Infants' sense of pain is recognized, finally (1987)

Some of the most aggravating people you can meet are those that respond to common sense observations with "citation please".

From a brief skim of the literature, the main difference seems to be that darker skin is better protected against aging effects from sun exposure, and better maintains its elasticity (etc.) when exposed to ultraviolet radiation over decades. But less research than might be expected has been done about other differences between the skin of different groups.

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> There exists substantial evidence to support that Black skin has a higher transepidermal water loss, variable blood vessel reactivity, decreased skin surface pH, and larger mast cell granules compared with White skin. Although some deductions have been made about Asian and Hispanic skin, further evaluation needs to be done. Differences in water content, corneocyte desquamation, elastic recovery/extensibility, lipid content and skin microflora, although statistically significant, are inconclusive.

https://link.springer.com/article/10.2165/00128071-200304120...

> The thickness of the skin is higher on the cheek compared with the dorsal and ventral forearm, with no ethnic or age-related specificity. We confirm that the sub-epidermal non-echogenic band is a sensitive marker of skin aging, and reveal for the first time that it is less pronounced in African Americans. From OCT images, we bring out evidence that the thickness of the dermal–epidermal junction (DEJ) decreased with age, and was higher in African Americans than in Caucasians. Finally, by comparing US images at 150 MHz with OCT images, we show that papillary dermis thickness can be measured and appears to be quite constant irrespective of age or ethnic group.

https://onlinelibrary.wiley.com/doi/full/10.1111/j.1600-0846...

> Skin roughness, scaliness and stratum corneum hydration varied significantly in different anatomic areas and age groups. There was no racial variation in skin hydration between any anatomic site, nor significant differences in roughness and scaliness between races, except for the preauricular area. Skin roughness was significantly increased in the aged, compared to the young at the preauricle, volar forearm, lower back, thigh and lower leg. Older women demonstrated significantly more scaling at the preauricle than younger women. Stratum corneum hydration correlated with scaliness. No significant correlation between stratum corneum hydration and skin roughness was observed.

https://www.karger.com/Article/Abstract/17932

It was all of the above. Some doctors were prescribing them at higher doses than necessary; others were prescribing them in normal doses for longer than is safe. I am sure that at least some of these doctors were driven by compassion for their patients.

I'm gonna be annoying and contrary here from a position of ignorance and for that I apologize but this is a good example to discuss something interesting and kind of what we often do around here - hopefully with some humility about it.

Was the "infants don't feel pain" thing just a rank justification to make everybody feel better about the unpleasantness of doing "the right thing." Yet another paternalistic lie "for the greater good." E.g. Here's a study, says what we need, sure we can "science" parents with that, let's not look too hard at it.

For us, now, let's go with the idea that infants /do/ feel pain and basically everyone knew it then.

A doctor has to operate on a newborn, possibly premature, deeply unwell baby. Analgesia is an additional layer of risky over and above the effing awful odds this infant is already facing to cling to life and have it become one of a reasonable quality. No anesthesia or analgesic is deeply unpleasant but it's their best damn shot. The parents are distraught of course they are. How could you not be? How to make them feel better. "Got studies babies this age don't feel pain. Science." It must have been a horrible business trying to keep babies alive and failing so often. We've come a long way.

Now what's the downside, of what for an older child and certainly for an adult would be an extremely traumatic experience, for the infant? Do we have science on that?

The infant won't remember it, that's clear. Is it doing something to the neural pathways or similar that causes lasting negative impact because analgesia and anesthesia sure can do that. Including death.

Is this horrible situation of just operating without pain relief something that the future child and adult will never know nor care about because the pain does not affect them? Is the opposite true? What evidence do we have? What does our probability distribution look like on that? I note the answer to this concern may well be well known and superbly well supported and I'm just ignorant of it.

On top of that, medical science, the real stuff, has advanced since the 40s and was significantly better in the 80s when this was written including analgesia and anesthesia understanding. The correct trade off changes over time. Then you have to dump the lie you told to justify.

Now I'm super-strong on the idea that you do not "lie for the greater good" ever. When this is done and the bill becomes due the interest rate is far too steep to justify and in ways that can't be anticipated.

I'm also deeply, deeply aware there is a full spectrum of doctors from extremely kind to actually sadistic as well as from wonderfully competent to not that in any way. Most of us have read research and shook our heads that its authors are allowed out in public with minders because they can't be competent as humans.

Anyway there it is. "AKTSHUALLY." I said. But I'm also pretty aware that these concerns might also all be nonsense with quality research, replicated successfully showing it to be so. Someone around here may know to what extent that is true.

And if you go to Taiwan and look around, empirically you can see that people try to avoid being immediately downwind of a stinky tofu cart. (It’s pretty tasty, mind you, but IMO not worth the hassle.)