Journalists Bag a Big One: The American Pain Foundation
The action by the U.S. Senate Finance Committee and the surprisingly quick collapse of the foundation were prompted by two journalistic investigations:
The first was Charles Ornstein's and Tracy Weber's Dollars for Doctors series for ProPublica. In The Champion of Painkillers, which ran in December in The Washington Post, they describe how aggressive the American Pain Foundation has been in promoting opioids:
Years earlier, the foundation opposed several pain patients who had sued Purdue Pharma in an Ohio county court for allegedly obscuring the risks of OxyContin. The foundation filed a friend-of-the-court brief backing Purdue, arguing that the health of all pain patients would be harmed if the class-action lawsuit went forward because doctors would become fearful of prescribing opioids. Ohio was plagued by "opiophobia" according to a brief co-authored by the foundation and two smaller pain nonprofits. "Consequently many, if not most, of the state's residents had been deprived of adequate pain care," it said. The Ohio Supreme Court decided in 2004 not to allow a class action.
The other major journalistic investigation to draw the Senate's attention was by John Fauber at the Milwaukee Journal Sentinel, working in collaboration with MedPage Today. For several years, Fauber has doggedly covered conflicts of interest in academic medicine, ethical problems, the growth in pain medicine and the resulting rise in painkiller addictions and deaths. As part of his Side Effects series, in February 2012, Fauber wrote about the American Pain Foundation and other groups that promote pain pills: Painkiller boom fueled by networking:
Consider the American Pain Foundation, which has substantial financial ties to companies that make narcotic painkillers. In a patient guide available on its website, it says there is no ceiling dose for opioids as long as they are not combined with other drugs such as acetaminophen. It says the dose can gradually be increased over time if pain worsens. Independent doctors say that practice developed to treat the pain of cancer patients in the hospital or at the end of life. It should not be applied to chronic pain sufferers who are not getting their drugs in a hospital setting, said Sullivan, the University of Washington professor. A philosophy of "no maximum dose" can lead to more people on high doses of the drugs, which, in turn, can result in serious problems, including more falls and fractures in older people, respiratory depression, overdoses and fatalities, he said. "Risk goes up with dose, even if it is well done," Sullivan said.
You can see the foundation featured in a great infographic (right) that the Journal Sentinel created to go with the story. Then the American Pain Foundation posted on its website that on May 3, 2012, the foundation's board voted to dissolve the organization.
With deep regret and heavy hearts, we sadly inform you that due to irreparable economic circumstances, APF must cease to exist, effective immediately. The Board and staff have worked tirelessly over many months to address a significant gap between available financial resources and funds needed to remain operational. Unfortunately, the economic situation has not changed in any meaningful way, despite our best efforts. As you unfortunately know, the need for public outcry around the needs of Americans struggling with pain conditions is greater today than ever before in light of the multi-front assault occurring daily on our right to dignified care. Misguided state and federal policies are impeding access to appropriate and reasonable medical care for people struggling with pain, and deterring even the most compassionate medical providers from treating anyone with pain conditions. Elected officials, policy makers, and the media need to keep hearing from each and every one of you so they are not allowed to walk away from the consequences of this over-looked public health and medical problem.
I sent Ornstein a note about the foundation being shut down, and here's what he said:
Tracy and I believe strongly that patients do need a voice in discussions about pain and the growing number of deaths from narcotic painkillers. But the reason we focused on the American Pain Foundation is that it had such a deep dependence on the pharmaceutical industry and presented information that was, in some cases, not factual. It overstated the benefits and downplayed the risks of the drugs.
When I wrote Fauber, he responded:
It is unclear to me whether the Senate investigation or any media attention caused APF to close its doors. I think the group said its board made the decision on May 3, which may have been a few days before the Senate contacted them, though that would have to be checked. I am not saying the Senate investigation did not cause them to close, but if it did, it happened with amazing speed.
Indeed. The American Pain Foundation may be the first organization to fall, but it likely will not be the last. As Ornstein and Weber noted in their piece about the Senate investigation:
Letters went to three pharmaceutical companies, Purdue Pharma, Endo Pharmaceuticals and Johnson & Johnson, as well as five groups that support pain patients, physicians or research: the American Pain Foundation, American Academy of Pain Medicine, American Pain Society, Wisconsin Pain & Policy Studies Group, and the Center for Practical Bioethics.
Neither ProPublica nor the Journal Sentinel, as far as I can tell, mentioned the Center for Practical Bioethics in their work. But you can bet that reporters around the country are looking into the center right now. (I had already submitted this post when Alan Bavley at the Kansas City Star wrote a piece late Friday that examined some of the ties between the center and pharmaceutical companies.) What reporters may find is that the center is tied up with another topic much written about on Antidote: the ongoing troubles at the American Journal of Bioethics. I'll tell you how and why later this week.
Infographic credit: Milwaukee Journal Sentinel (reprinted with permission)