War on Drugs is, to not see the Extreme Harm the war on drugs in inflected not only on the US but the world, and double down on failed prohibitionist policies
>> in my experience the proportion of people who crow about "individualism" and who aren't in it to hurt those with fewer advantages than they have is a rounding error.
I must be in the rounding error then, I support many things that help people with fewer advantages, I believe these goals can be accomplished with liberty and respect of individual,
I also have a good understanding of history, and know that Authoritarian policies like the one you advocate for are often hardest on those not in the majority, on those that as "fewer advantages", Contrary to rose colored opinions authoritarians have, authoritarian polices are harmful to the less fortunate this has been proven countless time by countless authoritarian governments through out world history
Freedom and Liberty leads to prosperity, not Centralized Authoritarian Control
This is why you could only buy OTC codeine at pharmacies after you talked to the pharmacist about your condition and they checked and recorded your details in a database to see if you had been buying excessive amounts of OTC codeine.
We are moving from a system where we recorded who was buying codeine and making sure they were not needing help, to a system where there are no controls. The GPs in Australia lack any database on who has been prescribed codeine so it is now possible to doctor-shop around and abuse the system where previously it was regulated. About the only “winners” out of this change are the GP’s as they will now get more business from people like me.
Makes total sense. In the United States, despite their training pharmacists are mostly considered to be pill monkeys rather than meaningful medical professionals--what you get instead is an emoji shrug as the their-definition-of-freedom-lovers (the GP is a good example) froth out at the idea that their medical data should be available to medical professionals, leaving it an ongoing pain in the rear to try to get one pharmacy chain to talk to another (or to an independent pharmacist).
I sometimes forget that other countries have systems that actually work because the incidence of people trying to destroy societal systems is generally less; in that context what you describe certainly seems like an own goal to me.
On the contrary, since nobody in the US is willing to prescribe opioids any more, hospitals are doing Tylenol IV drips, and pharma is now charging 10x for acetaminophen.
They’re just fine with the hysteria and the studies, they still get paid.
In fairness my wisdom teeth removal wasn’t exactly textbook. I had to go to an oral surgeon and he had to dig into the lower jawbone to remove one of them, breaking it into pieces to get it off the nerve. I had a lot of damage to the gums and quite a few bone fragments migrated out over the next few weeks.
I was however even offered opioids for a root canal once (different dentist). I didn’t fill that prescription.
I had this done two time (jawbone cut, tooth extracted in fragments, stitches thereafter) and while the healing process was annoying, it wasn't painful unless I tried eating solid foods with the wrong side of the mouth or something like that (which was a good indication of the fact that it was too early to do so, which helped healing faster, which is why - even discounting addiction issues - taking painkillers for avoidable pain is dangerous).
The "quite a few bone fragments migrated out" part sounds pretty bad, on the other hand; that's not really supposed to happen as far as I know.
I agree that the opiates probably weren't needed. I took the recommended dosage at first and just completely passed out for hours, so I have no idea how much pain I would have been in. After that, I cut the dose in half for the next day, until I got really sick of feeling foggy and just stopped entirely. (I found the whole "high" to be really annoying and not particularly pleasant, aside from the pain dulling properties. All I wanted to do was read and I couldn't do that.) I suspect ibuprofen would have been sufficient but I don't really know, either, since I took the surgeon's advice and took the opiates at first.
I do still have one wisdom tooth left. If I ever get that one out, I'll see how it goes without the opiates.
Bone fragments migrating out are apparently not that uncommon. Any bone piece that breaks off but doesn't get completely removed will eventually migrate out of the gums.
Having had a bunch of dental work done, sometimes it's not unreasonable - I had my wisdom teeth out and was given hydrocodone for afterward, but I was fortunate and didn't have any pain warranting it after.
Being given opiates for a root canal seems insane, though - if you have crippling pain _after_ a root canal, I think that means the dentist did something horribly wrong.
Could you elaborate on how there's no such thing as a former addict? I'm curious, as there are a couple substances I used to be addicted to but am not any longer.
It's a belief of some advocacy groups, like AA and such.
In real life, there are lots of drug addicts and alcoholics that managed to recover for the rest of their life just fine, including drinking in moderation for social reasons without relapsing (as opposed the teetotallism stance advocated by said groups).
Not to say it's a bad thing to drink after recovering from alcoholism, but wouldn't that just be managed addiction?
My uncle is an alcoholic, but has managed to drink at a reasonable level (not healthy, but doesn't socially harm him, e.g. drink driving, losing a job) for the past few decades. He'll crack his first beer at 10 AM, but manages to keep a good level of control.
>Not to say it's a bad thing to drink after recovering from alcoholism, but wouldn't that just be managed addiction?
Not any more so than drinking before alcoholism is "managed addiction".
If you can manage it and drink whenever you want after being an alcoholic (e.g. not drink for weeks, then drink at a party and then again not for weeks, and have no withdrawal effects when you don't drink) then you're not addicted anymore.
Addiction is not just a chemical dependency. The context in which you use the substance matters. Your personality and past behavior matters. This friend, in particular, took partying to an extreme. Not one drink but twelve drinks and blackout situations. Not just drinks but drinking and drugs. A lot of people who do not know her history will innocently say something like "We're going to happy hour" or "Just have a drink, it is the holidays." She knows though that, for her, the likelihood of that one drink turning into passing out at 5AM after an all-night rager are dangerously high. This is why I say there is no such thing as a former addict, as you can throw everything away with just "one".
I’ll second this statement. Migraines for me (and my mom as well) used to be crushing, and would take me out for potentially days at a time. Sumatriptan was a miracle drug for me, and now if I take it in time, I don’t suffer. If I catch it late, it will reduce the duration of the migraine to just a few hours (which feels like a miracle in the moment).
I had tried previous to sumatriptan many other remedies, and nothing compared. I’ve heard from my doctor many respond well to magnesium supplements as a way to head off the migraines altogether but I can’t say it worked for me (but I gave it a shot none the less).
All that being said, I’m generally averse now to opiates after seeing their long term effects on my father who was also an alcoholic. They did allow him to push through pain, which resulted in ever increasing damage to his joints (and ultimately internal organs as well). By the end, he couldn’t walk, was self medicating heavily with alcohol, and couldn’t keep himself in a physical rehab facility because his urge for alcohol and opiates couldn’t get satiated in that environment.
He died at 61.
So, I applaud the author and those who seek to responsibly limit access to medications which are highly addictive and potentially unnecessary for treatment. Pain management is very important, but it does need to be weighed against the potentially catastrophic dependency issues it can cause.
Migraine is slightly different than post-op pain though. Post op pain is good pain. The treatment was the surgery, and the pain is expected. Minimizing it may make the treatment less effective (e.g. by exertion, lack of rest ect). With migraine, the painkiller is effectively the treatment.
I had all four wisdom teeth removed at once and all I needed was one ibuprofen the first night, but a fucking migraine and I need at least one, sometimes two.
I had a wisdom teeth removed and was given basically nothing, besides the anesthetic injection needed for me not to feel pain during the procedure.
Please note that my wisdom tooth was about 80-90% developed and outside the gum, so no "surgery" was required, just some lever movement to pull it out. Also, no stitches were needed.
I was sent home with just an advice to eat non-solid, cold stuff "using the other side of the mouth".
Quite frankly, everything went okay. It was weird feeling that hole in my mouth, but it eventually filled itself.
I can second that experience. I'm still quite baffled by how little force is required to remove a tooth. The dentist barely wriggled his wrist and it popped out.
All I got sent home with was a wad of bandage to bite down on for the first 10 minutes. All in all probably the least painful experience I've ever had at the dentist. (Novacaine doesn't quite work properly on me it seems)
Well one of mine was tilted 90°, it had to be cut into pieces first and then cut from the bone. The others were quite OK though, not just a wiggle but no crazy stuff involved.
Not all migraine sufferers are the same. I have suffered from fairly regular migraine headaches for about twenty years (can't believe it's been that long!) and sometimes taking something like 200mg of ibuprofen when you first feel it can result in the progress of the headache being 'arrested' at that stage and though it still lasts as long as a normal headache before it passes, sometimes it manages to stop it from fully blooming.
However, even within my own experience, only ~1/4 of my headaches respond this way. I've taken other medications as well, and the majority of my migraines don't respond to anything other than trying to soothe the symptoms :/ In the majority of cases ~3/4 of the time, there's nothing you can do to stop it, you just have to dig yourself in and get to a quiet dark place for a few hours until it passes.
Folks not reaching for a pill bottle are pretty rare, IME. I think the author of this article is touching on something pretty valuable with the willingness to be uncomfortable or even to endure pain. When I broke my leg in college, they gave me morphine while I was in the hospital (which just made me annoyed and mad) and I never touched the take-home codeine. Was walking in an air boot "early", too, as I was assured I couldn't hurt myself thanks to the metal rod through my shin and it just...didn't hurt that much.
I might take a naproxen if I have a bad headache or I tweak my neck and I can't stop working to take care of myself, but that's maybe two or three times a year (and I am being well-compensated for it). I know people, healthy people, who pop an ibuprofen in the morning just out of habit.
I don't think the average american uses that many pain pills.
OTC pain pills are a ~4 billion dollar industry. There are 320 million people so that's ~1$ / month in pain pill per person. And that's including both stuff that goes bad and is never used and daily Aspirin taken for cardiac health. https://www.chpa.org/OTCsCategory.aspx
5% of the population does take daily pain medication. At the same time it's common to go months without taking anything for pain.
And again, we are talking less than one prescription per year per person on average. With many of these prescriptions for 2-3 days worth of pain management. Though again, a minority of people get a lot of pain medication.
> Approximately 80 percent of the global opioid supply is consumed in the United States, which represents only 5 percent of the global population
That article is borderline irresponsible with how it reports that metric.
80% of global prescription opiate medications are filled in the US, but that doesn't mean that 80% of those prescriptions are consumed in the US (or consumed at all). Nor does it include no-prescription opiates, which are generally much easier to obtain in most countries around the world (and also a lot cheaper) than their prescription counterparts.
I'm very reluctant to take drugs, even over the counter pain meds or allergy pills, but this is an American trend that a lot of people I've interacted with have noticed and I wouldn't discount it outright.
Last Monday evening, I had an accident with an angle grinder in my garage. The cutoff disc went through my leather glove and bit deep into the middle finger of my left hand. After deciding against gluing the cut back together, I drove myself to urgent care and received five stitches.
Did I need any painkillers, the doctor asked? I declined; my finger was pumped full of lidocaine at the time.
