Dean's Lecture Series

Why is pain management the subject of so much controversy? That was the question posed by Keith Wailoo in his lecture “The Cultural Politics of Pain, from Percodan to Kevorkian,” the second of this year’s Dean’s Lectures. Wailoo traced the evolution of the field and contended that in the realm of pain management “there is a disturbing backdrop of cultural, political, and religious trends shaping every doctor-patient relationship.” Wailoo is the Martin Luther King Jr. Professor of History at Rutgers, with a joint appointment at the Institute for Health, Health Care Policy, and Aging Research. He is also director of the Center for Race and Ethnicity at Rutgers.

According to Wailoo, four main factors complicate pain management today. The first is that pain cannot be objectively measured. “Pain is sometimes spoken of as the ‘fifth vital sign,’” he said. “But is it a sign, like blood pressure?” (No is the answer.) Second, pain management is complicated by the fear of addiction. “All a physician needs to have strict oversight of his practice put in place, or even prosecution, is for just one patient to become addicted,” noted Wailoo.

Beyond measurement and fear of addiction, however, Wailoo made the case that pain management from 1950 to 1999 in the United States has been strongly affected by shifts in the political landscape and in cultural and religious values. He cited the drug Percodan. Hailed as a “non-addictive” alternative to morphine, it was widely used during the 1960s. By 1970, however, fears of addiction—“people eating Percodan like popcorn”—caused the drug to be classified as a Schedule II controlled substance along with cocaine and morphine. A major debate in pain management became “Which patient is deserving of relief?” Because terminal cancer patients were seen as clearly deserving, their pain management led the field during the 1970s, giving rise to the hospice movement along with the idea of palliative care.

Wailoo next focused on the 1980s. Dramatic change was on the horizon for pain management, he argued, because of strong political, cultural, and religious movements. Under President Ronald Reagan, conservatives’ worry about Social Security disability claims prompted a purge of “illegitimate” claimants from the rolls. Religious conservatives were prominent at this time, voicing concerns about the economic and social consequences of an “addicted class” claiming disability. Moving on to the 1990s, Wailoo used the physician-assisted-suicide controversy to show how both religious and cultural ideas about the end of life played a strong role in Dr. Jack Kevorkian’s prosecution and eventual conviction in 1999.

“Pain, by its nature, has never been firmly in the realm of the biological sciences,” said Wailoo. “That is why I think one can argue that pain medicine, more than any other kind of medicine, is subject to the back-and-forth of whichever way the political and social winds are blowing. Pain medicine really exists in a realm of its own.”

Photo by Martha Stewart

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