Bioethics Center with Money Ties to Big Pharma Has Habit of Downplaying Painkiller Risks

A U.S. Senate panel is investigating the role of The Center for Practical Bioethics in Kansas City in the current painkiller abuse crisis.

The Senate Finance Committee is looking at a long period of connections between painkiller makers and groups that helped spread the message that painkillers should be prescribed more generously-groups that have downplayed risks of addiction and death. The Senate inquiry also has brought unwanted attention to the American Journal of Bioethics. The Kansas City center was the journal's home until a few months ago, but the journal has hastened to distance itself from the Kansas City center.

So, let's look at three things. First, the links between the center and the journal and the attempts to erase some of those links – at least publicly. Second, the pain management science that resulted from those links. Third, the way some of that science heightened the need for pain medicine and downplayed the risks.

Ties between the Center for Practical Bioethics and the American Journal of Bioethics

Until recently, when readers visited the journal's website and clicked on "editorial offices," they were taken to the website for the Kansas City center. The journal featured the center's logo  on its back cover. At the same time, the center's website promoted its "Peer Reviewed Publication" with a link to the journal's table of contents.

Glenn McGee, the ethics journal's founding editor and his wife Summer Johnson McGee, the current co-editor, held positions at the journal and at the Center for Practical Bioethics. McGee was the John B. Francis Chair at the center. When the journal announced in February 2012 that McGee had taken a job at Celltex Therapeutics, a controversial stem cell company, the web links between the center's website and the journal were still up.  

That's not true today.  

After my post Monday about the American Pain Foundation , the following explanation of the McGees' working relationship with the center was posted on the ethics journal's site:

No member of the editorial group in Kansas City, including Drs. Summer Johnson and Glenn McGee, received any support from Purdue or any pain-related group nor did they receive any support for their editorial work from the Center for Practical Bioethics. Dr. Glenn McGee was paid a salary drawn entirely from an endowment given by the John B. Francis Foundation. Dr. Summer Johnson, then Executive Editor, was paid by the Center exclusively to serve as Director of Graduate Studies of the Center's Certificate in Clinical Ethics Program.  By contract, the Center for Practical Bioethics had no role in the editorial office's operations or decisions.

While McGee and Johnson McGee may not have received money from pharmaceutical companies, the Center for Practical Bioethics did. The center received $1.5 million from Purdue Pharma, the maker of OxyContin, to endow a chair in pain management, named the "Kathleen M. Foley Chair in Pain and Palliative Care." It has received other funding from Purdue Pharma, too, as Alan Bavley at the Kansas City Star reported last Friday.

This is where the hard work will start for the U.S. Senate Finance Committee and for journalists interested in tracing the sources of the country's current problems with painkiller abuse and understanding the ties between Purdue Pharma and the center, the journal, and its affiliated editors and authors.

While money flowed to the center from painkiller makers, the ethics journal based there published articles about pain management. They were written by the center's ethicists, including Johnson McGee. Many of these articles convey that pain is undertreated and pain patients stigmatized. The center's ethicists have published this type of work elsewhere and given talks based on it, too. The center has produced thoroughly researched and important contributions to the discussion around pain medicine; yet these messages ring cash registers for pharmaceutical companies like Purdue Pharma, which has helped to fund the research.

Chronic Pain Management as an Ethical Issue

Myra Christopher, the center's founder and past president, called attention to the ethical complexitities when writing for the American Journal of Bioethics in 2011, "It's time for bioethics to see chronic pain as an ethical issue."

It would be hard to argue that point, and Christopher makes a good case for more ethics research into pain medicine questions. But she also frames the discussion around the idea that pain is undertreated:

If bioethics, as many would argue, is concerned with social justice and the issues that most effect health systems, patients and practitioners, then persistent pain should be at the forefront of the bioethics agenda. In any case, the under-treatment of persistent pain qualifies as a bioethics issue, one that has been in large part ignored.

What I found troubling, however, is that neither Christopher nor the journal noted in the article that the center had received substantial gifts from Purdue Pharma. Since writing that 2011 piece, Christopher's position at the center has received funding from Purdue Pharma's endowment. She has made that disclosure in other articles, including this letter she wrote to Health Affairs:

In the interest of full disclosure, I hold the Kathleen M. Foley Chair in Pain and Palliative Care at the Center for Practical Bioethics. The Foley Chair was initiated by a gift from Purdue Pharma, which manufactures opioids.

Receiving money from a pharmaceutical company does not undo all the important work Christopher has done in patient advocacy and ethics. But the influence of pharmaceutical companies on pain research, especially Purdue Pharma, will certainly be reviewed in a new light. The U.S. Senate Finance Committee's investigation already appears to have sped the demise of the American Pain Foundation, for one.

Bioethicist Christiane Munthe, a professor of practical philosophy at the University of Gothenburg in Sweden wrote recently about the Senate inquiry:

My own take is that, even if the money does not lead to outright and calculated intellectual dishonesty or fraudulent behaviour, human psychology has to be taken into account. The money arrives because the funding party likes what one is saying and as one becomes increasingly dependent on the financial support, one will (like it or not, conscious or not) become less and less likely to say something else.

Downplaying the Risks of Pain Medicine

The lack of comprehensive pain care by highly skilled professionals has been an ongoing deficit in medicine, and it is one of the causes of the rise in painkiller addiction nationally.

But in their ambitious project on pain management, Christopher, Johnson McGee and other researchers focus on that issue while downplaying the potential for abuse. Writing in the journal Pain Medicine in August 2011 about their year-long, 110-person study for the PAINS Initiative, the authors say: 

While understood as a serious public health issue in its own right, the public has been subjected to media portrayals that overemphasize stories about outliers who abuse prescription pain medications and our system of care. Those at our meetings who live with chronic or persistent pain agreed that the stories and biases perpetuated about people who abuse the system of care and feign pain symptoms to obtain prescription pain medications have caused legitimate people with pain on opioids to be judged as addicts and abusers.

The authors published the research article three years after Purdue Pharma, its president, and its chief lawyer were ordered to pay $634.5 million for essentially misleading the public about OxyContin's addictive powers. That's certainly context worth including in a medical journal article about the ethics of pain medicine. If reporters and investigators are trying to connect dots, they would do well to look at similar omissions and sentences like the one that caps this journal article:

The PAINS Initiative is funded by the Lance Armstrong Foundation, the Rx Action Alliance, and Purdue Pharmaceuticals.

Rx Action Alliance is an advocacy group set up by Purdue Pharma and the corporate consulting firm of former New York Gov. Rudy Giuliani.

Johnson McGee continues to take her research from the PAINS Initiative on the road.

In February 2012, Johnson McGee presented at the PAINS Initiative at the American Academy of Pain Medicine's annual meeting. There she provided her Center for Practical Bioethics email address. (She is now working as an adjunct associate professor for Loyola University Chicago's Stritch School of Medicine.)

The academy, like the center, has received a letter from the U.S. Senate Finance Committee asking it to provide detailed records of payments since 1997 from corporations and groups that make or promote the use of painkillers.

Upon completing its investigation, the committee may decide there is nothing worth pursuing at the center or elsewhere. After all, assigning blame for the American painkiller problem may be too much even for senators with subpoena power.

Photo credit: Maximolly via Flickr