Conflict of Interest Kills Pain Control Advocacy Group

Here's another tale of Big Pharma insinuating itself into places it doesn't belong, to the detriment of quality care and patient safety.

Established to support patients with chronic pain, their families and the health-care professionals who serve them, the American Pain Foundation claimed to be the pain community’s largest advocacy group. Early this month, it abruptly shuttered its operation, attributing its demise to economic circumstances.

As several news organizations reported, that’s hardly the whole story.

Given the boom in prescription pain medicine—according to Marketplace.org, prescriptions for painkillers such as Oxycontin and Vicodin have quadrupled in the last decade—Americans clearly are hurting. You’d think there would be plenty of support for an organization that salved the pain.

But as explained in an investigative report by ProPublica, the foundation shutdown had to do with a U.S. Senate committee investigation into makers of narcotic painkillers and groups that champion them. According to ProPublica, nine of every ten dollars of the foundation’s funding in 2010 came from the drug and medical-device industry.

And—surprise!—its guidelines for patients, journalists and policymakers had minimized the risks associated with opioid painkillers and had exaggerated their benefits.

Senators Max Baucus, D-Mont., and Charles Grassley, R-Iowa, sent letters to the foundation and drug companies citing an "an epidemic of accidental deaths and addiction resulting from the increased sale and use of powerful narcotic painkillers."

Drug companies, they wrote, "may be responsible, at least in part, for this epidemic by promoting misleading information about the drugs' safety and effectiveness."

The senators are looking into the whole pain-control industry and medical oversight agencies to expose the financial connections among them. In addition to the American Pain Foundation and drug makers, recipients of the letters included the American Academy of Pain Medicine, American Pain Society, the Federation of State Medical Boards (the trade group for agencies that license doctors) and The Joint Commission (an independent nonprofit that accredits hospitals).

The U.S. Government Accountability Office (GAO) reported in 2003 that the Joint Commission had partnered with Purdue Pharma, the maker of Oxycontin, to distribute pain educational materials. In 2007, Purdue had pleaded guilty to federal criminal charges that it misled regulators, physicians and consumers about Oxycontin's risk of addiction.

No one denies that opioids might be appropriate for people in serious pain. But like any other drug, their benefits must be measured against their potential harm, and you can’t do that when manufacturers and so-called “advocates” supply inaccurate or incomplete information.

As quoted in the ProPublica story, Dr. Andrew Kolodny, chairman of psychiatry at Maimonides Medical Center in Brooklyn, N.Y., and president of Physicians for Responsible Opioid Prescribing, said, "These groups, these pain organizations … helped usher in an epidemic that's killed 100,000 people by promoting aggressive use of opioids. What makes this especially disturbing is that despite overwhelming evidence that their effort created a public health crisis, they're continuing to minimize the risk of addiction."

Sales of these potent drugs have risen 300 percent since 1999. And opioids were involved in 14,800 overdose deaths in 2008, more than cocaine and heroin combined. In 2009, the use and misuse of the drugs were cited in more than 475,000 emergency department visits, nearly doubling the 2004 number. The figures come from the Centers for Disease Control and Prevention (CDC).

One in 8 high school seniors surveyed for a research paper in the Archives of Pediatrics & Adolescent Medicine said they had used prescription opioids for nonmedical reasons.

Another report in the Journal of the American Medical Association found that the rate of newborns diagnosed with drug withdrawal jumped threefold from 2000 to 2009. The rate of mothers using opioids at the time of delivery was five times higher in 2009.

Typically, medical professionals and patient advocacy groups acknowledge that drug overdoses are a legitimate concern, but say that most deaths involve illegally obtained drugs. They also say that patients' risk is low if they do not have addictive personalities, and people who suffer from serious pain should not be deprived of relief.

No, they shouldn’t. But narcotic manufacturers also shouldn’t be bankrolling advocacy groups whose job is to provide objective and complete information about drugs.

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