Pain Medicine: Business or Profession?

Michael E. Schatman, PhD


May 13, 2011

In This Article

The Deleterious Impact of Special Interests

It has been opined[14] that the primary cause of the deterioration of pain medicine in the United States is not a function of physician practice, but rather of the impact of numerous stakeholders who have become progressively more influential in determining how pain medicine is practiced. These stakeholders, including the health insurance, pharmaceutical, and implantable device industries as well as certain pain societies, do not consider themselves to be bound by any fiduciary obligation to pain sufferers, but rather to their shareholders. The moral codes of these special interest groups, which operate under the "business ethic" of cost containment and profitability, often collide with traditional medical ethical principles of autonomy, nonmaleficence, beneficence, and justice[15] by which physicians are ideally motivated. The victims of this collision, unfortunately, are the patients who suffer from pain because they and their physicians are no longer the primary governors of the treatment with which they are provided.[16] Even the education that physicians receive is often tainted by the will of these special interest groups.[17]

In response to this blatant commodification of pain medicine, not all practitioners are willing to sit by passively and watch the profession become bastardized. The journal Pain Medicine is currently undertaking a courageous and controversial year-long special series on the "Transformation of the 'Profession' of Pain Medicine to the 'Business' of Pain Medicine.[14]" In this series, the role of special interest groups who concern themselves with business and seem oblivious to the concept of profession is being addressed by luminaries in the field including Allen Lebovits, Salimah Meghani, Ron Kulich, John Loeser, Mary Lou Taylor, Jerome Schofferman, Mac Gallagher, Jim Giordano, Roland Benedikter, and Barbara Kornblau -- as well as the author. This committed group has dedicated hundreds of collective years to the practice of pain management, and has chosen to express its concerns in regard to the tragic reality of special interests now trumping pain patient well-being, with human suffering relegated to inconsequential status.

Additionally, we have witnessed the genesis of a patient advocacy/special interest watchdog organization, the not-for-profit Foundation for Ethics in Pain Care (FEPC) ( The FEPC advocates for the improvement of the integrity and quality of pain care in the United States through educational programming for healthcare professionals and increasing public awareness through the media as well as conducting research on issues relating to pain and ethics. In order to assure maintenance of scientific integrity, the organization refuses to accept funding from special interest groups, which is a unique and refreshing approach to gaining support. Additionally, the FEPC serves as a research institution. Once again, it maintains a policy of not submitting grants to industry-based funding sources.


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