Just Add Water: Did the American Medical Association Really Teach a Course in Addict-Making?
The American Medical Association is the last organization you’d suspect to downplay the risk of opioid addiction, let alone develop a mechanism that actually helped to create addicts. Yet their Pain Training Program apparently did just that. That’s what addiction professionals are alleging anyway, after Mother Jones investigative reporter Julia Lurie did a deep dive into the AMA’s relationship with Purdue Pharma and showed them the results. And after the pros read past the double-talk.
“The effectiveness of opioid therapy may be undermined by misconceptions about [the drugs’] risks, particularly risks associated with abuse and addiction.”
So read some of the teaching materials the AMA circulated among members seeking to school themselves on opioids. Another sleight of word was “pseudoaddiction,” which is apparently what happens when pain patients seem to be “inappropriately drug seeking”. These patients weren’t really, truly addicted, claimed the course, they just needed more pills.
And we now very well know those patients were given more pills too. Lots and lots of more pills. Over and over, again and again. Until pseudoaddiction became addiction proper and they really had an appropriate reason to take pills.
More is Less
We also now well know how many of those patients there were. Well, we’ve got a way to estimate how many anyway. The opioid overdose death rate. Which is now larger than the number of American deaths from all of our wars combined.
And people are still dying.
The AMA isn’t entirely responsible for the opioid epidemic of course, though it is responsible for its response. The organization is also responsible for whatever coursework it distributes among its members. And the AMA’s pain management coursebook contained instructions that were at once egregious and alarming. That’s especially so for the material that were directed toward tender age children.
For young children who were unable to verbalize their pain, materials encouraged prescribers to use the “Poker Chip Tool”: lay out four poker chips in front of a child, explain that the chips are “pieces of hurt,” and ask how many pieces of hurt the child has.
“Do not give children an option for zero hurt.”
In other words, these children were going to be prescribed pain pills. Period. It didn’t matter how old they were or how high their risk of addiction might be.
We sometimes wonder why the instructors were even bothered to ask about pain.
How to Create An Addict
Lurie discovered that the AMA first released the above cited pain management course in 2003 and then updated the materials throughout the next decade. Far as we know, the Nieman Fellow didn’t end up discovering whether those updates became any more responsible about opioid addiction. We’re guessing she looked though. Hard. We’re also guessing the quo remained status. Meaning the coursework continued to err on the side of prescription.
Lurie thinks that the AMA erring on the side of prescribing shouldn’t come as a surprise. Not in this case anyway. Why? Because “down in the fine print, the AMA-branded course materials reveal that the training’s development and distribution was made possible by an educational grant from Purdue Pharma.”
Purdue Pharma paid for the AMA’s pain management teaching tools. That means the pain pill providers were behind the pain pill tutorials provided to over a quarter million doctors and students. Okay, so maybe the course wasn’t taken by every member. But thousands did take the course, said Lurie. That was one of the reasons she was compelled to get an expert’s opinion.
In this case the expert was Dr. Roneet Lev, the first Chief Medical Officer of the White House’s Office of National Drug Control Policy, host of the High Truths podcast and emergency physician at Scripps Mercy San Diego.
In other words: a true expert.
“I would call this ‘How to Create an Addict’ education.”
The High Cost of Privilege
So the drugmaker paid for the “educational course materials” that taught doctors the efficacy and safety of the drugs that they made. But Lurie found that Purdue Pharma also paid for the privilege of teaching those doctors. Big time.
In fact, Purdue Pharma paid the AMA and its philanthropic AMA Foundation more than $3 million between 2002 and 2018. That ranked them among Purdue’s top-paid third-party groups. And though the AMA did ostensibly stop taking Purdue loot back in 2007, the organization continued to offer the Purdue-funded pain management course for at least another seven years. The AMA Foundation, for its part, didn’t finally cut off the Purdue spigot till 2018, “well after the opioid crisis had morphed into a full-blown epidemic.”
How does either the American Medical Association or its Foundation justify being in league with such egregious harmers of American health?
Well, it helps if the harmer sits on your board. Yep, Purdue Prez Richard Sackler himself sat on the AMA Foundation’s Board of Directors from 1998 until 2004. Perhaps more importantly, Purdue kept kicking into the kitty for years and years after his run. In fact, Purdue was what’s called a “platinum level” donor, which was enough to place Purdue executives in semiannual league with AMA leadership, including the group’s chief executive, as well as the chair of its Opioid Task Force.
Talk about guarding the henhouse.
But the AMA is a prestigious organization. At least it’s supposed to be. The “unified voice” of America’s quarter million doctors. Furthermore, the AMA claims to be dedicated to “the art and science of medicine and the betterment of public health.” Purdue undoubtedly knew this. They apparently also knew that if you want the privilege of that level prestige, it pays to go platinum.
Follow the Money — and the Numbers
Just like nearly everything else in this revenue-obsessed world it pays to follow the money. Here it also pays to add in the numbers associated with the money. Because the ensuing sums will reveal who’s got the digits to really count.
With $430 million in annual revenues, the AMA advocates on behalf of its 272,000 doctor and medical school student members and nearly 200 affiliated medical societies. It publishes the prestigious Journal of the American Medical Association, one of the most widely circulated general medical journals in the world. The AMA Foundation, with some $25 million in assets, funds medical school scholarships and community health initiatives. And over the past two decades, the AMA has been the third-largest spender on political lobbying, topped only by the US Chamber of Commerce and the National Association of Realtors.
That’s a whole lotta loot. It’s also a whole lotta influence. Loot and influence that impacts the wellbeing of every American who sees a doctor.
Trust Not Doubt
Healing Properties wants to trust the American Medical Association. We really do. More importantly, we want to be able to trust the American Medical Association. So do Americans. After all, the organization represents our caregivers. The very people who largely determine not just how we live and die, but whether we live or die. If we can’t trust our own doctors, then who can we trust?
We also want to believe in the AMA. Why? Well, mostly because we believe the AMA is a necessary part of American healthcare. Or at least it should be. But that would mean putting patients and doctors first. Right now it seems their primary interest is in its membership. Yes, we know, an advocacy group is responsible for advocating on behalf of its members. But it’s also responsible for its member’s charges. You know, those to whom its members have pledged to “do no harm”. And when an organization’s members are tasked with nothing less than the wellbeing of an entire nation, its advocacy needs to broaden accordingly.
Why can’t the AMA look out for both us and themselves?
That’s a helluva question alright. And so long as cutthroat companies such as Purdue are able to game the AMA, there will be no good answer. Still, we can’t help believing the AMA knows better than the bad guys, can do better than the bad guys, and in fact, is better than the bad guys. Surely there have been plenty of occasions when that truth became evident too. But Lurie found the AMA got infected by an organism that kills good dead. And if doctors can’t protect themselves from such pathogens, what chance do we the common people have?
What about you? Were you prescribed opioids? Over-prescribed? Did you have trouble stopping? Are you having trouble stopping? Would you like some help? Help is out there. (Thank Zeus!) Almost everywhere. It can be effective too. Entirely effective. In fact, it can change your life. Completely change your life. The hurt and the hopelessness? Gone. The desperation and need? Ditto. Friends and family? Back beside you, cheering you on. Remember, they want you to succeed as much as you do. Maybe even more so. Give them a chance. Give yourself a chance. Please. Then give us a call.
(Image Courtesy the Great Good Folks at Wikipedia)