Public television stations across the country have begun airing a documentary about pain treatment produced by a doctor with significant financial ties to the manufacturers of opioid medications — a fact not disclosed in the program.
“The Painful Truth” chronicles the plight of several patients struggling to find effective treatment for chronic pain. Throughout the 57-minute-long program, politicians, federal agencies, and others are depicted as having overreacted to the epidemic of opioid-related overdoses; the documentary suggests pain specialists have been discouraged from prescribing opioids to patients who genuinely need them.
The program accuses the US Drug Enforcement Agency of unfairly targeting pain doctors and putting a “bounty” on pain clinics the agency aims to shut down.
“The political culture has declared war against opioids and those who prescribe them,” the narrator of the program says. “The DEA is the army. The pain patients are the civilians caught in the middle.”
The producer, Dr. Lynn Webster of Utah, and several of the experts he quotes in the program, have long-standing and extensive financial relationships with pain medicine makers. When asked why these relationships are not disclosed to viewers, Webster told STAT that he did not receive any drug industry funding for the documentary. He said it was funded entirely by himself and his wife.
“I am cognizant of that issue, but I think I dealt with it as carefully as I could,” he said in an interview. If viewers want to know whether any of the individual doctors associated with the documentary have financial relationships with pharmaceutical makers, Webster said they can search for that information on the web.
Webster has been paid by dozens of pharmaceutical companies for research, consulting, advisory board positions, speaking engagements, and travel expenses. From 1990 to 2010, Webster operated a pain clinic in Salt Lake City. In 2003, he cofounded a research facility that operated out of the same building as his pain clinic. He has focused on research since closing the clinic in 2010, most recently as vice president of scientific affairs at PRA Health Sciences (PRAH).
Not referenced in the documentary is the role of pharmaceutical companies that misleadingly marketed opioids by downplaying addiction risks and convinced doctors to prescribe the potent painkillers for conditions the drugs are not approved to treat. Physicians who treat pain patients are described as victims — of overzealous authorities and coldhearted insurance companies. Also criticized is the Centers for Disease Control and Prevention, which last year issued voluntary guidelines that advise doctors that the use of non-opioid treatment is preferred for chronic pain. An undercurrent of resentment regarding media coverage of opioid addiction runs throughout the program.
“There are dozens of important stories about people with opioid addiction almost daily but rarely is there a story about people in pain,” Webster said in an email to STAT.
The program is being distributed by the National Educational Telecommunications Association, which makes the documentary available to public television stations across the country. Public television stations pay an annual fee to NETA for the rights to broadcast the programming it offers. “The Painful Truth” was brought to NETA by MontanaPBS, which acts as the presenting station and helps Webster and his co-producer market the program to other stations.
The documentary was first offered on March 1 and has been booked for broadcast in 20 markets. It is scheduled to air in the country’s largest market when it runs on WNYE in New York City Monday and has already aired on stations in Ohio, Montana, New Mexico, and Georgia, according to the documentary’s website. It can be viewed online on the PBS website.
Aaron Pruitt, director of content at MontanaPBS, said he was “not aware” of any financial connections between Webster and companies that make opioid pain relievers. “If there is some evidence of that, I have seen nothing,” he said. After being directed to public disclosures of those relationships, Pruitt wrote in an email, “As far as I can tell, he has been working with companies to find safer, less addictive treatments for patients.”
In a pitch to television stations offered the documentary, the distributors write that “NETA and MontanaPBS have carefully reviewed The Painful Truth, and the credentials of Dr. Webster. We have found Dr. Webster to be one of the country’s experts on pain treatment, a past president of the American Academy of Pain Medicine, and an advocate for the safe prescription of opioids.”
Pruitt said he and the director of programming at NETA did look into a DEA investigation of Webster’s pain clinic after several patient deaths. Government officials never disclosed what they were investigating. Webster said he received a letter informing him the investigation was closed with no action taken. The US attorney’s office in Utah was quoted in 2014 confirming there would be no prosecution of Webster.
Some of Webster’s industry relationships are detailed in the federal government’s Open Payments database. From 2013-2015, Webster was listed as the principal researcher on just over $9 million worth of contracts with pharmaceutical companies, including Pfizer (PFE) Inc., Mallinckrodt (MNK) LLC, Bristol-Myers Squibb Co., Jazz Pharmaceuticals Inc., and Orexo US, Inc.
While much of the research is opioid-related, the nature of the work ranges from a study of a medication to treat opioid dependence to examining the abuse potential of certain opioids. Webster said the research money is paid to whatever research company he is working for and he is not privy to details of contracts with the drug makers.
