For the past half decade, the Academy of Integrative Pain Management (AIPM) has carried the policy mantle for integrative pain treatment into ever more influential places. The beacons were the 2017 and 2018 Integrative Pain Care Policy Congress. The most recent convened 70 stakeholder organizations, including key payers and federal agencies. On January 29, 2019, AIPM announced that it has ceased operations. Amidst the present opportunities for transforming pain treatment, the integrative pain field lost its engine. Oddly, the very challenges to the pharma industry in the center of the dominant pain model were part of AIPM’s undoing.
“This is an incredibly difficult and sad decision,” said Bob Twillman, PhD, who was AIPM’s long-time policy lead: “Our message has never been more relevant than now, amid the nation’s opioid crisis, yet we have found it increasingly difficult to maintain the resources needed to sustain our efforts. We are proud of our message and of what we have accomplished, especially over the last several years. We hope that others will step into the void we will leave in the pain field and carry on this vital work.”
The AIPM release focused on the hit the organization took from trends that are facing many professional organizations:
“AIPM has been challenged in responding to the changing demographics and information consumption patterns of the health care work force. Joining associations like ours just is not a high priority for younger health care providers, and decreased interest in attending in-person educational events has contributed to significantly decreased conference revenues for AIPM.”
In an interview follow the news of AIPM’s shut down, Twillman noted the devastating blow from another another corner: loss of huge contributions from the opioid industry:
“The irony is that attacking the pharma companies has ended up hurting the effort to attack the opioid problem with sane pain practices.”
Here’s the twist. During the past 30 years as the leading multidisciplinary pain organization, AIPM always accepted support from pharmaceutical companies. Included were routine sponsorships from opioid promoter Purdue Pharma and others. As recently as 2014, AIPM’s total investment from pharma “ran as high as mid-6 figures” recalled Twillman. “At the high point of their support, one of these companies would easily drop $100,000 or more on its booths and sponsorships for our conference. If you have 2 or 3 of these companies at this level …”
Pharma money was at times 20% of the organization’s budget. These helped fund AIPM’s staff that was advocating for an integrative model. The total dropped to less than $50,000 in 2018.
The decline of pharma donations coincided with the AIPM’s name change and embrace of the “integrative pain management” mantle over the last half-dozen years. That work peaked in the high profile policy congresses. Twillman was himself recently named to a key committee for the National Academy of Medicine’s Opioid Collaborative. He is the sole integrative health specialist who is formally part of the initiative.
Twillman points to what he considers a more significant factor in the loss of industry investment that is not specific to AIPM: “In the pain space, the vast majority of resources have always been from opioid manufacturers. Now the companies are all fearing lawsuits [related to damage from opioids]. They are dropping their support. All the pain organizations are feeling economic pressure, all are struggling with the decline.”
Integrative pain treatment is a dicey space when it comes to balancing incentives and alignments. Everyone agrees there is a place for pain killers in optimally integrative pain treatment. Most believe there is a place for opioids. But is there a place for accepting financial support from these powerful and compromised industry players? Virtually all consumer groups have taken support. The potential for corruption has rightfully been the focus of Congressional hearings.
What’s next for the AIPM core team of Twillman, Amy Goldstein, MSW and Katie Duensing, JD? “I think I can speak for all of us in saying we would all like to continue this work.” When asked about a minimum to keep them functioning – perhaps housed in another organization – he guessed that with $300,000/year the trio could carry on.
Yet, failing any such philanthropic largess for the former AIPM team from some unknown quarter (to be clear, Twillman has ended his efforts to save the organization), the challenging question is will anyone pick of the mantle? His answer references two organizations with which AIPM has partnered:
“I really don’t know. This is one of the things that saddens me. Maybe the Integrative Health Policy Consortium? The Academy of Integrative Health and Medicine? I think the leadership has to come from the integrative medicine community.”
How many rightfully have cursed the excesses and biases in the US medical industry – and the harms to human health – via pharma’s billions to purchase fealty of lawmakers, media, educators, scientists and healthcare professions? So then how odd it is to dream wistfully of what Twillman and his AIPM team might do for US pain care with a half dozen more years of a few 6-figure investments from pharma ahead of them?
“We’ve had major breakthroughs – to have all of the stakeholders working together is truly phenomenal,” reflects Twillman. “We can’t lose that.” The AIPM shutdown is huge loss, at a time when its work is gaining traction for non-pharmacologic practices and practitioners and in establishing integrative pain treatment as the nation’s standard in pain treatment. How will the integrative health community and its philanthropic partners respond?