Wyden Asks Tax-Exempt Pain Group to Disclose Tax Returns

1) In your December 28^th letter, you wrote that revenue AAPM received from pharmaceutical companies was derived from advertising and educational programming grants. Tax documents your organization provided show that in 2017, AAPM received more than $1.1 million in contributions and grants — nearly a third of the organization's revenue for that year. Of that total, $680,000 came from pharmaceutical manufacturers, including opioid makers; $285,000 came from continuing medical education companies and $40,000 from device manufacturers. Similarly, in 2011 and 2012, AAPM reported receiving contributions and grants totaling $1 million or more, much of which was also derived from pharmaceutical companies, device manufacturers, continuing medical education companies, and other medical interests, tax documents show. These documents also show that AAPM received significant revenue from conferences and meetings, exhibits, membership dues, and its journal. Please provide Form 990 filings, including Schedule B filings, for AAPM for 2010, 2013, 2014, 2015, 2016, and, when it becomes available, 2018. In addition, please provide an itemized list of payments to AAPM from pharmaceutical companies, device manufacturers and CME companies, including the name of the entity making the payment, the date of the payment, the amount of the payment, and the purpose of the payment, for each year from 2010 through 2018.

2) AAPM reported in its 2017 tax return that it receiving contributions and grants of $98,055 from the AAPM Foundation, an affiliated entity. Funding sources for the AAPM Foundation are not disclosed; however, all of the AAPM Foundation's revenue has been categorized as contributions and grants, according to publically available Form 990 filings. The foundation's Form 990 filings further indicates that it has received contributions and grants in excess of $5,000, which necessitates filing of Schedule B forms. Please provide Form 990 filings, including Schedule B filings, for the AAPM Foundation for 2010-2017, and, when it becomes available, 2018.

3) Rollin Gallagher, one of the Task Force members associated with AAPM, was paid more than $975,000 from 2011 to 2017 to oversee the AAPM's journal, Pain Medicine. In your December 28^th letter, you wrote that Dr. Gallagher's salary is paid from an “editorial allowance provided to AAPM by the publishers of Pain Medicine . . . AAPM, the Spine Intervention Society (“SIS”), and the Australia New Zealand Faculty of Pain Medicine of the College of Anaesthetists (“FPMCA”).”

4) Open Payments records show that you received a $24,600 payment from Purdue Pharma in 2017. According to information you provided, the payment was for your participation on an “Opioid Sparing Tapering and Discontinuation Committee” (“Committee”) that Purdue organized and promoted. According to a request for proposals that the Committee issued in 2016, “preference will be given to proposals that incorporate Purdue's opioid products.”

5) In September 2018, as AAPM's president, you authored an article that promoted Purdue's public relations campaign regarding opioid dependence, writing in part, “as the professional society representing the nation's doctors, nurses, researchers, and other clinicians who are tasked with treating pain, we could not agree more with Purdue Pharma's statement that we need a new approach to prescribing opioids.”¹ The article was contemporaneously promoted by AAPM on its Facebook page.²

6) In your letter, you cite that AAPM has been in compliance with the Accreditation Council of Continuing Medical Education (“ACCME”). According to ACCME data, AAPM provides 69 CME courses, for which it received both commercial support and income from advertising and exhibits. Please provide an Excel Workbook that includes the following information for each course or activity:

7) Your letter cited previous communications authored by a prior AAPM president, written in 2014, regarding the organization's management of conflicts of interest. The 2014 communication discussed steps that AAPM intended to take to reduce the organization's reliance on industry money, and ensure that suitable safeguards were in place to police conflicts of interest.

8) According to your letter and the documents that accompanied it, the AAPM criticized the 2016 opioid prescribing guidelines developed by the Centers for Disease Control and Prevention (“CDC guidelines”) for a lack of evidentiary support. As an alternative, the AAPM touted a 2009 study it funded with the American Pain Society (“APS”). That 2009 APS/AAPM study was the basis for prescribing guidelines issued by the organizations that defined a “high” dose of opioid therapy as exceeding 200 mg of morphine equivalent³ — more than twice what the CDC would eventually recommend in its 2016 guidelines. The 2009 APS/AAPM guidelines have been criticized for both their permissive attitude toward prescribing high doses of opioids, and because 14 of its 20 authors reported financial conflicts of interest, many with opioid manufacturers.⁴ One author, Dr. Gilbert Fanciullo, has since criticized the guidelines as being “'skewed' by drug companies and 'biased in many important respects,' including its high presumptive maximum dose . . . and claims of a low risk of addiction.”⁵ Three years after the 2009 APS/AAPM study was released, its lead author, Roger Chou, said in an interview that “at the time, there wasn't much evidence on incremental risks associated with higher doses, and recent studies suggest that risk starts to go up at really relatively low doses. . . . there is growing recognition that a substantial proportion of patients with chronic noncancer pain simply don't respond to opioids — and that if these patients have not responded by the time they are at the equivalent of 60 or 80 mg per day of morphine, they probably aren't going to respond at higher doses.”⁶