Webster has also received direct payments from industry — more than $100,000 from several companies in the 2013-2015 period reported on the government website. He received $11,400 in consulting fees and other compensation from Insys Therapeutics, an Arizona company whose marketing of a powerful prescription opioid called Subsys is the subject of numerous investigations. He was also reimbursed by the company for travel to Las Vegas, Miami Beach, and Chicago.
He was paid $3,000 by Zogenix Inc. for speaking at a non-accredited medical education event related to the company’s controversial opioid painkiller Zohydro ER, which it later sold to another company. He has received $6,000 for consulting for Depomed Inc., which makes a long-acting opioid pain medication.
The government database does not include all of Webster’s recent financial relationships with industry, and his work for pharmaceutical companies in prior years is not disclosed on the site. Webster has in earlier years reported industry relationships in medical journal articles and at speaking engagements, but the amounts and specific nature of payments are not public.
For instance, Webster reported in 2010 that he was a member of the advisory board at Purdue Pharma, the manufacturer of OxyContin, whose aggressive marketing of the prescription painkiller has been blamed for helping seed the opioid addiction crisis. Three company executives pleaded guilty to charges Purdue fraudulently marketed the drug by falsely claiming it was less addictive.
Webster also reported being a consultant for Cepahlon Inc., which at the time sold a fentanyl product called Actiq. Cephalon, which was acquired by Teva in 2011, paid a $425 million fine to resolve allegations it improperly marketed Actiq and two other drugs.
Webster was the president in 2013 and 2014 of the American Academy of Pain Medicine, which has received significant funding from pharmaceutical companies.
Among the physicians featured in the documentary is Dr. Russell Portenoy, who helped write a 1996 consensus statement on behalf of two pain societies that has been criticized for allegedly playing down the risk of addiction and overdose with opioids when prescribed to treat chronic pain. Portenoy was a frequent lecturer on the topic, although he later acknowledged that some talks he gave about the risk of opioid addiction were not true.
Both Portenoy and Webster are named as defendants in ongoing lawsuits filed by three counties in New York alleging they were part of a conspiracy with drug makers to deceptively market opioids as safe and effective in the treatment of chronic pain. The doctors, in a court filing, strongly denied the charge and called it an attack on their free speech rights to express medical opinions.
Webster said he attempted to include differing views of opioid treatment in his documentary and reached out to a member of Physicians for Responsible Opioid Prescribing, a group that has called for more cautious use of the medications. He declined to identify the person he contacted, but said it was by email and he never received a response.
Jane Ballantyne, the president of PROP and a professor of pain medicine at the University of Washington, said she was never contacted by Webster and doesn’t know of other members of her group who were. She has not viewed the documentary.
“The message should be that opioid treatment of chronic pain is the exception not the rule,” she wrote in an email. “Lynn Webster would like it to be the rule, I think — and so would pharma who keep pushing that way.” Ballantyne said she did not have any financial relationships with industry. In 2015, she reported receiving consultancy fees from a law firm that has sued prescription opioid makers.
“The Painful Truth” is critical of the DEA and features a doctor who was found innocent of charges related to illegal prescribing following a federal government investigation. Webster said he has served as an expert witness or consultant in more than a dozen cases on behalf of pain doctors charged with improper prescribing of opioids. His own case with the DEA and his expert witness work for doctors is not disclosed in the documentary.
“There is a lot in the media and press about the bad doctors and the overprescribing and the pill mills,” Webster said in an interview. “What there isn’t, and the reason for the documentary, is to bring something out that is not well-known. That is there are doctors being accused of wrongdoing when there is probably not justification. And that has had a negative impact on the ability of physicians and their interest and willingness to treat people in pain whether with an opioid or not.”
A former DEA agent is shown in the documentary saying the agency is often “used as a bogeyman.” A DEA spokesman, Russell Baer, said the allegation in the documentary that the agency has placed a bounty on pain clinics or that agents receive bonuses for successfully going after pain doctors is “false.” Baer said he “took offense” to that allegation and the accusation in the documentary that the agency views pharmaceutical companies and pain doctors as “the enemy.” He said the DEA actively works with both drug manufacturers and prescribers to find ways to address the opioid epidemic.
The patients featured in “The Painful Truth” include some who are fearful of losing access to opioid treatment, as well as those who say some doctors have refused to treat them and pharmacies have balked at filling their prescriptions. The apprehension among some pain patients that they won’t be able to get opioids has been reported in several media outlets, including STAT.
Webster acknowledged that several of the patients in his documentary are “miserable” even while taking opioids, and the documentary makes the point that better treatments are desperately needed. For now, however, he said opioid medications are often the best of several flawed options.
“With all of the focus on opioid addiction, we are forgetting many people with pain who have benefited,” he said. “It’s the only thing that keeps them from suicide.”