In the middle of the night, the lidocaine wore off, and while the finger hadn't hurt in the immediate aftermath of the injury, it certainly hurt then. After tossing and turning for about an hour, I decided to get up and try to find something to take.
The only analgesic I had in the house was an expired tiny bottle of ibuprofen. I needed about five minutes of digging before I found even that.
I simply don't use painkillers very often. I might take ibuprofen once or twice a year. I can't remember the last time I took anything other than ibuprofen, not even acetaminophen, not even when I twisted my knee.
I'm not sure if I have a higher tolerance of pain than other people or if other people like to self-medicate when the least bit of pain rears its head. Or, perhaps, I've simply been lucky enough not to have much pain.
Well it's a bit tough to do actual work when there's pain that keeps distracting you. In the article the author talks about just needing to rest... But many of us don't really have the luxury of taking multiple days to rest. At least when you're on painkillers you can still do white collar work, albeit at reduced capacity. Without painkillers though, all your mental capacity would be going towards managing the pain.
This may be another geographic difference - In Germany, unless you are self-employed, if you get a dr's note saying you should rest employers aren't allowed to ask you to come to work. And the amount of sick-leave is unlimited.
Side note: They can't even ask WHAT exactly you have that prevents you from working. Important detail in case you have something that could be stigmatising or somehow discriminated against.
It's cheating you out of needed rest. Without painkillers you are be forced to rest and prevented from making matters worse. The concept of pain has an important function. Here's a story of a family that doesn't feel it:
I've notice this too. But it was a more general mindset: "If I have a health disturbance, I need a _dedicated_ solution.". The _dedicated_ word is important. It can't be a _generic_ solution (like walking, sleeping, change my eating for few days, etc.) so they too "the thing" and don't change anything like if the problem would be solved by this. As an European, it was so weird for me.
Interesting. I wonder if we have stats on painkiller usage per country? I found this ranking of countries by Opiate usage[0] which places the US at 27 (below Ireland, Switzerland, Italy, and the UK.
Maybe I only hang out with granola Americans, but the only people I know who think the way you describe-- looking for pills to solve minor problems-- are relatives of medical personnel.
I can't think of the last time I personally took a pain killer. I didn't even take one after a major surgery I had a couple of years ago.
"The list does not include opioids, which is classified as a different drug under the World Drug Report 2011 list, which is considered "opiates and prescription opioids."
Same for me. When I take something during a headache it doesn't change anything, and most of the time I'll even throw up in the next 30min if I take something. So I just try to sleep.
I don't use pain killers at all, but headaches are sometimes the exception. I rarely get a headache (maybe once a month?) but when I do, I know that it won't go away before a good night's sleep. So I either go to sleep in the evening or take an Aspirin or something when I'm at the office. I just can't work or even properly think with a pounding headache.
I have noticed how the vast majority of my American friends do not express any reactive need to unnecessarily take pharmaceuticals (especially painkillers, in the case of pain) when they have a medical problem. Does my single anecdotal datapoint negate your single anecdotal datapoint?
I’ll throw another spanner in to mess things up: I am European and know other Europeans who feel compelled to take painkillers for any little thing (I personally will take them only if the pain is really severe or interferes with work or such, which is quite rare typically).
Anecdotally, it's fairly prevalent in Europe as well. Living in Europe, I know just as many Europeans who pop ibuprofen like candy compared to Americans.
Speaking for the UK you can buy ibuprofen, paracetamol (acetaminophen) and aspirin off the shelf in any shop.
You're limited to 2 packs of 16 tablets each (for a total of 32 tablets) per transaction, in an effort to reduce the incidence of spontaneous suicide attempts.
On the other hand, at least in the cities there is a ton of pharmacies - sometimes even across the street form one another, and easily every few hundred meters along major routes. There are way too many. When I walk through downtown Nuremberg I walk past several of them, right on the main pedestrian-only street of the city. And they are all allowed to advertise in their shop windows. So that's some prime advertising space, right in the hard of the city. On my way to downtown, a twelve minute walk, I walk past four pharmacies if I take the route along the street (vs. the lake route, which is a park).
Also, they are allowed to advertise for things like cold medicine, when I still had a TV (log time ago, admittedly) I remember seeing lots and lots of such ads: "WICK MediNait cold medicinefor the night", list of ingredients: https://www.aponet.de/wissen/arzneimitteldatenbank/suchergeb... (active ingredients Paracetamol, doxylamine hydrogen succinate, ephedrine hemisulfate, Dextromethorphan hydrobromide-1-water)
> Direct consumer advertisement of drugs is also illegal in Germany.
Only for prescription drugs ("verschreibungspflichtig"), so no "ask your doctor if XYZ is right for you" bullshit.
Non-prescription drugs ("apothekenpflichtig") are heavily advertised in pharmacies, sometimes on billboards, and on TV. Most TV ads for drugs are running on ARD and ZDF [1] since that's what old people watch.
[1] Though only between 18:00 and 20:00, which is when the public broadcasters are allowed to air ads.
In the UK, ibuprofen, aspirin and paracetamol are sold freely everywhere (but only in small packs). Painkillers containing codeine are available over the counter, after talking to a pharmacist. Anything stronger requires a prescription.
The 500/5 cocodamols will cause liver damage before any codeine kicks in.
What is interesting is that if you really interesting is that a certain large pharmacy does a 200/12 ibuprofen + codeine combo.
I once had a prolapsed lower disc (from sport) and neck spasm (from stupidity) at the same time. Whilst I couldn't take naproxen (lots of reflux even with omeprazole), that and 500/15 cocodes with diazepam was the only way to get to sleep.
In the UK, you can buy a pack of 16 generic Ibuprofen tablets at the supermarket for as little as £0.25 ($0.35, €0.28). Similarly, Aspirin can be bought for as little £0.45 for a pack of 16 tablets.
Got shoulder surgery recently. I enjoyed taking hydrocodone even though I could prbly have gone without it. Made recovery that much more enjoyable, it was fun while it lasted :D.
Pharma ads play a role but hardly explain this behavior. I believe a primary aspect is simply that Americans (including myself) expect and are expected to fill every waking moment with productivity or similar, rather than having flexibility to take a few hours/days/etc off to allow for healing and/or exploration of causalities; we instead use coping strategies and even with lackluster results continue down that road, seeking more alleviation of symptoms - initial, and consequential side effects from treatments for initial - rather than examination of root causes (which are complex and individualized to a large degree).
It doesn't help when others influence by saying "just take ... for that." I can't begin to explain why others do so, except that people generally have good intentions and are empathetic?
TLDR: Americans often don't invest the time and resources to identify and eliminate behaviors/conditions that are the cause of their ailments, and instead cope with any "quick fix" drug/product/strategy that never eliminates the cause of symptoms and often introduces new issues.
Last two thoughts: Many in modern society are very averse to discomfort - understandably, but regardless of degree/origin - and many doctors are happy to feed into this behavior instead of educating the patient that pain is sometimes a part of the process.
Many in modern society lack (or do not have the energy for) self-awareness and/or critical thinking to examine root causes of ailments/symptoms, and instead trust that taking ... will help without understanding the actual mechanisms/effectiveness of the treatment.
I think a lot of this behaviour can be attributed to how the US treats sick leave - unpaid.
However, the quality and quantity of medication ads in the US has truly amazed me when I visited. I wouldn't want to be a hypochondriac over the big pond, because the TV ads were so suggestive.
Today I was walking around SF and saw a billboard for a medication, and it didn't say anywhere what the medication was for. Drug advertising in the US is simply baffling to me, and I'm American, even.
By the standards of many places in the world, medicine in the US is quite prudently distributed.
For instance I can buy antibiotics, or things like prozac at most any pharmacy. Pharmacies being a bit different than in the US. In many places prescriptions are not filled at pharmacies, but at the hospital itself. Pharmacies are often stores that sell only drugs, usually without prescription, as opposed to the US thing where you have a general goods store with a pharmacist filling prescriptions in the back.
And all the regular stuff acetaminophen/ibuprofen/etc are also of course available, though there is a difference that generally it is sold in blister packs rather than in the huge bottles of it you can buy in America.
I'm not sure it's a valid point since I can just enter in one of the 3 pharmacies near me and buy a box of aspirins for 2€. We don't have medications in supermarket but we have a LOT of pharmacies here (France).
It's still different. Needing to go to a specialized store with trained personnel to buy painkillers has a completely different appeal than just tossing bottles of painkillers into your cart next to milk and candy.
I think that's the point the parent is making, there's a lot more friction involved, you'd have to get out of your way to get large amount of drugs (amount in one box in the US is just way more than what you'd get in e.g. France).
the deal isn't the price, but the quantity: if you need 1,000 pills of any medication, you should be under medical supervision/follow-ups, not buying them like they were groceries.
Generally, sure. As for aspirin, though, if you're a couple on a common low-dose daily regimen, that's 730 pills in just 1 year without a single head or body ache.
Ibuprofen and the like are also available from the supermarket in most of Europe. Codeine and the like are not, as they're prescription only but it's not a big trip to go to a pharmacy anywhere.
I live in Europe now, but lived in the US before. The difference is that buying medications is part of weekly grocery shopping in the US more or less. It is also how it is advertised all over the place. Besides, many medications that are prescription here (or are just smaller doses) are available in large doses in the US in grocery stores.
That's bizarre and not at all a part of my experience in the US. I go to the supermarket when I need things. If one of those things happens to be a medication (because I have an immediate need for it), then I'll buy it. Otherwise, I won't.
I think this is probably quite accurate. Looking at tv in various countries, they just don't have the pill advertisements like America does. ask your doctor about...
That freaks me out. The doctor is supposed to tell me what to assume, not the other way around.
Also, I have seen too many stories of drug representative sellers with no background in medical sciences convincing doctors to prescribe a drug with many, more-or-less honest arguments.
The other bizarre and ludicrous thing about the constant "ask your doctor" refrain: how many US adults have a personal physician whom they see regularly enough to even be able to call the person "their doctor"?
I'm willing to bet most people have a more substantial relationship with the barista at their local Starbucks than whoever happens to be on duty when they need to go to the doctor.
When I was a kid we all (including my parents) had regular doctors that we had a relationship with. These days a doctor visit for me is rare (once every couple years), so I wouldn't say I have a strong relationship with my doctor, but I do go to the same doctor every time.
I think this is pretty normal; many insurance plans in the US have the concept of a "primary physician" who you nominate as your go-to doc for general issues. (It's easy to change, though.)
