Pain in the 5th Vital Sign: Retrenchment in the US Regulatory Regime

• In Event: Policy Innovation, Diffusion, Retrenchment and Feedback: Recent Advancement

Abstract

The Joint Commission is a nonprofit organization that sets voluntary standards for healthcare accreditation. It accredits over 80% of the hospitals in the United States and is seen as key cog in the US regulatory infrastructure. It also has been subject to a great deal of criticism for accepting money from industry, including Purdue Pharma, the maker of Oxycontin. Opioid manufacturers were particularly attracted to the Joint Commission's ability to change the way physicians treat pain in the early 2000s. They helped pay for the distribution of the revamped treatment guidelines that sought to place pain on par with four other life signs that should be evaluated in clinical encounters with patients. What is less clear is where these pain guidelines came from and why, despite growing concerns of prescription drug crisis, the Joint Commission failed to revise these guidelines. This research makes use of the new opioid industry document archive and other public sources to understand the role of academic pain advocates and private philanthropy to institutionalize pain management into the Joint Commission's standards. In so doing, we provide overdue scrutiny into the questionable practices of knowledge brokering within a pseudo regulator amidst an industry-sponsored public health crisis. This provides important lessons about corporate actors' abilities to misconstrue scientific evidence, target gate-keepers of professional norms, and manipulate private philanthropy in service of their market-oriented objectives.

Author

• Adam Koon, Georgetown University