Center for U.S. Policy Senior Fellow Lynn Webster, M.D. responds to article, “How Nonprofits Helped Fuel the Opioid Crisis.”

Dear Mr. Rendon:

I read “How Nonprofits Helped Fuel the Opioid Crisis” with dismay and disappointment. The article makes a number of sweeping accusations but does not provide much support for its central premise. In writing a piece predicated on the unquestioned assumption that industry collaboration is inherently bad you have, perhaps unintentionally, crossed the line that separates journalism from propaganda.

You correctly reported that pain advocacy groups are among the many patient advocacy nonprofits that receive support from industry. For example, in FY 2017-2018, the American Heart Association received just under $180 million — about 19 percent of its budget — directly from pharma, biotech, medical device, health insurance, and other corporate interests.

Why should pain advocacy organizations be held to a different ethical standard than other types of health-related nonprofits? The argument that certain pharma companies are in some unique category deserving of special treatment because their products can be dangerous is disingenuous and poorly considered, at best. It fails to acknowledge that a great many other medications prescribed for common conditions can cause serious medical complications, dependency, addiction and even death. The nitroglycerin tablets used to treat chest pain have dangerous interactions with common medications. Over-the-counter Tylenol — which is increasingly offered to patients in lieu of opioid pain relievers — can cause fatal liver toxicity and other dangerous complications when used incorrectly.

Other studies have reported that the number of annual deaths from nonsteroidal anti-inflammatories is comparable to overdose deaths from prescription opioids. Many widely prescribed medications, including several antidepressants and anticonvulsants, can cause physical dependence. Widely available cough medicines are often misused for their intoxicating effects. Like opioids, the amphetamines prescribed for ADHD can be addictive and are frequently stolen for sale on the black market, but millions of American children take them daily. And yet, advocacy groups representing these patient groups are not subject to the same scrutiny, nor are they expected to operate without accepting money from industry.

While corporate funding should be handled with careful monitoring and clear-cut ethical boundaries, it is not necessarily a bad thing and does not, in and of itself, prove a group is unethical or subject to manipulation. Nor does it demonstrate a direct relationship between advocacy for suffering people and a widespread U.S. opioid problem. The fact that Richard Sackler wanted advocacy groups to shill for him is not evidence that the groups did so. The fact that Purdue referred to these groups as “partners” is not proof that the groups thought of themselves as partners or acted as such.

Patient advocacy groups have many shared altruistic goals with industry. These goals should be lauded, not denounced.

The decision to focus your article on the American Chronic Pain Association (ACPA) was particularly misguided and unfair because it singled out a group that, according to your own reporting, has consistently been transparent. ACPA may have supported appropriate prescribing of opioids, because that is the only affordable and effective therapy available to many patients. That should be considered reasonable and compassionate.

There are tens of millions of Americans with severe disabling pain. Most of these people do not have a voice and rely on organizations like ACPA to provide them with support, education, resources, and public and legislative advocacy. As the founder and CEO of ACPA, Penney Cowan did that honorably and not for personal gain. It is worth noting that Cowan’s grassroots group has, in fact, used money from opioid manufacturers to promote non-opioid pain-management techniques. If nonprofits like ACPA are disparaged and shuttered due to lack of funding opportunities, the people for whom they advocate will suffer.

All in all, the decision to cast aspersions on ACPA is particularly ironic, given your failure to acknowledge that The Chronicle of Philanthropy profits from corporate efforts to influence nonprofits — after all, the website for your publication urges potential advertising “partners” to “Advertise with us for a direct line to the decision-makers and influencers in the nonprofit world.”

I believe you owe Penney Cowan and ACPA a public apology.


Lynn Webster, M.D.

Senior Fellow

Center for U.S. Policy