After Their Society Was Sued Out of Existence, These Scientists Are Building a New One

In the mid-2000s, the American Pain Society was issuing pain-treatment guidelines in major journals, had convinced hospitals and agencies that pain was a “vital sign” that doctors should measure in everyone, and was ending each year more than $1 million in the black.

Less than two decades later, the society’s fortunes have reversed. As an epidemic of prescription-painkiller addiction swept the nation, cities and insurers
sued the American Pain Society, alleging that it downplayed the dangers of opioids and acted as a “front group” for opioid manufacturers, which donated generously to APS. Weighed down by the lawsuits and years of falling revenues, the society declared bankruptcy in 2019, then dissolved.

Courtesy of Michael Gold

Now, some former American Pain Society members are organizing a new society, called the U.S. Association for the Study of Pain, or US-ASP. They say they miss their colleagues and research collaborations. They emphasize that they’ve learned their lessons from ASP’s demise. “This is not American Pain Society 2.0,” said Jessica S. Merlin, an associate professor of medicine at the University of Pittsburgh and the new society’s elected secretary.

Merlin and her colleagues are now debating rules for what corporate funding, if any, US-ASP should accept. They’re rethinking what a biomedical research society should look like, whom it should serve, and even how luxurious its annual conference should be. As a professional group founded after a period of increased scrutiny of dirty money in academe, the nascent group provides a glimpse at what researchers and the public now expect from the scientific enterprise.

Over the past two decades, a body of literature has emerged to show that even relatively small gifts from drug-company salespeople can influence what doctors prescribe, perhaps unconsciously. America’s opioid epidemic showed the consequences of this tendency, taken to the extreme. But these problems aren’t unique to the American Pain Society or pain research, even APS’s critics say.

“To me, the problems that APS got into were not because anyone in APS was necessarily acting so outside of the range of what might be accepted at a lot of societies. It’s just that the drug involved here happened to kick off a massive public-health crisis,” said Erin E. Krebs, a professor of medicine at the University of Minnesota-Twin Cities who studies how to manage chronic pain. “It’s not that APS was uniquely evil or naïve. We’re all susceptible to allowing our organizations to be influenced by money.”

Krebs donated $1,000 to a GoFundMe campaign started by former APS members who wanted to buy the society’s scientific journal, The Journal of Pain, when Elsevier put it up for auction. “I wanted to demonstrate that researchers are willing to support a more member-oriented, less industry-dependent society,” she said. The purchase was successful. US-ASP will now run The Journal of Pain.

US-ASP volunteers’ effort to build a new society distills the kinds of debates that many biomedical researchers and clinicians are having, around their professions’ relationships with drug and medical-device makers.

Merlin and Michael S. Gold, US-ASP’s president, exemplify two visions for the new society’s funding stance. Gold, a professor of neurobiology at the University of Pittsburgh, describes himself as “not hard-line” about drug-industry funding. “It all depends on how the donation goes and how and where they mandate their advertising,” he said.

Gold saw the benefits of involving industry. Drug companies can be valuable sources of money for early stage research that’s otherwise hard to fund. They could help a society keep membership and conference fees low, another goal of US-ASP’s leaders. Finally, industry scientists are still scientists, and have research and insights to contribute to the field, Gold said. (No potential members The Chronicle spoke with advocated barring industry scientists from joining as individuals. US-ASP will not allow corporations to join as members, Gold said.)

Merlin is more skeptical of industry funding. In 2018, she ran for and won a spot on the American Pain Society’s board — only to resign after her first board meeting, when she saw how much of the society’s budget came from opioid manufacturers. “When I brought it up, it was clear it wasn’t going to change,” she said. “Then in the next year, things blew up anyway.”

She declined to specify what policies she wanted to see US-ASP adopt with regards to outside funding, however. “It’s not my decision alone,” she said. She wants “values-based decision making” that keeps the organization’s principles and recent history in mind. Although Gold said he and Merlin frequently disagreed about what US-ASP’s funding rules should be, Merlin said she was confident they would do the right thing.

One biomedical-research society that Merlin, Krebs, and others pointed to, as a potential model for the infant US-ASP, is the Society of General Internal Medicine. SGIM has a 13-page external-funding policy that includes safeguards such as the requirement that the society must always be able to publish its scientific findings freely and limits to what proportion of the overall operating budget may come from outside donors. Meetings don’t have banner advertising for sponsors, a big point of contention among scientists. Some societies have sold ad space at their conferences for tens of thousands of dollars.

“I think it helps create that sense of trust,” said Elizabeth Dzeng, an assistant professor of palliative medicine at the University of California at San Francisco and chair of the Society of General Internal Medicine’s ethics committee, “for members to know that it is truly an academic, professional organization.”