I do have more of a relationship with some bartenders at my favorite bars, though; you're right about that.
I had jaw surgery recently... while I wouldn't describe it as incredibly "painful", particularly since everything was numb (they have to slice through nerves for this procedure), it was really uncomfortable and stressful for a couple of days afterwards.
I wasn't at all ashamed to take percocet after the surgery. Could I have lived without them? Sure. Did they turn me into an instant addict? Of course not.
This story isn't about the crackdown on opioids since it sounds like it's more just a cultural thing in parts of Germany, but it does strike me that people experiencing legitimate pain are becoming casualties of our crackdown on "inappropriate" prescribing.
people experiencing legitimate pain are becoming casualties of our crackdown on "inappropriate" prescribing.
Perhaps in America they are so easy with the opiates because people have a real or perceived need to get back to work. When I had to have two impacted wisdom teeth removed the pain and swelling was completely under control with ice bags, aspirin and two days off work. A low wage at-will worker in the US can't do that.
This is a rather salient point. In the Netherlands, if I needed (in consultation with my doctor, of course) to stay out of work for a year to recuperate from illness or injury, I can do that and continue to receive my full salary. The second year would be at 70% salary. My job would await my return - only after 2 years would I be separated from my employer and have access to other long-term disability benefits.
In the US, FMLA generously "guarantees" 12 UNPAID weeks of medical leave in any 12 month period while still being able to return to work (provided you've met other conditions of hours worked, and the location where you work has 50 or more employees, etc etc.) Enforcement may require lawyering up, so it's de facto useless for low-wage workers - or middle-class workers who don't want to be blacklisted from future employment, as, yes, background check databases do prominently flag people who have sued their employers.
And did I mention FMLA leave is unpaid? If you can't afford to take unpaid time off work, you're using vacation days unless you're in one of a handful of localities that require employers offer a few paid sick days per year.
If you can't afford to take unpaid time off work, you're using vacation days unless you're in one of a handful of localities that require employers offer a few paid sick days per year.
Yes, on occasion they do send mass email here asking to donate vacation time to XY, who is recuperating from surgery. It makes one reach for the bucket to throw up in every time.
For the first six weeks the employer (small employers need mandatory insurance for that), after that their health insurance (which gets some lump payments from the federal government for that).
Short and long term disability insurance is common with professionals jobs in the US. After that social security kicks in.
The only think I can think of is the abuse must be rife in the Netherlands? Shit, at full salary I certainly wouldn't be in a rush to get back to work.
I'd hardly consider taking days off from work only to sit at home in pain to be "rest". I'm lucky enough that I can afford to take days off to rest when in pain post-surgery, but I'd still want something to help with the pain.
"Did they turn me into an instant addict? Of course not."
That's the case for you but others are more prone to addiction. My girlfriend some years ago had a surgery and got opiates afterward. The pain was gone a after a few days but it took a lot of convincing and almost force to make her stop with the opiates. This stuff is really addictive for some.
It must be. I've had Vicodin a few times, and found it had had no effect other than pain relief. There was no experience of a "high" or euphoria. I have never finished a prescription, as it simply stops occurring to me to take it once the pain is gone.
I abused vicodin, taking 40-50mg of hydrocodone at a time explicitly to get high. Once I ran out, I shrugged my shoulders and that was the end of it.
Some people have addictive personalities. Some don't. I don't discount people turning into heroin addicts from the stuff. It's my favorite drug in the world.
The article seems to be behind a registration wall - are you able to provide a summary?
Also, do you know if this is a widely held position or just emerging?
I found a couple of things, but none of them are as clear cut as "it's okay to stop antibiotics early".
This [0] article says
> Health professionals are trading in the "complete the course" slogan. Instead, they recommend that patients take their medicines "exactly as prescribed."
which seems to be a quote from this [1] linked article.
Last time the doctor did not give me enough penicillin, I was required to take a disgusting roadband antibiotics, which I had to mask with taste-numbing food, to not throw up the instant it hit any muscous membrane. Due to that, we had a tablet of it on a plate in the corner of the kitchen, and were wondering in the (no door; adjacent) living room, where that horrible smell came from.
Anecdata: since then, I fear horrible broadband antibiotics being needed.
I would prefer phages, but they are soviet tech, and soviet died.
Yeah, I question the idea that it's beneficial to experience pain - why should I? Especially if it's going to cost me days of my life that I could do something with. Maybe not go out, but at least be able to catch up on some of the more passive content... seems like a needless waste of life.
The experience of pain (and I'm separating this from the dopamine-release thing for people who groove on that sort of thing) is, for my money, a useful training facility for willpower and restraint. Separate from the pain-as-warning-signs noted by 'lukeschlather, few things hurt that much and the fact that you are not the master of even yourself is a valuable reminder.
The experience of being uncomfortable is not a bad one to have, nor a bad one to make peace with. Pain and discomfort are a part of humanity: when they don't exist, we invent ways to have both. And there certainly exists a line where chronic pain makes it humane to blunt it--but most folks don't have that problem at all.
And "content" is what you are left with when the soul is leached out of creativity by people who lack it. It is a soul-suckingly awful construct in the twenty-first century and decent people should reject it. Please don't promulgate its notions.
People talking positively about pain (and especially immediate post-surgical pain as in the article) makes me uneasy. Sure, some level of pain is useful as a warning sign. And wanting painkillers primarily to avoid resting is unreasonable.
But, if there is too much pain, it will cause extreme stress during the day and they will probably be unable to sleep at night - it is hard to imagine this being beneficial for recovery.
Also, if the pain is too great, people will avoid future treatment, even if it is medically advisable.
I think there have been problems with anesthesia in the past, where people woke up during surgery (although still unable to move), and I think it led to negative outcomes even though it is only pain - although I admit, I am reluctant to look up the details.
At the very least, I think it is good to give enough pain medication so that the patient does not want to die, although I understand it may be unavoidable when the level / duration is high enough.
It looks like in the article, the level of pain and recovery for this procedure is not very bad (probably because it's laparoscopic), and the doctors know this, so their recommendations were appropriate and the patient was worried over nothing. But, I don't think this means that the same is true for all procedures, and suggesting that people just make peace with it or whatever without knowing what the level is seems wrong. Especially in the case of surgical recovery where the first day or two is usually the worst, and the risks of medication over such a short period are low.
I wouldn't wish for a more serious level of pain on my worst enemy. I do not think it is useful or possible to make peace with, unless you are Buddha himself.
> I don't think this means that the same is true for all procedures, and suggesting that people just make peace with it or whatever without knowing what the level is seems wrong
It's like I literally expressed that? Maybe I made it trickier to parse by referring primarily to chronic pain--if you want to lump extreme, trauma-induced pain into that? Sure. When lives are on the line, whatever, do what needs to be done; we have doctors to make educated decisions based on the information available.
But I will contend most Americans--and my observations are largely limited to us--mostly harm themselves in the effort to avoid what we have largely decided is pain and is in many ways merely discomfort. And I tend to think that that ramps up into greater problems along the way.
I see that makes more sense now, I think that line did throw me off somehow.
I haven't seen any close friends or family just pop a Tylenol for every day aches and pains, but it certainly seems to be a thing, so I'm open to the idea that I'm living in some kind of bubble in that regard. I've always thought of pain medication as for bringing severe pain down to a lower (but non-zero) level, so for example it might not be taken at all if you break a toe, but would be more than reasonable for the jaw surgery in the first post in the thread.
It's interesting, chronic back pain is one of the most common chronic pain causes, and a doctor was talking to me recently about it (in general, luckily I don't have it). Apparently once it gets started it can have its own self reinforcing process, and there are measurable biological changes to how nerves fire etc. that are independent of any initial underlying injury. Probably there's some people faking or overstating it, but I could easily imagine such a process getting pretty severe. Unfortunately, the outlook is pretty bad I think once you've had it for a set amount of time.
So concerning chronic pain / opioid use I can't figure out if Americans are less willing to deal with pain, or actually have more pain, or some combination of both. If back pain just needs an initial injury to set it off, then escalates from there, the unhealthy lifestyles and ever increasing obesity levels here would do a lot to explain why it is becoming an increasing problem.
I don't buy the "it's good and normal for you; suck it up" perspective. Pain is a useful signal that you're doing something wrong with your body, or that you need to rest to recover and heal. But if you're lying still on your bed recovering from a surgery and are still in pain, what purpose does that serve? It "builds character"? If that makes you happy, go for it, but don't impose that view on the rest of us.
This seems to me to be entirely backwards. If you appreciate creativity, don't you want to have as much time as possible to experience and enjoy the world around you? To learn? To create? Why would you spend the day stuck in bed feeling like shit, unable to do anything but watch TV when you could easily solve that and do more?
There is a joke about Americans (which I extend to "most people", and definitely to most technical people I know): if one is to stop being stimulated from outside, then one runs the very real risk of having to consider what is inside. I tend to consider the cavalier American use of painkillers to be in that "stimulated from outside" bucket--and I try very hard to be unafraid of considering what might be inside.
I already don't watch TV when I feel poorly (or in general). I might work--usually on something that I care about, so as to make me feel good that I have done it. Or I might read. If circumstances are uncomfortable enough that concentrating is difficult, then I know I need to sleep. If sleep is very difficult--not merely difficult--due to pain, then sure, then painkillers are on the table for me. Otherwise, why would I try to change how I feel externally?
Painkillers do not change the underlying state. If it is something you literally cannot bear, then sure, get some help. But I have learned over time that the world includes discomfort and pain and that they're really not that bad, most of the time. The world around me includes me. And it includes the need to be mindful about me, too. This is part of that.
I think you're confusing some sort of emotional pain which may deserve analysis with physical pain which analysis cannot bring any insights from - it's just pain. Nothing revolutionary.
Pain is really important. You can't properly heal from an injury without pain, because you won't know when you're worsening the injury. In the worst case you'll get into a descending spiral where you need to take more and more painkillers as you attempt to go about your day normally until you've injured yourself to the point where painkillers are no longer able to let you ignore the injury.
And in the best case (and almost 100% of the time) you'll just heal anyways, but won't give a shit about the pain and will actually be able to do stuff.
I think I'll roll that dice, thanks anyways. I'm generally able to restrict myself without the need for pain.
You are projecting anecdotally your own situation and extrapolating in a somewhat irresponsible manner. Statistically it is shown that these prescriptions do lead to addiction in a frightfully large number of people. Being "uncomfortable" and "stressed" is a part of pain and it's an important signal that you need to take it easy. If pain is to the point where you can't sleep and heal appropriately, than I can see where it might be used. Even then it's important not to confuse general insomnia with pain induced waking.
