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In the early 2000s, when Dr. Jane Ballantyne was director of the Pain Center at Massachusetts General Hospital, the opioid-pill maker Purdue Pharma struck a deal with the Boston hospital to start a pain program there.

To Ballantyne, it seemed like a boon. Two organizations — one academic, one a drug company — with the shared goal of easing patients’ pain coming together to collaborate. Working with Purdue, she said then, “will assist us in finding ways to clear up misconceptions and misunderstandings about pain and provide caregivers with the knowledge and resources they need to help patients.”

In 2003, however, Ballantyne co-authored a New England Journal of Medicine paper that raised concerns about the safety and effectiveness of opioid painkillers for patients with chronic pain. It was a direct threat to how Purdue had been marketing its drugs, but Ballantyne didn’t think of it that way.

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“I thought, in my naivete, that Purdue would want to know that as well, that they would want to know it wasn’t working for patients,” Ballantyne said in an interview Wednesday. “But that wasn’t their goal at all.”

Purdue instead saw the sponsorship of a pain program at Mass. General as a way to gain sway at one of the most influential academic medical centers in the country and boost its revenues — by encouraging doctors to prescribe OxyContin and Purdue’s other opioids to more patients at higher doses and for longer periods of time — according to a court document made public Tuesday.

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Ballantyne, who is now at the University of Washington, left Mass. General in 2008. The following year, Purdue decided to re-up its sponsorship, paying the hospital $3 million for the Massachusetts General Hospital Purdue Pharma Pain Program and — as a result — access to prescribers, ties to medical students and physician trainees, and political capital at a time when scrutiny of opioid manufacturers was increasing, according to the court filing.

The filing in Massachusetts Attorney General Maura Healey’s lawsuit against Purdue generated national headlines for detailing how members of the Sackler family — which controls the privately held Purdue — allegedly directed an aggressive and misleading marketing campaign to promote their drugs, including OxyContin, and obscure the risk of addiction and overdose. Citing internal emails and reports, the filing depicts the Sacklers, particularly Richard Sackler, a former Purdue president, haranguing staff for poor sales and ignoring concerns about the negative consequences of widespread use of the drug, all while they made “billions of dollars.”

The filing also revealed new details about the cozy relationship Purdue pursued with Mass. General, Tufts University, and other academic institutions, drawing scrutiny about what Purdue was promised in exchange for its funding and raising conflict-of-interest questions.

“My first reaction was kind of ‘yikes,’” Genevieve Kanter, an assistant professor of medicine, medical ethics, and health policy at the University of Pennsylvania, said about reading the court documents.

Tufts and Mass. General have not commented about the details in the legal filing, and they did not answer questions from STAT Wednesday about whether they still have ties to Purdue.

Purdue has denied the allegations in the Massachusetts lawsuit. In a statement on Tuesday, the company said the new filing cherry-picked details from millions of records, omitted key details, and contained “biased and inaccurate characterizations.”

The Sackler family name adorns galleries and museum wings from New York to Beijing, as well as a brain and spine institute at NewYork-Presbyterian/Weill Cornell Medical Center, a sciences institute at Yale University, and an institute for translational neurodevelopment at King’s College London, among other research programs. Details about the funding arrangements are mostly private.

But the court documents appear to pull back the curtain on what Purdue got in return for its philanthropy at Mass. General and Tufts. They show, ethicists and conflict-of-interest experts said, how drug companies can wield donations in an effort to gain academic allies for the marketing of their medications. Purdue’s efforts were so aggressive that even top executives were enlisted in the outreach.

“It’s clear that at this very highest level of the company, they wanted to not just cultivate relationships with Tufts and MGH, but to use their brands,” said Michelle Mello, a professor at Stanford’s medical and law schools. “I think that’s very disconcerting.”

The experts cautioned that the court documents do not include, for example, the full contracts between the drug company and the institutions, so it’s difficult to know exactly what occurred. Still, they pointed to a few details that they said raised their eyebrows:

At Tufts, the Sacklers gave funding to start a master’s program in pain research, education, and policy in 1999. And in 2011, a Purdue employee was named an adjunct associate professor, according to the court filing.

