Daniel S. Goldberg

Pain as a global public health priority

BackgroundPain is an enormous problem globally. Estimates suggest that 20% of adults suffer from pain globally and 10% are newly diagnosed with chronic pain each year. Nevertheless, the problem of pain has primarily been regarded as a medical problem, and has been little addressed by the field of public health.DiscussionDespite the ubiquity of pain, whether acute, chronic or intermittent, public health scholars and practitioners have not addressed this issue as a public health problem. The importance of viewing pain through a public health lens allows one to understand pain as a multifaceted, interdisciplinary problem for which many of the causes are the social determinants of health. Addressing pain as a global public health issue will also aid in priority setting and formulating public health policy to address this problem, which, like most other chronic non-communicable diseases, is growing both in absolute numbers and in its inequitable distribution across the globe.SummaryThe prevalence, incidence, and vast social and health consequences of global pain requires that the public health community give due attention to this issue. Doing so will mean that health care providers and public health professionals will have a more comprehensive understanding of pain and the appropriate public health and social policy responses to this problem.

Job and the Stigmatization of Chronic Pain

Many ethical and policy analyses of the devastating undertreatment of chronic pain leave unaddressed the role played by stigma, even though the notion that such stigma exists is well documented. This article examines the social and cultural roots of the stigma of chronic pain in American society. I document the long history of illness stigma in Western societies as a way of illustrating the power of this meaning-making construct, and I use the Book of Job as a framework for understanding the deep link between sin and suffering in the context of illness and chronic pain in the United States. Unfortunately, while illness stigma can be ameliorated, there is little evidence of such progress in the undertreatment and stigmatization of chronic pain sufferers, and I explain some of the reasons why the best evidence does not demonstrate much improvement. I conclude by sketching some recommendations for diminishing the stigmatization of the chronic pain sufferer, and warn that the focus on altering the opioid regulatory regime is unlikely to have the desired impact in reducing the suffering of millions of Americans.

Against the very idea of the politicization of public health policy.

I criticize the concern over the politicization of public health policy as a justification for preferring a narrow to a broad model of public health. My critique proceeds along 2 lines. First, the fact that administrative structures and actors are primary sources of public health policy demonstrates its inescapably political and politicized nature. Second, historical evidence shows that public health in Great Britain and the United States has from its very inception been political and politicized. I conclude by noting legitimate ethical concerns regarding the political nature of public health policy and argue that open deliberation in a democratic social order is best served by acknowledging the constraints of the inescapably politicized process of public health policymaking.

Concussions, Professional Sports, and Conflicts of Interest: Why the National Football League's Current Policies are Bad for Its (Players') Health

_____________________________________________________________________________________ Daniel Goldberg, J.D., Ph.D.(c)., Fellow, Chronic Disease Prevention & Control Center, Baylor College of Medicine, 1709 Dryden, Suite 1025, Houston, Texas 77030; email: danielg@bcm.tmc.edu. Concussions, Professional Sports, and Conflicts of Interest: Why the National Football League’s Current Policies are Bad for Its (Players’) Health

Religion, the Culture of Biomedicine, and the Tremendum: Towards a Non-Essentialist Analysis of Interconnection

The question of the extent of the interconnection, if any, between religion and the Western culture of biomedicine has received considerable scholarly attention over the past several decades. However, any phenomenological analysis that begins by positing an essence of religion is, if not doomed, deeply flawed from the outset. This paper employs William Alston’s non-essentialist notion of ‘religion-making characteristics’ to assess the extent of the interconnection. The conclusion is that the culture of biomedicine does share many, if not all of these characteristics, and that both religion and medicine overlap in significant ways on, to use Erwin Goodenough’s metaphor, the painted curtain that separates man from the tremendum.

Youth Sports & Public Health: Framing Risks of Mild Traumatic Brain Injury in American Football and Ice Hockey

The framing of the risks of experiencing mild traumatic brain injury in American football and ice hockey has an enormous impact in defining the scope of the problem and the remedies that are prioritized. According to the prevailing risk frame, an acceptable level of safety can be maintained in these contact sports through the application of technology, rule changes, and laws. An alternative frame acknowledging that these sports carry significant risks would produce very different ethical, political, and social debates.

Obesity stigma: a failed and ethically dubious strategy.