"Columbia University researchers found that opioid addiction had tripled over a 10-year period, with the proportion of Americans reporting abuse or dependence increasing from 0.1% of the population in 1991–92 to 0.3% in 2001–02."
It's true... in a population of 350MM (the USA), that's over a million people reporting abuse or dependence. Though I'd like to see a further breakdown of what abuse means in this context.
Of course, the question that needs to be asked: how many of those began as legitimate prescriptions and ended in dependence? Certainly not all of them, perhaps even a small fraction. But a well-to-do person become addicted after minor surgery tends to get more attention than poor people substituting fentanyl for heroin.
Finally, there's a cost/benefit analysis. Painkillers have an obvious benefit for people who need them - whether to treat chronic pain or temporarily after surgery. What is the cost to restricting access to those who have a legitimate need for these drugs?
I don't have answers to these questions. I will note that public health policy has a checkered past when it comes to unintended consequences. Our attempts at wide-scale social engineering, particularly that driven by outrage and headlines, rarely work the way we expect.
To whit, I can't help but think that the crackdown on prescription painkillers in our recent past (central registries, jailing physicians, imposing production ceilings on opioid manufacturers) has directly lead to the rise of synthetic alternatives we're seeing today.
Although the article‘s premise seems reasonable (given the author‘s origin, the USA, being renown as prone to prescribe pain killers and psychotropics for the most menial things[1]) - a similar bias must be outlined when trying to understand the German perspective: That we are still romanticists.
Many German doctors will send you off with „some rest“ and „tea“. Some will prescribe homeopathics, which are to some extend even covered by our universal healthcare, which makes „sense“ since a large part of the electorate believes in it. Even in IT you will regularly hear: „i feel like I’m getting a cold - better take my homeopathics quick or it will definitely evolve into one!“
Alternative healthcare is a big market here, many individuals spending 100s - 1000s € a year for the most obscure things. Which doesn’t sound much per se, but for Romanticism Germans who regularity castigate Pharma- and Medical industries as capitalistic, to throw money so willingly away kind of beats the purpose of coming across as mindful.
Anyone remembers the the Mitchell and Webb sketch about the „homeopathic ER“? Well fun fact: the Nazis did try to make this happen. In order to get rid off the evil, jewish (science based) medicine. They wanted to make homeopathy the official medicine of the Reich - including the Wehrmacht, which for better or worse, the Generals intervened against.
[1] I have no proofs for this being actually true, just the representation that the US medical system gets by German media - and many Americans
This is not true. Doctors do not and must not prescribe Homeopathic stuff in Germany. If it is payed for by the government/healthcare, it has to be proven effective.
It is. There are many doctors openly advertising being open to alternative medicine. Nowhere did I say „they must“. They can though, and often will since patients who believe in Homeopathy will often choose another doctor if theirs isn‘t „into“ it.
When I feel like I'm getting a cold, I take a multivitamin (or at least some vitamin C), maybe a Dayquil/Nyquil, and try to sleep as soon as I can. Nearly always solves the problem.
The homeopathy prescriptions are baffling to me. Have any of these gone through clinical trials? If not, I assume the doctors must be hoping for a placebo effect when they feel that prescribing something actually effective is overkill. At least I hope that's what's happening.
AFAIK not a single homeopathic treatment beats placebos in clinical trials.
But "universal healthcare" to some extend means that the electorate can decide "what's right". By law, the public insurances are explicitly allowed to cover homeopathy. Weird enough, but understandable if a large chunk (and generally more important chunk) of voters are also Homeopathy adherent patients.
While Homeopathic doctors are by no means the majority here, the majority of "science" doctors will shy away as much as possible from confronting their patients with their stance on alternative medicine.
Yes. Especially if the patient has the above-mentioned "need to take something" because just waiting it out is not a sufficiently palatable option (even if it is the only one).
But IIRC you got to pay it yourself in many cases.
Not really. Some insurances offer to take the cost of homeopathy, but no doctor will prescribe "crystals" or other new age stuff. Are there black sheeps? Yes, like in every profession.
How a doctor reacts depends highly depends on the illness. If you have a cold, your doctor will recommend some tea and rest, but if you have a tonsillitis, you will get anti-biotics. And there is no such thing as a pain index.
Out of 110 existing "statutory health insurance companies" 84 cover Homeopathy [1][2]. They aren't required to do so, but are by law explicitly allowed to cover it [3], which is weird enough. And as the numbers suggest, most of them happily do because it attracts many Germans, especially the well-offs.
> I didn’t mention that I use ibuprofen like candy
Never, ever become like this person. Do not make a habit out of taking ibuprofen and assuming it's benign. If you have to take painkillers every day to function then something else is wrong and you need to address that. NSAIDs alter chemical production in your body and over the long term can cause permanent damage.
Lots of cough/cold medicine will make the user drowsy. The typical cough suppressant dextromethorphan can cause drowsiness on it’s own. First generation antihistamines such as doxylamine are also often included in “cough and cold” medicines and can cause significant drowsiness.
Near as I can tell, doxylamine has literally no purpose in these medications except to cause drowsiness. It doesn’t do anything for the cough or for a runny/stuffy nose caused by an infection. You’ll find this combo in NyQuil.
So yes, it’s really a thing, though it probably shouldn’t be (the doxylamine part at least).
Some over the counter cough medicines contain a first-generation antihistamine, which causes drowsiness. Back in the day, some also contained codeine, but I’d hope this is no longer the case.
Interestingly, in Europe, NSAIDs like ibuprofen are frequently paired with vitamin C, because the addition of vitamin C has been shown to protect the stomach from damage [1]. Not sure why this apparently doesn't exist in the US.
There's something deeply concerning to me about claiming overall universal insights in pain management based on laparoscopic surgery.
Good for her that she was fine, but I've had the opposite experience with more serious stuff. Moaning in bed unable to sleep due to the pain being worse than anticipated is no fun, and that was in a hospital with the nurses aware but waiting on the proper overnight staff to have time to check in to decide if something stronger was justified.
Being uncomfortable is expected and fine, I don't want to be so numbed I hurt myself from overexertion, being unable to rest due to the pain is not.
But mainly, let's get rid of the stupid numbered pain scale. I don't know what the fuck a 5 vs a 10 is, but being told "you said it was at a 4, so we try to keep it under 5, so we didn't think you needed more at first" is annoying when I'm just basing my numbers off of some "I imagine getting shot in the knee could still hurt quite a bit worse" standard.
My wife was adamant that she not receive opiates after both c-sections. At the first hospital, the nurses were outwardly hostile toward her decision. "Why wouldn't you want medicine? I don't think you understand. You've had _abdominal surgery_. Do you understand that?"
She asked for NSAIDs and they refused, saying they would have to speak to her doctor in the morning. She waited it out and the doctor came to visit. He was not aware of the request, and was as appalled by the exchange as I think any reasonable person would be.
It's not just that they're handing drugs out, they're actively scaring people who refuse them.
As to the outcome, I don't think of my wife as a particularly "tough" person, but she felt fine with NSAIDs and recommends them to other women having the surgery.
Heroin was initially marketed as a non-addictive version of morphine. It was challenged by experts on the spot. But Bayer promoted it in ads as a remedy against cough and cold for children regardless. [1] In some sense they weren't first to come up with the idea - TIL ancient Egyptians used opium to stop children crying. [2]
Anyway, IMO the real wtf is drug companies being allowed to advertise prescription drugs in the US. A few lines into the article I eventually assumed Vicodin was an opioid-based painkiller; whereas I'd gather many a NYT reader would be familiar with the name. I find it unfortunate that the author doesn't connect the dots and spell out the conditioning of consumers through pharmaceutical ads.
My wife had somewhat involved oral surgery (1 regular extraction plus removal of 2 impacted molars embedded in her jaw - it was difficult enough that they said a broken jaw during the procedure was a possible complication. The doctor prescribed a week of hydrocodone, and said that she absolutely will need that bottle, and may want a refill.
She didn't want to use the opioids so went with the alternating ibuprofen+acetaminophen route, and though the first couple hours after the Novocain wore off were a little painful, she was pretty comfortable after that.
Not to put a fine point on it, but you don't know what you're talking about. Have you ever seen someone who is in so much pain that they're projectile vomiting just because of the pain? I have.
There is pain, and there is PAIN. If you can get by with some NSAIDS, then you're just in mild pain. This is not likely to interfere with healing. This is the kind of pain the person is talking about in the article. It's scary for most people because they're not experienced with pain.
I was with a loved one who underwent a very serious surgery. This person has a very high pain theshold and thought that they would ignore the doctor's advise and take something a lot less strong than what was provided.
They ended up back in the hospital on a morphine drip to recover from their pigheadedness. Not taking the prescribed opioids had let their pain get out of control. Severe pain is very serious and can greatly interfere with the healing process.
By way of comparison, this same person had a minor surgery (a couple of years after the very painful one) and the doctor was shocked at how they didn't seem to really be any pain, because their pain threshold was much higher than before.
My point is that the doctor said she she not only needed a week's worth of vicodin to manage the pain for recovery, but she'd likely need more.
Yet she really only needed zero vicodin. Just like the person in the NYTimes article.
But thanks for your illuminating anecdote of someone who had some procedure and ignored some medical advice and took something else than the something that was prescribed.
Well no, I think her doctor is basing his/her advice on what he typically does, and what patients expect (see the original NYTimes article where the author was adamant that she needed stronger painkillers, but turns out she didn't).
The dangers of opioids are well known, and it turns out that the evidence for opioids being the best option to be routinely diagnosed is shaky. From the article I linked to:
The authors of the new trial, led by Andrew Chang of Albany Medical College in New York, note that common medical practice and guidelines, including those championed by the World Health Organization, suggest that opioids are simply more effective at treating acute pain than non-opioid medications—or combinations of them. Yet, the data backing that is shaky.
So maybe, more discretion on when and how many opioids are prescribed would be better for everyone.
I agree. In my experience, specifically Vicodin, does almost nothing for inflammation. Ibuprofen has consistently proven more effective when it came to actual pain.
I must applaud the doctors, as they did the right thing, and even gave explicit and detailed explanation. Pain is indeed important. It is a feature, not a bug. If you don't know what resting after a surgery means, then you are in need of more pain, not less, as pain is exactly what effectively teaches you what to do and what not to do.
Also, Ibuprofen is really bad for your kidneys. If you take it, then make sure to drink sufficient water. And don't give Ibuprofen to old people without doctorial advise.