“The university should ask exactly what expertise a drug company can offer that the fine faculty at Tufts cannot,” Kanter said.

At Mass. General, the agreement with Purdue allowed the company to suggest curriculum for pain education and appoint a member of the Educational Program Committee, according to court documents. Kanter called these provisions “yellow flags,” noting that the records don’t make it clear whether Purdue, for example, successfully changed training standards.

In a 2002 letter to the editor in the Boston Globe, Dr. Warren Zapol, then Mass. General’s chief of anesthesia, defended the agreement with Purdue, saying that it “in no way allows the company to design medical seminars or materials focused on treating pain” and that Mass. General controlled all educational programs. The letter was provided to STAT on Wednesday by a Mass. General spokesman.

And despite Purdue’s funding, Mass. General researchers reached their own conclusions about opioids. The court filing cites a July 2011 email from Dr. Craig Landau, Purdue’s then-chief medical officer and current CEO, about a study done by Mass. General researchers that questioned the use of opioids for chronic pain. Landau seemed concerned that a Purdue-funded study wasn’t backing the use of its medicine, the filing indicates.

Still, to Dr. Andrew Kolodny, co-director of Brandeis University’s Opioid Policy Research Collaborative and a prominent Purdue critic, Mass. General should not have renewed its agreement with Purdue in 2009 — two years after the company and three executives pleaded guilty to federal charges of deceptively marketing OxyContin.

“In 2009, for MGH to take $3 million from a company that had been found guilty of criminal charges — and you have MGH operating in a city that is suffering from the devastating effects of Purdue’s aggressive promotion of OxyContin — for them to take $3 million of their blood money, it’s disgusting,” Kolodny said. (Kolodny has served as a paid expert witness for plaintiffs suing Purdue and other opioid manufacturers; Ballantyne has served as a paid consultant for a plaintiff law firm in the litigation. They are both leaders of the group Physicians for Responsible Opioid Prescribing.)

Hospitals and research institutes have grown more protective of the independence of their practices, research, and education programs over the years, experts said, but there is still debate about just what is an appropriate way to accept money from drug companies or other industry players. With limited public funding, private money is crucial for research and training programs, but it can bias the results of a study, for example, or lead to concerns about doctors promoting drugs they have a financial stake in.

“In general, conflicts of interest are rampant in medicine,” said Jennifer Miller, a bioethicist at Yale University School of Medicine. Private funding can enhance services at a hospital, she said, but the question is if they are the right services for patients.

Experts say that universities should require industry grants to come with no restrictions, and perhaps place them into a general fund instead of into a specific area that the company’s product addresses. When companies directly fund a study, institutions typically allow them to get a preview of the results, but not control study design or how the results are reported.

“It’s purely about what the details of the contract are and how the university manages it,” Kanter said. And it depends what kind of program is in question: While a pharma executive might make a great adjunct professor at a business school, such an arrangement would pose ethical issues at a medical or public health school.

Ethicists say drug companies should also keep in mind their role. At the most basic level, they need to steer their donations in ways that benefits patients.

“That means you do not let the marketing department drive your entire mission and activities,” Miller said.

This story has been updated with information about Dr. Andrew Kolodny’s and Dr. Jane Ballantyne’s work in suits against Purdue and other opioid makers.

  • MGH is leading the way–in the wrong direction. Partners is building an empire on the backs of clinicians and patients. No amount of glossy PR can hide the hubris that drives decisions to maximize growth, power, and profit above all else, including patient care.

  • Let the drug-makers fund research, but prohibit the research institution, physicians, and staff from ever publicly interpreting the results or speaking on behalf of the product or the company. The results of the research should be analyzed and interpreted by completely independent research teams.

  • I m a former Police Chief, we knew in 03 that Purdue had nuked the country and made billions off it.
    Sadly, Mgh made a deal with the devil. Purdue was founded by a Hedge Fund Mgr.
    These deaths and suffering are on Purdue and anyone who enabled them. So disappointing that Mgh would do this.

