>Prof Felicia Knaul of the University of Miami, chair of a recent Lancet commission on palliative care, said the Congress members’ report was not evidence-based. “Actions that are not based in evidence will do harm,” she said.

>The stakes were high, she said. “I believe that policies that work to deny access to necessary pain relief medication in low- and middle-income countries because of the situation in the United States are akin to denying food to people suffering from malnutrition because there is an obesity epidemic in the United States.

>“More than 60 million people every year require pain relief and palliative care and we know that more than 80% get virtually nothing. The vast majority of those individuals live in low- and middle-income countries. I consider it despicable from an ethical point of view and completely antithetical to the goals of global health and sustainable development to have children and adults living and dying in extreme pain when we have very inexpensive safe medications that we could offer them. Poor policies in the United States are not an excuse for allowing that to continue to happen.”