But some pain after surgery is far cry from chronic pain.
From my experience, there's very clear difference to be in pain for a quick moment, few hours, day or two, a couple weeks.. Fortunately I didn't have to experience it longer than that.
But I feel pretty confident to say it grows at geometrical progression. Short, even very strong, pain is nothing compared to week-long, even much lesser, pain. Post-surgery pain for a day or two is a joke compared to chronic lifelong pain.
"Time is a flat circle. Everything we have done or will do we will do over and over and over again- forever."
For those of you who were around in the late 80's early 90's. Today's moral panic about opioids will give you a chuckle.
Back in the 1980's opioids were the devil and many patients, even in hospice, had undertreated pain due to fear of addiction.
In the 1990's it dawned on doctors that maybe they should be a little more aggressive in treating pain. It made sense. Pain can slow recovery as it can leave patients immobile. In addition, it's criminal to have someone suffer in pain when you can prevent it.
So doctor's prescribed more and things worked out fine. Then they went to far and prescribed heavy narcotics where they weren't really needed. In addition, the public mood shifted towards opioids (as it had shifted towards cocaine in the 1980's). Who needs to buy heroin when you can do a doc to write you a script for 100 80mg Oxycotin?
So the crackdown begins. We have hospitals stating they won't give out anything more than Tylenol or Ibuprofen.
I predict in the next decade we'll start the whole process all over again. Patients in desperate pain won't be adequately treated. There will be a public outcry and opioids will become "tools that can be appropriately use for all types of pain."
I think calling current thoughts around opioids a "moral panic" is ridiculous.
Much of today's response to opioids is an actual panic given that there is a real, ongoing epidemic of opioid abuse that is killing tens of thousands of people. The number of deaths by opioids more than doubled in 2016 compared to 2015.
I was around in the 80s, and this isn't just some "cyclical response". Take a look at any of graphs of opioid deaths or overdoses - there is no cycle, just something that is shooting up and up and up.
When I read comments like "just one Vicodin and you're addicted for life!", "nobody should take opioids" and "opioids are destroying our country" it's moral panic.
As for the number of overdose deaths, take a look at other countries that never saw the massive overprescribing of opioids like Canada. The deaths are due to synthetic opioids mostly coming from China.
I'd say it's a moral panic. The response to this very real epidemic of deaths seems to be to moralize about opioids rather than to look for ways to reduce deaths from opioid use. Thus this is a moral panic as much as it is a health issue.
In much of the conservative south, the stigma surrounding opioids never left, and economically underprivileged people have been suffering ever since.
Over the past decade, one of my longer-haired male family members has on separate occasions been forced to endure sizable fractures and even orthopedic debridement without analgesics.
The greatest irony is that tightened controls only seem to exacerbate substance abuse in communities with epidemic problems.
The title of this article is misrepresenting the content to the point of distortion. Her doctors never "prescribed" herbal tea (at most they mentioned coffee in the context of stool softeners).
The author sounds a lot like my wife, actually. My wife cannot stand to do "nothing". To me, a day doing "nothing" is like a gift from the universe. I might nap, read a little, noodle around online, learn more of a new language -- all without any particular goal in mind. Heaven! Or Hell, for some people!
I have no doubt that pills are overused, and Europe is a rather ahead of America in terms of natural remedies and a less pill-pushing approach. That said, doctors should take care: the only thing worse than overprescribing necessary medications is underprescribing them.
> the only thing worse than overprescribing necessary medications is underprescribing them.
There are only three categories: overprescribing, underpresribing, and prescribing the correct amount.
In the case of opioid-based painkillers, overprescribing leads to unnecessary addiction, in turn leading to heroin or fentaynl abuse, breakup of families, overdose, etc.
If you’re underprescribed opioid painkillers, you just feel temporary pain (or not, since non-opioid painkillers exist).
So, they’re not even really close in terms of long term consequences.
>If you’re underprescribed opioid painkillers, you just feel temporary pain (or not, since non-opioid painkillers exist).
Without taking a political stance on regulated pain killers, I'd like to point out that the concept of 'temporary pain' is largely a myth. There has been much work done (mostly with chronic pain sufferers) to show that pain (and more generally over-excitation of nerves) can cause permanent nervous system damage, brain chemistry changes, and CNS rewiring/plasticity-like changes.
Much of this research originated from the correlation between chronic pain sufferers and un-treatable (or difficult to treat) depression.
> In the case of opioid-based painkillers, overprescribing leads to unnecessary addiction
So does underprescribing in a world where extremely effective yet more addictive illicit painkillers are easy to come by. I've had to resort to this for a few days after a wisdom tooth removal and would much rather have had access to better regulated options.
This is just a guess, but I would imagine (based on a glance at U.S. stats) over-prescribing accounts for a lot more pain and death than under-prescribing ever could?
Well, I suppose in Germany they also have a week of vacation, sick leave, or disability to take off while feeling this pain and drinking tea. When that's the case in the U.S., let's revisit this. Till then, let's hold off on the moral judgements when the reality is some of us literally have to go back the same day to work as the surgery. I've only taken pain killers once for a bad dental abscess that my dentist was too dumb to see on an x-ray a couple of hours before I could no longer chew. That was on a Friday and if I hadn't had pain killers from previous surgeries, I'd have been in agony. I don't think it's up to any prissy ass doctor to tell me, or anyone else, when I should feel pain or not and whether I will need pain killers or not. As the very least, I think we've established that people have different pain thresholds and a doctor should know this before even entering medical school.
> Well, I suppose in Germany they also have a week of vacation, sick leave, or disability to take off while feeling this pain and drinking tea.
No, we don't have "a week of vacation, sick leave, or disability". We have as many days or weeks as it takes. In many companies, you don't even need a doctor's notice for the first three days.
>This, however, is not a story about the benefits of universal health care
Despite this phrase and the title ("wanted" as opposed to "needed") being technically accurate, you'd think the article is going to be the disadvantages of a universal healthcare system but it's not.
It's about nothing.
Just an entitled patient bugging her doctors to prescribe her Vicodin before her surgery even began and them not doing so because, as it tuned out, her biggest hurdle after the surgery was boredom and not pain.
I think the article tells the opposite story. She's not necessarily entitled, just misinformed and mistaught. She's been taught to rely on pain meds instead of using them as a supplement to understanding the pain. I think it's more of a piece on education related to pain and meds rather than a study on boredom.
I am German living the US, and I can absolutely second this.
Neither view-point in inherently better or worse, just different.
Note that Germany does have two class system now. The public class, and the private class. When you're in the public system you often sit in different waiting rooms for hours while those with private insurance get priority treatment, choice of Dr., better rooms in hospitals, etc. Many Germans now follow a hybrid, basic coverage through public insurance, with private add-ons.
It sounds like the poster had private care.
Most vividly I remember the birth of my son some years ago in the US. We had to practically force the doctors to stop looking at monitors and machines and actually look at the mother. They wanted to control the whole process like a machine, instead of letting nature do its thing, unless and until something goes wrong.
Afterwards the bill was $32k (for a no frill, no complications birth) $24k charged to his mother, $8 charged to my son (at age of the few days, his first official mail).
The insurance covered it all, still the cost seemed staggering.
However, _would_ something have happened, I felt extremely confident that we would receive the best care and treatment that current technology could deliver.
It's also often different from Dr. to Dr. and region to region. I have not come across a chamomile sipping Dr. in Germany, yet. :)
I do subscribe to reducing "fixing" things with pills. Often that's the instant-gratifying, cheap way out. Health requires thought, time, and "work". And of course I would not try to cure cancer with herbal tea.
Never heard of those. What are they exactly? Orange juice?
I had a minor operation last year, also via laparoscopy. Didn't take any painkillers afterwards, and all was fine.
I think pain has a lot to do with fear: if we don't expect it and we don't know why it's there, it's horrible, but if we know where it comes from and how it's supposed to evolve it's a lot more bearable (within limits of course).
Something that seems more important than the pills is rest.
A lot of countries have, by law, a certain number of sick days, annual leave days, and a attitude that if you arn't functioning well then don't be at work or you'll make mistakes and cause more work.
why does the US have a 'play though the pain'/'your letting the team down' attitude towards people taking care of themselves?
The article abruptly ended without its appropriate summation commentary on the cultural dependence on drugs inherent, normalised, and seemingly encouraged, in the US.
Admitting taking ibuprofen like candy? Even as a joke, it would only be funny where such behaviour isn't too far from normal. No wonder your pain threshold is low.
Just spent two weeks on the other side of the border from Munich, in Austria. The article is very accurate on over the counter meds - you can’t get what you are used to in US.
I caught a really nasty flu the first few days there and by end of the week was searching for something to ease the cough. The cough syrup I was able to buy tasted like rubber and did not contain the active ingredients you normally find in US. It sort of worked - better then nothing, but certainly did not really help the situation. Cough drops I was given plain did nothing for me. All was purchased in a local Apotheke and dispensed by a pharmacist.
Upon return to the US, I continued to struggle with the cough and finally gave up and when to a doctor. Sinus infection and antibiotics... so much for the non-drug way of healing.
There is certainly a difference between 'just' a flu and something worse (sinus infection, and so on).
The body notices when there is something more to it than just a flu.
That's the point were you get yourself a nice appointment at your 'Hausarzt' (family doctor, sounds wrong tbh) and let yourself check thoroughly. If somethings wrong, you'll get your medicine. If not, well just get yourself some rest. Our social systems and working rights give you the freedom to be ill for a long time and not needing to worry about losing your job.
Maybe in the US you are so used to getting your painkillers and hardcore medicine for a simple flu (, and so on) that you cannot withstand some pain.
Most dentists don't prescribe you painkillers or even antibiotics after a wisdom tooth removal, even if it was a operation and not just pulling it out. Yes it hurts as hell, but just stay at home for 3-5 days, get some rest and live happily ever after.
It's unclear cough medicines work at all, and if they do, it's probably only from the soothing effect of sticky liquid in your throat. In the UK the NHS recommends just making your own lemon and honey tea in favour of buying cough medicine [1].
Flu can certainly impair one's immune system and pave the way for an opportunistic bacterial infection, but in the general case, antibiotics do nothing for viral infection.
I think that was deliberate. The author was trying to illustrate her preconceptions about medication and pain and eventually discovering a different point of view.
