Center for Practical Bioethics

Better Support Needed for Patients in Chronic Pain – from KC Medicine, the Journal of the Kansas City Medical Society

By John G Carney, MEd, Sukumar Ethirajan, MD

Thank you for publishing the summer 2018 Kansas City Medicine edition highlighting the impact of the opioid crisis. The Center for Practical Bioethics recognizes that the lives ravaged by addiction and the lives destroyed by pain are both major U.S. health concerns. The moral obligation to serve and protect the interests of persons whose lives are devastated by the misuse of opioid medications weighs heavily upon society as do our duties to serve the millions of those who live with debilitating chronic pain.

We need better care and more safeguards. We need more effective evidence-based approaches to treatment. We need more compassionate and comprehensive care, including effective alternative therapies and options not currently covered by insurance. We need sound and scientifically supported health care policy. These tenets have been the foundation of the Center’s advocacy and policy work over many years.

For nearly a decade, the work of the Center has been instrumental in highlighting the tragic consequences of inadequate public policy and lack of comprehensive clinical support for the 100 million Americans who live with pain on a daily basis. For much of that time our work has been focused in leadership of the Pain Action Alliance to Implement a National Strategy (PAINS)—a national alliance of professional societies, consumer advocacy organizations and others working collaboratively to promote the recommendations called for in the 2011 Relieving Pain in America report published by the then-Institute of Medicine (now the National Academies of Sciences, Engineering, and Medicine).

Since 2011, our efforts in developing the National Pain Strategy led to our convening seven national meetings attended by hundreds of collaborators from diverse fields to address comprehensive aspects of care, essential to the development of a comprehensive patient-centered response for dealing with chronic and high impact pain. From the beginning of the Center’s PAINS project, as cited in its first policy brief, we defined and cited the need for “Integrated Pain Management” and “Biopsychosocial” models emphasizing “Interdisciplinary and multidisciplinary nonpharmacological” approaches to the treatment of chronic pain.1

We have produced a series of reports and nearly a dozen policy briefs that have responded to and adopted the priorities identified by the Departments of Health and Human Services and Veterans Administration.2 These briefs and reports have been widely distributed to care providers, policy experts, professional associations, and consumer and patient advocates. They remain available to anyone online at www.painsproject.org. This repository of studies and recommendations on dealing with America’s pain crisis reflect the Center’s work and is now hosted by the Academy of Integrative Pain Management.

The Center publicly acknowledged early funding of this work that came from pharmaceutical companies. At no time did any funder direct the course of our work or influence the outcomes of our projects. It should also be noted that primary funding during this period came from non-pharma foundations including multi-year grants totaling more than $1 million from three funders: the Millbank Foundation, the U.S. Cancer Pain Relief Committee Inc. and the Mayday Fund. All work was directed at collaborative solutions with various stakeholders including those involved in abuse prevention, drug diversion and risk reduction. Dozens of groups were convened by the Center to seek common ground in exploring and promoting solutions to the pain crisis with a goal of creating long term, comprehensive, collaborative and interdisciplinary approaches to evidence-based pain intervention strategies.

Over the course of the last decade, the Center has been the recipient of a number of grants and gifts from pharmaceutical and device manufacturers that has brought significant scrutiny and public press attention. All gifts were publicly acknowledged. Projects were designed and directed by Center staff without funder input, influence or direction. All activities of the projects were periodically reviewed by our Board of Directors through staff updates and reports.

In 2012, the Center was one of nearly a dozen entities, including the American Geriatric Association, The Joint Commission and Federation of State Medical Boards, who were required to submit extensive information to the Senate Finance Committee detailing support from opioid manufacturers from the period of 1996-2012. The Center complied with the request, providing extensive documentation—much of it having been available through our publicly available 990s and website donor recognition.

Again in 2016, U.S. Sen. Ron Wyden (D-Oregon) requested additional information from many of the same organizations in an attempt to determine if pharmaceutical companies unduly influenced our work or participation in HHS committees. The Center once again complied by providing information about extensive vetting requirements for federal NIH committee appointments similar to those our staff, Myra Christopher and Dr. Richard Payne, had undergone.3 In 2017, Sen. Claire McCaskill of Missouri, through a Department of Homeland Security (DHS) request, sought updated financial information for the period of 2012 through 2017. Again, the Center submitted the requested information.

In neither of the first two instances was any further communication requested by those elected officials or their offices, nor was any report issued taking further action. Sen. McCaskill’s report, which was published with the title “Fueling an Epidemic”4 under the DHS Government Affairs Committee, ranked the Center 11th out of 14 organizations in its support from opioid manufacturers—but made no other reference to the Center. Funding from opioid manufacturers during this period  represented less than 1.5 percent of overall Center operations.

The Center provides public reporting of its support through the Greater Kansas City Community Foundation and links to Guidestar, which is the national website serving foundations and the public regarding the standards and reputations of non-profits nationwide. The Center strictly follows its Corporate Integrity and Corporate Relationship Policy statements that appear prominently on our website and are considered best practice in the non-profit and philanthropic community.

In conclusion, we would like to reiterate our concern and support for those whose lives are ravaged by opioid addiction. Overwhelming evidence has documented inappropriate behavior by opioid manufacturers. Misleading claims about safety, efficacy and improper marketing and distribution strategies have caused undue harm to thousands of patients and families. Unfortunately, those who live with chronic debilitating pain have also suffered, often marginalizing them and stigmatizing them because of their conditions. The injustices need to be corrected, and the work of establishing sound policy to adopt comprehensive, inter-disciplinary and integrative pain management throughout the U.S. must continue.

John G. Carney, MEd, is president and CEO of the Center for Practical Bioethics. He can be reached at jcarney@practicalbioethics.org. The center’s website is www.practicalbioethics.org.

Sukumar Ethirajan, MD, is an oncologist in private practice in Overland Park. He is a board member of the Center for Practical Bioethics and a past president of the Kansas City Medical Society. He can be reached at kancer@me.com.

 References

  1. PAINS Overview: Impact of State Policy and Regulations on those living with chronic pain. Policy Brief #1. https://www.practicalbioethics.org/files/pain/pain-policy-issue-1-spring-2013.pdf
  2. Policy Briefs may be retrieved here: http://practicalbioethics.org/resources/chronic-pain-resources.html and here: http://painsproject.org/our-work/pains-priorities/public-education-communication/.National Meeting report may be accessed here: http://practicalbioethics.org/files/pains/NPS-Collaborators-Meeting-Report.pdf and in Video form (scroll down) http://practicalbioethics.org/resources/chronic-pain- resources.html
  3. NIH Committees appointments occur only after thorough vetting by governmental entities to determine expertise, validate credentials, examine potential conflicts of interests (including person investments) and affiliations. Full disclosure of the Center’s support from opioid manufacturers was available to HHS and Dr. Richard Payne’s personal affiliation with opioid manufacturers was included with the information he submitted.
  4. https://www.hsgac.senate.gov/imo/media/doc/REPORT-Fueling%20an%20Epidemic-Exposing%20the%20Financial%20Ties%20Between%20Opioid%20Manufacturers%20and%20Third%20Party%20Advocacy%20Groups.pdf