One of six commentaries on “Obesity: Chasing an Elusive Epidemic,” by Daniel Callahan, from the January-February 2013 issue.

On the Erroneous Conflation of Opiophobia and the Undertreatment of Pain

Taylor & Francis makes every effort to ensure the accuracy of all the information (the “Content”) contained in the publications on our platform. However, Taylor & Francis, our agents, and our licensors make no representations or warranties whatsoever as to the accuracy, completeness, or suitability for any purpose of the Content. Any opinions and views expressed in this publication are the opinions and views of the authors, and are not the views of or endorsed by Taylor & Francis. The accuracy of the Content should not be relied upon and should be independently verified with primary sources of information. Taylor and Francis shall not be liable for any losses, actions, claims, proceedings, demands, costs, expenses, damages, and other liabilities whatsoever or howsoever caused arising directly or indirectly in connection with, in relation to or arising out of the use of the Content.

Investigating Trust, Expertise, and Epistemic Injustice in Chronic Pain

Trust is central to the therapeutic relationship, but the epistemic asymmetries between the expert healthcare provider and the patient make the patient, the trustor, vulnerable to the provider, the trustee. The narratives of pain sufferers provide helpful insights into the experience of pain at the juncture of trust, expert knowledge, and the therapeutic relationship. While stories of pain sufferers having their testimonies dismissed are well documented, pain sufferers continue to experience their testimonies as being epistemically downgraded. This kind of epistemic injustice has received limited treatment in bioethics. In this paper, we examine how a climate of distrust in pain management may facilitate what Fricker calls epistemic injustice. We critically interrogate the processes through which pain sufferers are vulnerable to specific kinds of epistemic injustice, such as testimonial injustice. We also examine how healthcare institutions and practices privilege some kinds of evidence and ways of knowing while excluding certain patient testimonies from epistemic consideration. We argue that providers ought to avoid epistemic injustice in pain management by striving toward epistemic humility. Epistemic humility, as a form of epistemic justice, may be the kind disposition required to correct the harmful prejudices that may arise through testimonial exchange in chronic pain management.

What Kind of People: Obesity Stigma and Inequities

One of the foundational lenses in the humanities is Aristotle’s great question: “What kind of people do we wish to be?” Although this framework is applicable to many topics in medicine, it is particularly important to disease stigma because stigma is a social process; it is inevitably people who stigmatize. The most widely studied cases of disease stigma in the United States pertain to infectious disease, which is not surprising given the nature of communicability and the overtly moral implications of contagion. Yet, the prevalence of chronic noncommunicable disease in the United States is approximately 50% of the total population. 1 Although the reasons for stigma vary with the disease, one risk factor common to many chronic illnesses is increasingly a focus for stigma: obesity. 28 One of the foundational lenses in the humanities is Aristotle’s great question: “What kind of people do we wish to be?” Although this framework is applicable to many topics in medicine, it is particularly important to disease stigma because stigma is a social process; it is inevitably people who stigmatize. The most widely studied cases of disease stigma in the United States pertain to infectious disease, which is not surprising given the nature of communicability and the overtly moral implications of contagion. Yet, the prevalence of chronic noncommunicable disease in the United States is approximately 50% of the total population. Although the reasons for stigma vary with the disease, one risk factor common to many chronic illnesses is increasingly a focus for stigma: obesity. The concept of obesity is highly contested. Obesity is, of course, a significant risk factor for a number of chronic illnesses, and yet there remains dispute, for example, over whether obesity itself ought to be understood as a disease and over the extent to which it is possible to be obese and metabolically healthy. What is less disputed is the prevalence of obesity stigma. There are many reasons that obese people are recipients of such stigma, but one factor may be the tight linkage between sin and suffering in the United States. This onnection, which is as old as Judeo-Christian morality itself, uggests that it is easier to believe that illness is caused by ersonal misconduct than to believe that human suffering is andom and arbitrary, afflicting the innocent for no discernible eason. The evidence that many Americans believe in the so-called just world theory—that people generally earn their lot in life—is testament to the power of this linkage. However, akin to most other risk factors and to disease burden itself, obesity is distributed highly unequally in the United States. Health inequities correlate strongly with social inequities; as Hilary Graham puts it, “unequal social positions