Would you rather live in a country where medication is freely available over the counter, or one in which you need a prescription for everything? Having lived in both, I'd choose the former. What is a problem in the latter is trivial in the former. Does requiring medical intervention lessen drug abuse? Not entirely. But the vast majority of medications purchased are not drugs of abuse. When was the last time you heard of patients abusing blood pressure medication? Or heart medication? Sure, there are idiots who will eat Tide pods. An adult can purchase a semi-automatic rifle in my country, but .375 milligram aspirin? God forbid.
I'd choose the former as well. After moving to Belgium I discovered that I need a prescription for almost every medication. Even metamizole, topical minoxidil and contraceptive pills need prescription.
But Tylenol is freely available, so I guess you can give yourself liver poisoning an die, but you can't treat alopecia without going to a doctor.
Prescriptions for everything work better. People end up trivializing medicaments when they are freely available. Talking to a doctor helps control certain conditions that are easily masked with self-medication.
Of course, it's hard to do this without having universal healthcare.
There have been times I needed opiate painkillers, I melted all the skin off my right hand in an accident, needed a major skin graft. I did become physically addicted but the experience was so harsh any time anyone offered me opiates outside a medical context I was like hell no. I don't consider that pushing opiates because the level of pain when growing back nerve endings is off the charts.
Hi,
I read your article and many of your experiences are - sadly - the normal behaviour with pain and pain killers in Germany. In the south of Germany even more than up in the north (from my experiences). But there is hope... I would recommand that you search for a new doctor - in the best case a young doctor fresh out of the university. The reason is simple. Pain management have only recently become a major topic in the professional training and myths and wrong behaviour are strong. younger doctors understand more and more that pain means stress and stress make sick and is a negative influence to the healing process. I hope that more and more doctors in Germany understand, that feeling pain is not a guide - it's a burden that nobody should carry. Wish you the best. Quazni (I hope my english is not as bad as I think it is.)
I think you completely failed to read between the lines - the article is a criticism of rapidly increasing number of people addicted to pain pills in US and their excessive consumption across the country.
I'm pretty sure the author is a woman... the article says she got a hysterectomy, which is surgery to remove a uterus. (She also mentions her husband in the opening paragraph)
Overall this is a pretty disappointing article, for a verity of reasons, one it does not really express anything it just tells a very boring story with seamingly no point
It advocating for less pain management in the US? or better pain management in Germany, I cant tell
It is critical of the idea that citizens of the US desire to eliminate pain? I am critical of cultures that endorse and support living with/in pain
"Excessive" consumption is subjective depending on your point of view. Further the increasing number of people addicted to opioids is a complex issue that has some correlation to prescriptions but can be debated on if that is the cause as other factors can be at play, further the increase in DEATHS as a result of said increase in addiction IMO can be more closely linked to the ever increasing desire to treat addiction as a crime not as a medical issue which causes a whole host of black market issue including quality and potency inconsistency in supply chain directly leading to more Overdoses
> younger doctors understand more and more that pain means stress and stress make sick and is a negative influence to the healing process
I hope you are wrong because I would hate so see anythign resembling the painkiller addiction wave in the US here in Germany. The doctor in the text is correct in saying that pain can be an important guide for your own healing process. Otherwise, you can easily overwork/overexert yourself which damages the healing process
The opiate prescription policy in Europe is currently absolutely not converging with US practices. Practitioners are instead looking into alternative means of pain control, such as hypnosis (which is less of a scam than one may think).
The whole point of the article was that she did not need the painkillers and actually prefers it in hindsight.
With the american "sick day" system drugging yourself to work is a necessity. The german take as many sick days as you need lets you choose the healthier route.
Not only is it healthier but also better for the employer long term. A drugged employee makes more mistakes and might suffer injuries from lack of attention.
The sibling comments have already discussed that you're misreading the article. I want to address your actual comment with a counter-anecdote.
My previous general practitioner retired a few years ago, and passed on his office to a younger colleague who's in her 40s. I'll visit her maybe once or twice a year because of some infection or internal inflammation. There's a marked difference in how she treats those things compared to my old doctor: He would always prescribe me a few over-the-counter drugs for symptom relief. My new doctors's approach is to just prescribe rest [1] in most cases, together with recommendations for homemade remedies. If that's how younger doctors play the game, I'm all for it.
[1] And lots of it. Sick notes are never for less than a week, and she insists that if the symptoms are not completely gone by the end of that time, I shall come back and get another few days off.
I agree on the stress, you can however remove some of the stress. It's not because you are in pain you have to suffer. I know it's not entirely true, but it is to some extend.
What is more worrying about US healthcare and the big pharma, is that they are trying to impose the same modus operandi in other countries. I hope none of the other developed Nations take this threat lightly.
Somewhat tangential to the article, but interesting to note: various studies have indicated that ibuprofen and acetaminophen are as effective as opioids at treating acute pain:
There was a study at Mass General Hospital studying if pre-surgery carb loading reduced the need for post-op narcotics. (Not sure what the outcome was.)
Aren't they worried about the patient vomiting and choking? I had a dental implant done at the end of last year and I wasn't supposed to eat anything before surgery.
The one participant I know of was told to chug a lot of Gatorade the day before, and a little bit the day of (IIRC). The main restriction on the Gatorade (aside from quantity) was which colors were acceptable. Apparently some colors make it hard for surgeons to differentiate blood from residual bowel content.
Although he had the surgery circa 2014 and the stated purpose was to study the need to avoid opioids, not to reduce hospital stay. But like the 2006 study someone cited earlier, it was colon surgery.
That's interesting. I was told to eat and drink nothing except enough water to swallow the pills I needed to take beforehand (pain killers and an antibiotic).
Might be this study https://www.ncbi.nlm.nih.gov/pubmed/16919107 "Pre-operative oral carbohydrate loading in colorectal surgery" "[...] leads to a significantly reduced postoperative hospital stay, and a trend towards earlier return of gut function when compared with fasting or supplementary water."
Friend in the US had a benign type of surgery. The procedure carries minimal pain after the first 24 hours other than maybe aching (and my friend really had a pretty boring recovery). She was still given a bottle of probably 20+ pills of Oxycodone that fortunately went unused (later disposed.)
While my friend was responsible in her recovery, I wonder how many people medicate themselves just because.
Fascinating to hear so much anti-drug commenting here. Sounds a lot like the comments for stories praising DEA raids of medicinal marijuana facilities (“Americans just use too many drugs! Doctors prescribing drugs just to ease the pain of patients are enabling a gateway to addiction”)
I really wonder how much psychological trick one can play on it's post surgical pain. You know if you're in a blissful happy environment and not a post-butchery waiting room it might change your day from dread to "ok".
”Beecher initially wondered whether these war-wounded men were generally insensitive – for chemical or hormonal reasons, for instance. However, this turned out to be untrue since even badly wounded patients who claimed not to be in pain cursed medics who were rough when giving them an injection. Instead Beecher concluded that the best explanation for the men’s lack of pain involved their emotional state. They were not suffering because their wounds represented an escape “from an exceedingly dangerous environment, one filled with fatigue, discomfort, anxiety, fear and real danger of death,” but because they provided them with “a ticket to the safety of the hospital”.”
Simplifying the explanation, it seems optimism (?or delusion?) (“things will get better” or, maybe, “the pain prevents me from doing things that will do more harm”) helps decrease suffering.
I also think of how one person sees a sensation of mild pain. As a kid, most falls, even harsh at times, don't last in your mind. I remember nasty crash on mountain bikes where we would dust ourselves off, laugh and go. The thrill of the action made the pain very secondary. Even the day after, when the injury would hurt a bit more we wouldn't really complain. Because it's part of the pleasure of trying, achieving.
After a certain point, the brain shifts, we're not in growth, we're in maintenance mode and every problems is void of side value, it's just this, a problem.
Maybe it's also because these are self or externally inflicted sensations, compared to surgery for an internal disease.
My wife took only ibuprofen after the C-section birth of our son. She was ok with it. The nurses had her walking around the next day to help with the healing.
I hope they're not just knee-jerk going "pain is a part of life" for everything. I had surgery to set a broken ankle last year, and the first night I was nearly in agony after taking a prescribed Vicodin. I can't imagine how bad it would have been if they'd tried to fob me off with ibuprofen.
i had a surgical procedure years ago. one of the most painful experiences (during recovery), i felt like putting dynamite into my mouth and exploding it.. this is when i first tried Vicodin. it was a total life saver. and no i did not become addicted from taking 3-4 pills to manage extreme pain. this is the only time i took such strong pain killer. im glad these pain killers are readily available option in USA(filled in 20min at local CVS).
Cue the anti-drug (really, anti-medicine) comments from all the people who have never encountered chronic debilitating pain, either personally or in a loved one.
Absolutely. Pain needs to be evaluated on a case-by-case basis. I have experienced cluster headaches for decades. Then, a few years ago I had a small stroke which left me with central pain syndrome. After working with my local pain clinic, and based on my types of pain and inability to take some alternative medications, opiates were my best bet. With small, regular doses, I can function and work with minimal pain. I am not pain-free but these medications allow me to go about my daily activities with relatively few problems. So, in my case, the key was finding the right opiate mix and dose, ongoing medical monitoring, and long-term physical therapy. Opiates have a place in modern medicine and their use is not black and white. Lumping all types of pain, plus chronic vs temporary pain, is bad medicine.
Pain is definitely undertreated in Germany (e.g. dentist).
It is overtreated in the US. I had two Surgeries in the US and was given stuff like Vicodin to take home. Never took it. Would have rated the pain 0 out of 10. But I am very pain tolerant.
There are definitely some people who view it as a kind of ascetic and/or natural-living thing where it's actively "good" not to take painkillers. But I don't think that's how most of the medical profession in Europe thinks of it. For doctors it's more of a pure risk/benefit type of thing, where how likely a doctor is to recommend or prescribe painkillers relates to both the type/severity of pain and the risk of the painkillers (e.g. ibuprofen is safer than vicodin, so there's a much lower bar for using it).
In addition, the things the doctors said was exactly right: pain can be a hugely important signal, especially when you're healing. It tells you of you're overexerting yourself, it tells you what you need to do to heal properly, it tells you when you're getting better. Dulling pain has a significant cost.
I don't think people should suffer pain "needlessly" either, but pain has a purpose. Long-term health consequences (whether they are risk of addiction, or a worse healing process) has to be part of the calculus when making decisions about pain management.
It's one thing to suffer with pain needlessly, it's another if the treatment of pain could have long term harmful effects, e.g., addition to opioids.
I had impacted wisdom teeth and needed dental surgery. The dentist gave me a couple of codeines to take home but I never took them. The day after the local anesthesia wore off was miserable, but it became easily manageable after that. I found a lot of times the fear of the pain was worse than the pain itself.
