title: The ladder and the clock: cancer pain and public policy at the end of the twentieth century.
abstract: The origins of the WHO Cancer Pain Relief Program (the Analgesic Ladder) and its research basis in two very different research traditions, one at Memorial Sloan-Kettering Cancer Center in New York, the other at St. Christopher's Hospice in London, are discussed. The Sloan-Kettering group emphasized precise relative differences in analgesic effects of various drugs, whereas Twycross at St. Christopher's used patient well-being as the crucial benchmark. Despite these differences, both traditions presented evidence of the safe and effective use of strong opioids for cancer pain relief, in a setting of individualized attention and close physician monitoring. The success and limitations of the Ladder as a global health policy are briefly addressed.
authors.affiliation: Department of History, University of California at Los Angeles, Los Angeles, CA 90095-1473, USA.
authors.forename: Marcia
authors.initials: M
authors.lastname: Meldrum
mesh_terms: D000698:Analgesia / Q000266:history*; D049673:History, 20th Century; D006738:Hospices / Q000266:history*; D006801:Humans; D008131:London; D009369:Neoplasms / Q000266:history*; D009518:New York; D010146:Pain / Q000188:drug therapy / Q000266:history*; D011640:Public Policy