Senate panel looks at ties between advocacy groups, pain pill industry
By ALAN BAVLEY — McClatchy Newspapers
Posted: 1:00am on May 11, 2012; Modified: 5:36pm on May 11, 2012
A U.S. Senate committee is examining a Kansas City, Mo.-based bioethics think tank's financial ties to the pain pill industry.
The inquiry is part of a sweeping investigation by the Senate Finance Committee of connections between pain drug manufacturers and organizations and physicians who have advocated for increased use of narcotic - also known as opioid - painkillers.
Abuse of these potentially addictive pain medications has become a national epidemic and accounts for more overdose deaths than heroin and cocaine combined. About 5 million people had used the drugs recently without a prescription, a federal survey found.
The Center for Practical Bioethics is one of seven organizations that received letters this week from the Senate committee asking them for information about their financial ties and collaborations with opioid manufacturers.
The other organizations are the American Pain Foundation, the American Academy of Pain Medicine, the American Pain Society, the Wisconsin Pain and Policy Study Group, the Joint Commission on Accreditation of Healthcare Organizations and the Federation of State Medical Boards.
Recent investigations by news organizations have found that some of these groups, such as the American Pain Foundation, a patient advocacy group, are funded largely by the drug industry.
The Senate committee is seeking to determine whether any of the groups promoted misleading information about the risks and benefits of opioids while receiving financial support from manufacturers of the drugs.
A Senate aide told The Kansas City Star that the investigation may bring into question guidelines for pain management, or the legitimacy of some of the organizations under scrutiny.
One of the organizations, the American Pain Foundation, disbanded last week, citing "irreparable economic circumstances."
The Center for Practical Bioethics and its founder and former president Myra Christopher have long been advocates for providing adequate pain relief, particularly to people in chronic pain or at the end of life. The center also has long-standing ties to Purdue Pharma, manufacturer of OxyContin and other pain drugs, as well as to other drug companies.
Purdue gave the center $1.5 million as seed money for an endowed chair in pain and palliative care that Christopher now holds. As recently as last month, Purdue was a leading sponsor of the center's annual dinner and symposium, contributing $25,000 of the $280,000 that the event raised.
In a statement released Friday, center president John Carney said the center planned to cooperate fully with the Senate committee's request for information.
Christopher was on vacation and unavailable for comment, the center's spokesman Lorell LaBoube said.
In the past, Christopher has said that grants from Purdue have come with no strings attached.
The center's corporate gift policy states: "The acceptance of corporate support does not and shall not mean or imply the Center's endorsement of a corporate sponsor's policies, activities, products, or services."
Christopher, who is not a physician, is a recognized authority on pain treatment. She was a member of an Institute of Medicine expert panel that published a report last June on chronic pain in the United States.
But Christopher also appears on a consumer website, "In the Face of Pain," sponsored by Purdue.
"There are so many good people working on the undertreatment of pain," Christopher says in a statement on the site.
"But one of the big challenges to moving forward in the direction that we all want to is that this public health issue bumps heads with another serious matter. And that is the abuse of prescription drugs. And what we've spent much of our time working on here at the Bioethics Center is ... to try to promote balanced policy."
In 2008, Christopher and other researchers published a study that concluded that physicians "have little objective cause for concern" that they would be criminally prosecuted or disciplined by their medical board for inappropriately prescribing opioid drugs. Between 1998 and 2006, just one-tenth of 1 percent of practicing physicians faced such penalties, the study found.
Three of the researchers on the study reported numerous financial ties to drug companies. The bioethics center reported it received funding from Purdue that was unrelated to the study.
In 2010, Christopher and other experts published an article in The American Journal of Bioethics that raised concerns about the growing use of "pain contracts" between physicians and patients receiving pain medications. The contracts frequently call for urine screenings, require patients to use a single pharmacy and limit prescription refills. Patients who don't abide by the terms may be dropped from treatment.
If used indiscriminately, such contracts could harm the physician-patient relationship, the article's authors argued.
"All of us are concerned about the increasing abuse of prescription pain medications," Christopher wrote in November in the journal Health Affairs. "However, in my opinion, too few people are as concerned about another critical public health issue: the undertreatment of chronic pain and the 116 million Americans burdened by it."
Christopher cautioned doctors about efforts to limit the use of pain drugs.
"As we grapple with conflicting public health issues, we must be careful about adopting unproven models with potential negative effects on those struggling with pain."
Carl Elliott, a professor in the University of Minnesota Center for Bioethics and an outspoken critic of the pharmaceutical industry, has monitored the Center for Practical Bioethics' involvement with Purdue Pharma over the years.
"What does seem pretty clear is the message is that chronic pain needs to be treated not as a symptom, but as a disease," Elliot said.
"It's a reasonable position to have. It doesn't seem to be the worst example I've ever seen of disease mongering. But it does seem to be friendly to the drug manufacturers."
Some of the Kansas City bioethics center's positions appear to mirror those of other organizations targeted by the Senate committee, Elliott said: "If you look at what they produce, it's all about how chronic pain is undertreated."
Elliott said the vast majority of bioethicists do not take money from industry. But financial ties to drug companies are not uncommon among prominent bioethicists who are frequently quoted in the media.
"They have a lot of influence worth buying, but most bioethicists don't see it (as a conflict of interest). I don't know why. I've never heard a good argument."
The Center for Practical Bioethics' relationship with Purdue Pharma goes back more than a decade.
In a March 2001 letter to The New York Times, Christopher said:
"On several occasions, our efforts to educate consumers and health care professionals about undertreatment of pain and end-of-life care have been supported with small grants from Purdue Pharma. Not once have any conditions been attached."
By the time Christopher wrote that letter, addiction to Purdue's OxyContin already was becoming a national problem. Chewing or crushing and snorting the pills offered a high equal to that of heroin.
In 2002, Purdue hired Giuliani Partners, the firm of former New York City Mayor Rudolph Giuliani, to perform legal and public relations damage control.
And in 2007, the company and three of its current and former executives pleaded guilty to misleading the public about the drug's risk of addiction and paid fines totaling $634.5 million.
In 2010, the bioethics center conducted interviews about pain treatment with doctors, patients, academics and legislators in five cities across the country.
This program - Pain Action Initiative: A National Strategy (PAINS) - concluded that "legitimizing chronic pain as a disease, one that disrupts the life narrative and creates discontinuity in the person's work, life, and self, is critical. This shift of public perceptions about the use of opioid therapy and other aspects of chronic pain care will allow those who suffer to find validation for their medical problem."
PAINS was funded by Purdue, the Lance Armstrong Foundation and the Rx Action Alliance.
The creators of the Rx Action Alliance? Giuliani Partners and Purdue Pharma.
Summer Johnson McGee, a former member of the University of Kansas Medical Center and former director of graduate studies at the Bioethics Center, participated in the PAINS initiative.
In a posting on KU Med's website, Johnson McGee acknowledged the significant role played by drug company money.
"The monetary source for many of us working on chronic pain is the pharmaceutical industry," she said. "I believe you can receive pharma's support and do good intellectually honest research ... but we'd still prefer to not be so reliant on private funds."