Not to mention, there are plenty of safer viable alternatives. Is ibuprofen or acetaminophen as effective at preventing pain as oxycodone for most people? Probably not, but they're good enough for most wisdom teeth extractions, a common operation that unfortunately results in many opioid addictions. I had some particularly difficult extractions so I took some ibuprofen for a few weeks to make eating manageable, but avoided the oxycodone-acetaminophen I was prescribed once I left the doctor's office. When I reported this, the nurse who checked in on me was surprisingly taken aback, but to me, the potential consequences of opioid use to better mitigate temporary pain seem irresponsibly high.
10-12 years ago I would get small dose (5mg or less) Hydrocodone for an infected tooth or pre-root canal
Today it is just high dose ibuprofen, luckily I have pretty good dental insurance now (did not in my late teens and early 20s) so I do not need the dentist for anything more than cleanings but I do think my luck that I went through that pain back then instead of now, taking high does IB would not have let me sleep back in those days as I had to wait for the Antibiotics to kill the infection before they could remove or fill the tooth, that took anywhere from 2 to 7 days (had 2 infected teeth a couple years apart, I was hard on my teeth in youth, a lesson learned the hard way)
For what it's worth, I was prescribed the oxycodone-acetaminophen combination last month for an extraction of my four wisdom teeth in the US. My extractions were apparently some of the hardest in the surgeon's 30 years, so I'm not sure if this is the norm.
This is why my individualism, and Self Ownership come it to play as I feel that should be my choice if I want to take the risk, it should be up to me if the pain is server enough to warrant opioids or not as I am the one experiencing the pain.
Every person reacts differently to procedures and to pain, some people having their wisdom teeth removed may not be painful, others it might be terrible pain. It should be up to the individual as a adult to make those choices for themselves
I am sure that will be an unpopular opinion given the state of society is that no one should be treated as adults and that governments or "others" should tell people have to live ...
At multiple times in my life I have been given hydrocodone, I have almost never used the entire prescription, but when I needed them I would glad to have them. The idea that a 3rd party can tell me "ohh your pain is not that bad just live with it" when there is a easy solution to allow me not to live it it, well I find that morally reprehensible
> it should be up to me if the pain is server enough to warrant opioids
It is!
You do get the drugs you need. If you actually ARE in pain. But this woman, as predicted by her doctor, was not. If you read the article, she did not have the pain, it was only fear of it.
Society does have to pay the price in the end if people are given what they want. See the problem of over-subscription of anything from pain killers (in the US) to antibiotics.
Not least, those drugs show up in ground water and in drinking water supplies, and water companies can't really filter that stuff out.
If you think "the levels are low - that is save", there is no scientific basis for such a statement. We have no clue what low-level exposure to drug cocktails does.
On an individual basis, good for you that you can handle yourself. You are indeed a victim of the majority. However, making opiates freely available would be catastrophic for society to a point that would dwarf the current epidemic.
In other words, it is a shame that the system can't do better for you, but your point of view is selfish.
I disagree, having studied this topic for more than a decade most of the current epidemic problems, including the death toll can be more accurately attributed to prohibitionist policies as the "War on Drugs" than to any legal availability.
On the topic of Society in General, the US War on Drugs has lead to an inordinate amount of abuse, loss of freedom, and the elimination or reduction of most constitutional protection.
treating Addiction as a Crime is what is bad for society
Opioid painkillers aren’t necessarily particularly expensive. They are considerably more dangerous than NSAIDs, though, hence the reluctance to prescribe them where not absolutely necessary. It’s not a money thing.
But the public health insurance system (which covers 90% of the population) makes joint decisions (through broad guidelines) on what is covered. An economic assessment is always part of the decision. Representatives of doctors are heavily involved in the process as well. Gemeinsamer Bundesausschuss is the name of that body.
Which is why I also oppose single payer, but that is a whole other topic. The fact that Single Payer is used to make those justifications is one of my primary reasons to oppose it
Hows that? It's my understanding that in a single payer system you are still allowed to pay for whatever you want or buy supplemental insurance to cover types of care the baseline single payer system will not.
I don't think this is the popular understanding of "single payer" by its advocates in the USA. They think it means "I get any medical care I want, any time, with no waiting, for free."
This is a disingenuous characterization of single-payer advocacy in this country. Nobody-but-nobody claims scarcity doesn't exist; the single-payer argument is to deny that the fitness function for who-doesn't-die-from-preventable-disease should be the person with a bigger bank account.
Easy, once there is even a "baseline" of health services that becomes a platform to start restricting and taxing other things deemed to effect health. Things like smoking, Soft Drinks, high fat or high sugar foods, exercise mandates, and a variety of other public policies around "health" become justified because of public funding for healthcare.
Now I am sure most people including you are going to agree with these public policies but again I am an individualist and believe in personal choice and freedom rare in today world of Nanny State's and collectivism
Smoking is not illegal in most places, and realistically there is an argument that it should be (at least in public) because you don't have a right to expose other people to your habit.
I don't know a single country that has socialized medicine that has illegalized high fat/sugar products or has mandated exercise. If you could point me towards instances where single payer healthcare is being used to outlaw/force such things, I would much appreciate it.
Of course they do not make it illegal, they have learned their lesson from prohibitionist policies on drugs, I can not image the horrors of human rights abuse and violence making candy illegal would bring
They do however regulate and tax to the extreme, For example, how many restaurants in socialized care nations have free refills on soda? How many places in socialized care nations can you buy candy by the pound with just normal sales tax..
>>at least in public
What the hell lets open up another can of worms... That would depend on how you define "public". See in recent years in the US there have been many laws passed the prohibit smoking in businesses that allow general consumer access, incorrectly called "public" businesses. I disagree with these laws as it should be up to the owners of the establishment if they want to allow or disallow smoking in their place of business. For example if a Bar wants to have smoking and you do not like smoking you are free to no go to that bar. However many people in the US believe it is their right to tell that business owner what his policy is, and they have a right to assert their dominance and their view on smoking upon others.
> They do however regulate and tax to the extreme, For example, how many restaurants in socialized care nations have free refills on soda? How many places in socialized care nations can you buy candy by the pound with just normal sales tax..
This is some bizarre fantasy. There's no connection to reality in your post.
To offer the other perspective (though I guess you get that from your EU friends) - as one of those 'pain is a signal' people; I tend to avoid painkillers because when pain is tolerable, I'd rather use it as a guide for what is helping and what is delaying the recovery. Say you have a muscle spasm or something; isn't it better to feel exactly at which point it activates, so you can slowly stretch it out? A headache - well I behave differently when it is alleviated by reading a book, then when talking a walk outside makes it better, than when actually I'm just hungry and after eating a meal it goes away.
I don't know how I'd identify and distinguish those scenarios if I took painkillers every time.
Not sure how you manage to come up with such a comment after reading this particular article. Clearly she did not have the pain she feared she would have. She said she took two Ibuprofen - that she did not need!
So why would you think she would have been better off taking drugs against pain that she didn't have?
Real pain is treated here in Germany - of course!
But taking pills for mere fear of pain that isn't even there?
I had had four wisdom teeth removed all at once, that's when I got and took a few (a few!) Ibuprofen during the following week. Only because I actually lived and worked in the US at the time (but had the surgery done during a vacation in Germany), and had to go back to work, doing IT training for a few days. Otherwise I would have taken even less.
Later I had jaw surgery, lower jaw extension by 4 mm (no metal left inside me, by the way, it was a z-cut followed by the shift and half of a bone could reattach to the other half, just shifted lengthwise a bit), so a complete cut through the lower jaw. I did not need a single pain pill.
>>So why would you think she would have been better off taking drugs against pain that she didn't have?
Never said she should have or would have been better off. I am making the claim that choice should have been hers and hers alone after getting advice from professionals.
Doctors could have told her "You do not need them, here are the reasons why" that is fine. the legal prohibition is what I have a problem with
>Real pain is treated here in Germany
That is not my understanding and I have known a couple people that have come to the US for pain management because they were unable to get it in the EU, I dont know if they were in Germany or not however. My understanding is that many EU nations have very strict and subject definition as to what "real pain" is. This is evidenced by the personal stories being told here how people "went through X and did not need pain meds" that is fine for them, people have different tolerance levels for different types of pain, and a tooth extraction may be a minor pain for some people and excruciatingly painful for others, yet most of these nations treat pain based on the average response by type of procedure not in individualized reactions.
You've clearly misunderstood what's happening with pain management in Europe.
Firstly, it has nothing to do with cost. European pain management is expensive but available.
1) If you are in short term pain you will get pain relief. A wide range of options wil be available, from non-pharmacological options at one end (easing fear, for example) through non-opioids (paracetamol, ibuprofen, entonox) but using opioids when needed. Here's a guide form one of the English NHS Ambo trusts: https://www.swast.nhs.uk/Downloads/Clinical%20Guidelines%20S... You should be reassured that the entire document talks about properly treating pain, and reducing the pain the patient is in. There is no mention of cost in that document.
2) The reason they don't just go direct to opioids is because opioids have side effects. They have more side effects than other pain control meds. This causes harm to the patient.
3) If you are in long term pain things are more complex. People in long term pain fall into different groups. Some of them will be cured from their long term pain with lifestyle modification. Most, but not all, people with lower back pain will be cured if they lose weight and get exercise. It would be cheaper to give them opioids, but because diet and exercise are more effective and safer they get a package of care that includes access to a gym and physiotherapist, access to weight loss clubs, access to dieticians. Some people with long term pain will never be cured, but will be able to manage with access to a pain clinic. But some people with long term pain will always have that pain. There is no cure for it. We can't just give these people all the opioids they want because they develop a tolerance, and need an increased dose. At some point you have people taking very high -dangerous- levels of opioids but still not getting pain relief. These people need a package of bio-psycho-social care that includes access to specialist pain management clinics. Again, this is more expensive than just giving people opioids.
”There was no dependable relation between the extent of a pathological wound and the pain experienced. No significant difference was found between the pain of sudden injury and that of chronic illness. The intensity of suffering is largely determined by what the pain means to the patient.”
On that front, I think there’s a large cultural difference between Americans and Europeans.
I have a non-addictive personality, and have taken opiods 3 different times in my life, never killed me nor did I have an issue stopping.