  • Purdue was convicted of criminal offences that cost thousands of people’s lives and yet nothing negative at all happened to Purdue’s owners and controllers, the billionaire Sacklers. How does that work? Read Richard Sackler’s quotes and you will probably agree that he and other members of the family should be in jail.

  • The countless responses to the STAT column about the patient’s suffering and those whose lives are no longer a quality of life experience, in my opinion should be entered into evidence, so that Maura Healey has a profound chronicle of the crisis that this “corruption of a corporation, is responsible for the individuals who have been at risk for a long list of their respective nightmare experiences of their lives. The countless individuals who have been placed at risk for everything from profound suffering from pain that is beyond description, and the countless individuals who have declared their intent to end their lives because of their own experiences with opioids, is both heartbreaking and especially criminal for this specific greedy company who should all be in the docks in the court system of every place across the world where they have been responsible for the current situation, regarding the opioid crises of the citizens of our nation and the world.

  • Richard Sackler should be investigated for prosecution for murder. If the allegations are true, he should be imprisoned for a term commensurate with that of any drug dealer who sold toxic drugs that killed people.

    We’re talking about well over a half a million people who have died from opioid overdoses in the period of time that this article references.

    If the allegations are true, Richard Sackler is a mass murderer.

    What??…….Are we now going to specify in law that the ‘corporate veil’ should protect corporate officers from knowingly damaging public safety, to the point of hundreds of thousands of deaths?

    So…..Under the corporate personhood doctrine, corporate officers can knowingly do things that are going to cause people to die, but are “untouchable” ?

    So….corporate persons have all the rights and privileges of living citizens, and they are a gazillion times as wealthy and powerful as any mere plebeian, and they can kill a half million people and get off scot free?

    Hmm….Yea….OK….Sumpin’ jes’ don’t feel right about that….And this here Big Racket is the “home of the free” ?

    We’re all perfectly “free”, and our fellow citizens, the Big Corporations, are free to control us?

    Ohh…..Okey doke then…..Hey wait a minute……..(Where have you gone ole Jackie Gleason….A nation turns its lonely eyes to you).

    If these allegations are true, then Richard Sackler is guilty of mass murder.

    • “Richard Sackler should be investigated for prosecution for murder. If the allegations are true, he should be imprisoned for a term commensurate with that of any drug dealer who sold toxic drugs that killed people. ”

      It’s called “personal responsibility.” People overdosed from oxycontin because they crushed then snorted or injected, which is something that was specifically pointed out on each bottle that was filled by pharmacies. It’s the same thing that substance abusers and addicts do with other potentially addictive extended release medications.

      What Purdue did was wrong, but they’ve already paid out millions of dollars in lawsuits and fines. Substance abuse and addiction have been around since the beginning of time. In fact, experts agree that the rates of substance abuse and addiction have stayed relatively the same all throughout history. The only factor that changes from time to time is the abused substance.

  • The industry and academia ties are nothing new, and are not limited to Oxycontin. The Regulators failed to protect the American people as regualations were removed or unenforced. Not much has changed in 20 years. There is still no regualtion or accountabilty for any deceptive pharma maketing and people are dying from it. These corporate media outlets failed to keep us informed.

    • In this case, the point person for Big Medicine, Dr. Jane Ballantyne, is posturing herself as having had pure motives. She claims that she was so naive that she had no idea that profit was much more important to Purdue, to Big Pharma in general, than public safety.

      This woman is Director of Mass General’s ‘Pain Center’, and her ‘alibi’ now is that she is as naive as a giggly girl? It certainly stretches the concept of credulity beyond credibility to believe that a person in her station of life-and -death responsibility was totally oblivious of the possibility that Purdue Pharma prioritized profit.

      Dr. Ballantyne’s ‘defense’ then, is that she was such an ivory tower scientist that she was completely unaware that maybe American drug companies are about as trustworthy as any other drug cartels? She just assumed that they are always guided by scientific skepticism? (That’s exactly what she said, that she had no idea that Purdue would not be eager to learn that their drugs were killing people.

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