Opioids are only 30-40% addictive, meaning the vast majority of people taking them never develop an addiction. 30-40% is high no doubt, the highest of all pain killers, but the idea we should disallow people in pain from taking them simply because some people go on to abuse them is not rational IMO
As mentioned in the article, she was given a painkiller (ibuprofen, a NSAID). In much of Europe, doctors are far more reluctant to use opioid painkillers, granted.
You mean, $30,000 to $40,000, the median cost in the US, nearly all of which would be covered by insurance. No sense in fabricating magical numbers, like a multi-million dollar bill, everyone knows the flaws in the US system as is.
It costs about 1/3 to 1/2 as much in Germany, paid for by other tax payers.
It's not paid by taxes but by health insurance. We have both a private and a semi-public system (managed by "Krankenkassen", independent insurance entities, that compete for members; it's... complicated, but less so than in the US, and it does not depend on the employer).
Some might say it's like a tax, it gets deducted from your paycheck, but then that's the same everywhere, including the US. Difference is that it's managed by independent entities and not the government, and they even compete. The private insurances are quite significant in Germany too. You are allowed to leave the government-mandated "Krankenkassen" if you earn over a certain amount of money per year, then you have to get private insurance - which is less expensive if you are young, but unlike the Krankenkasse family members (e.g. non.working spouse, children) are not included and it may become much more expensive when you get older, it's hard to predict because it depends on many factors including if you picked the right insurance company (that didn't lose as much money and now has to raise prices).
I don't know if I would understand the German "insurance" system from that explanation. Maybe to complement your explanation another try at it:
Germany has two insurance-like systems to pay for medical treatments:
(1) insurances, with fees aligned with damage risk associated with the policy holder.
(2) a system of "funds" that provide insurance benefits for insurants, however, are not organized like an insurance.
The system (2) is quite old (dating back to the 19th century) and has a few peculiarities:
* fees vary by income of the member of the fund (principle of solidarity, basically people with well paying jobs subsidise others).
* half of the fee for a member is payed by the employer, half by the employee, deducted from the paycheck.
* family members can be insured, too, without increasing fees.
* fees are not dependent on your risk, i.e. they do not increase with age, preexisting conditions, etc.
The alternative to this fund are insurances that work on a risk-based pricing scheme - item (1) in the list:
* in order to be able to sign up for them, you need to have a certain steady income above a threshold (above 50000 EUR I believe).
* pricing is per insurant, i.e. extra insurance contributions for kids and family members if they are on the same plan, etc.
* for young adults these plans are usually cheaper than for older people, which means you can get "trapped" in a contract that is more expensive than the public funds I wrote about above.
For both systems, treatment prices are kind of fixed (as a rule of thumb, doctors can charge the insurance a bit more than the public funds, by a constant factor of 2-3, but I heard from doctors that this depends on the treatment).
If I read this story correctly the other day, giving birth to premature twins in the US can max out your $2M insurance cap and leave you with $450k of medical debt to boot:
back of the woods in Europe, the same would cost you nothing.
Sure, it would be much cheaper when one or more patients doesn't survive in the first place, for example.
Keep in mind that story is a donation appeal and is weak in details -- for example, why a healthy mom needs to stay in a $10K/day NNICU private room for months on end is beyond me (would that even be an option in "backwoods Europe"?) The article also misstates ACA numbers.
> for example, why a healthy mom needs to stay in a $10K/day NNICU private room for months on end is beyond me (would that even be an option in "backwoods Europe"?)
Yes, of course it would. Stop believing the myth that Europe just kills people when they get too ill.
You are splitting hairs. "people/companies who pay into the German universal health insurance system" are effectively being taxed, whatever the wording is.
No, they are insurance membership contributions in Germany. The contributions are specifically used to finance the health system, here the specific health insurer.
Taxes generally are not paid for a person, but for things and values, etc.. Taxes are also not bound to a specific purpose, but are going into the general budget of the country/state/town.
Taxes and insurance fees are different finance models. In Germany there are basically three types of financing for services: 'Steuern' = taxes , Gebühren = fee, Beiträge = contributions.
In Germany the health care system is based on 'Beiträge', i.e. membership contributions to a health insurance.
Public -> pays to general government budget -> government pays to health care services
vs.
Social Healthcare Insurance (example: Germany)
Employer + Employee + self-employed + Students + Pensioner -> pay to Private/Public Sickness funds/Insurers -> Sickness funds/Insurers pays to health care services
You cannot leave at "any time". To qualify, you need to have an income of over 59k € or be a freelancer. For most others (which is most of the population) private insurance is not possible.
You can however purchase additional insurance on top of the public one.
In International discourse and comparison (e.g. those done by the OECD) most of those typically run under the label "taxes". The German distinction doesn't translate well into other systems.
It should be noted that (based on the vague description from the article) her insurance probably got compensation payments from the federal government for her insurance (if it was in fact free through her husband).
> Most universal health care systems are funded primarily by tax revenue (like in Portugal[24] Spain, Denmark, and Sweden). Some nations, such as Germany and France[25] and Japan[26] employ a multipayer system in which health care is funded by private and public contributions
> Vorweg ist anzumerken, dass die in Deutschland vorgenommene Trennung zwischen Steuern und Sozialabgaben in vielen Staaten nicht üblich ist. Daher verstehen internationale Organisationen unter dem Begriff „Steuern“ („Taxes“) in der Regel die Summe aus Steuern und Sozialabgaben und behandeln die Sozialabgaben („Social Security Contributions“) als Teilbetrag der Steuern.
> Tax-Based Financing for Health Systems: Options and Experiences
> social insurance, private insurance and general taxation
Social insurance is the German model.
> By contrast, Germany's policy to combine its sickness funds into a social health insurance system -- generally credited as the first effort to enact universal health insurance coverage -- dates from the second half of the 19th century.
> Current Trends in Health Insurance Systems: OECD Countries vs. Japan
> There are three major types of social health-care systems: social insurance systems like Japan, France, and Germany, tax-based system like the United Kingdom and Sweden, and the United States—limited service to the elderly or disabled, called Medicare (Table 1).
Again, Germany has a social insurance system, not a tax-based system.
While it certainly makes sense to discuss the difference, for a US-based audience it doesn't make much sense to pedantically point out that these aren't taxes. Social insurance contributions are mandatory, based on income, and to a state entity (though independent from the government) enforced through exactly the same channels as regular taxation (as opposed to private debt).
The important difference is that they are legally committed to a certain issue (in this case: health insurance) and can't be appropriated to something else. That should be pointed out, yes, but the word "taxes" is internationally still appropriate for that.
That's simply not the case. It is exactly for an US audience important, because the German system is vastly different: universal health care, regulated by the government, 99.9% coverage, run by a system of 100+ insurers and various health care providers.
> Social insurance contributions are mandatory
Mandatory is to be insured.
> based on income
in a range, or if one is privately insured one pays based on risk/age
Family members (wife/husband + kids) without income are insured. Plus various other regulations.
> to a state entity
Krankenkassen and Krankenversicherungen are not generally state entities.
Would you call something like the Audi BKK a state entity?
> Krankenkassen and Krankenversicherungen are not generally state entities
They are state entities established by law (Körperschaften öffentlichen Rechts mit Selbstverwaltung) and have to follow the strict regulations of the public sector. They regularly issue Verwaltungsakte.
> Would you call something like the Audi BKK a state entity?
Yes, absolutely. It's a state entity that provides care for Audi employees, since 2010 for everybody (and they can't legally refuse members). Audi has absolutely no input on their inner workings, it's really just the name and the fact that they have many members working there (and thus provide special services for them). It's basically a historical quirk of how the German insurance system came to be.
> No, health care contributions are paid directly to the Krankenkasse/Krankenversicherung where one is a member, not the tax administration (Finanzamt).
The Krankenkasse (to be exact their Einzugstelle) is really just a Finanzamt for social insurance contributions. If you don't pay they have the whole range to force you that's
just available to state entities. See e.g. https://www.bundesversicherungsamt.de/fileadmin/redaktion/Kr... A private entity does not have these options and would need to go through general courts.
> Obviously not. In the health care domain, the Social Insurance systems and tax-based health care systems are different models.
They are different models (and should be contrasted) but both are financed through taxes (just different kinds). Yes, we don't call these "Steuern" in German but that doesn't translate 1-to-1 to other countries. "Abgaben" would be a much better translation for taxes.
Everybody is insured. If you can't work, you are insured. If you are ill and not employed, you are insured. If you are a baby just born, you are insured. If you are a student, you are insured - either through your family or on your own. If you receive social security payments, you are insured. Basically everybody, 99.9% of the population is insured.
If you are employed you pay to the health care insurance or sickness fund directly. Your employer also pays. The money is not collected by the tax authorities and is not administrated by them. Still it is public regulated system.
If you are privately insured, you pay directly to the private insurance company. This may provide additional services or a better quality.
OTOH if you are not member of a private insurance, then you still can get additional insurances from those. For example you can insure yourself privately for certain health care services if you travel to foreign countries.
In Germany we would only consider something to be a tax, if we pay somehow to the tax administration. For example if one is a member of the catholic church - which is voluntary - then one will pay 'Kirchensteuer' - 'church tax'. This tax is collected with ones usual tax payments, by the tax authorities - for the catholic church. If you are not a member of a church, like the catholic church (or some others), one does not pay this tax. If you are a member of a free church, then the tax authorities don't collect money for them. If you want to be a member, it is expected that you pay more or less 'voluntary' directly to them.
> I take it that as a German, working in Germany, I could not "opt out" of all of this and just take my chances?
You could opt out of the public system, and get a private insurance company. But once you have done so you can never re-enter the public system. And private insurances are cheaper for young people, but significantly more expensive later in life, so much that you’ll end up paying several times more over your lifetime.
You can't opt-out completely. Some people (including probably most HN readers) can purchase highly-regulated private insurance instead but even that isn't possible for the vast majority of the population.
I don't really know what you are trying to say. If you are saying that health care in Germany in total cost is cheaper than in the US, then you are right. If you are insinuating that the system is infused with tax money, then you are wrong. It is completely financed by the premiums of the insured people. Not saying that the german system is without issue, but compared with the USA, it is lightyears ahead.
“To paraphrase him [German anesthesiologist], he said: ‘Pain is a part of life. We cannot eliminate it nor do we want to. The pain will guide you. You will know when to rest more; you will know when you are healing. If I give you Vicodin, you will no longer feel the pain, yes, but you will no longer know what your body is telling you. You might overexert yourself because you are no longer feeling the pain signals. All you need is rest. And please be careful with ibuprofen. It’s not good for your kidneys. Only take it if you must. Your body will heal itself with rest.”’