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Beware of “astroturf”

As “Astroturf group” is one that looks like a “grassroots” organization that is actually founded, funded, and an advocate for a large organization.

Big pharma is infamous for the practice; one great example is the American Pain Foundation, an opioid-peddling outfit masquerading as a patient advocacy organization (thanks to WCC’s Elaine Goodman for the reminder).  The APF was shut down after an expose by ProPublica’s Charley Ornstein and Tracy Weber.

The APF is instructive.  90% of its funding came from big pharma and medical device companies.

Endo, J&J, and Purdue Pharma of OxyContin fame were major backers.  This is the same Purdue that pleaded guilty to federal criminal charges in 2007.  Sadly no Purdue executives went to prison despite thousands of deaths and millions of addicts from opioid over-prescribing.

And ruined communities – this was once a trailer occupied by a heroin dealer in Kentucky. (Credit HuffPo)


APF got both the Joint Commission – THE healthcare facility accreditation organization – and the Federation of State Medical Boards – to send letters and publish “guides” and other materials promoting pain as the “Fifth Vital Sign”, a brilliant marketing ploy that required physicians to ask about – and treat – pain.

Their reach extended into the Veterans Administration and hundreds of other organizations. The Fifth Vital Sign campaign, backed almost exclusively by opioid manufacturers, created the opioid disaster we are living thru.

This is not yesterday’s news it’s happening today.  In many state capitals the opioid industry remains a powerful and insidious force promoting opioid use.

The damage done is incalculable – hundreds of thousands of dead people, millions of addicts, destroyed families, devastated communities.


Why discuss this now?  Because big business is ascendant.  With the incoming administration focused on reducing regulations and oversight across pretty much every industry we will undoubtedly see Astroturf groups proliferate.

What does this mean for you?

Our families and our towns cannot afford another opioid epidemic.

9 thoughts on “Beware of “astroturf””

  1. Big Pharma has no friends in the incoming administration. I hope that continues. I’d like to see an immediate ban on direct to consumer advertising. Your discussion of the 5th vital sign is dead on and I agree is directly responsible for deaths. I’ve been against it since its inception. I still have yet to see a single patient die from 10/10 pain. I’ve seen them die from treating it,which is why is such a crock of shit. I’ve had arguments too many time to count with administrators about this very thing. Heart Rate, respirations, blood pressure, pulse ox are vital signs, FULL STOP. It is now so ingrained into such things as “patient satisfaction” it’s going to be damn near impossible to root out. There needs to be a sea change but I am pessimistic.

    1. hello Nate – welcome to MCM.
      While I’d like to think the new administration will not be friendly w pharma, given their avowed interest in de-regulation and Sec of HHS nominee’s history with pharma investments I’m not optimistic.

  2. Excellent. One issue is the anti vaxxer and pseudoscience term “big pharma”.

    The term poisons the well with evidence based scientists quickly.

    Maybe just use pharmacy companies?

    You know, they do a lot of good things too.

    1. Hi Adam – welcome to MCM.

      Not sure I follow you. The term “big pharma” was first used in the mid-nineties, predating the anti-vaxxers by a couple of decades. I’d note that I specifically named companies involved in the opioid promotion effort.

      no question pharmacy companies do good things. They’ve also killed tens of thousands. And no one went to jail.

      1. Hey Joe,

        I agree that people are dying and the first two things I teach every person that enters my clinic is that opiates kill, are only for surgery and cancer pain and if you are dying and if not, then for 3-7 days at the most. Don’t mix with “muscle relaxers” and that opiate induced hyperalgesia is a REAL thing.

        I don’t think the date of the start of the use “big Pharma” is important since now it is used by the conspiracy theorists and in my opinion removes necessary credibility to your important message.

        I really blame the prescribing doctors and the other professionals that won’t stand up to patients that just want meds by educating them.

        I’ve been helping IW for 14 years get off these horrible things so I’m with you.

        I also agree that the companies need to be held accountable. Did you see the John Oliver on the issue and how they promoted oxy as a miracle drug?

        Again the clinicians need to be held to the standard as well: Michael Jackson’s doctor Conrad Murray was tried for involuntary manslaughter and convicted. Why not more?

        1. Adam – thanks for clarification, very helpful. We’re on the same page. Not surprising that conspiracy theorists and other awful people have “re-branded” a label; they’ve been doing this for centuries.

          1984 is here.

          cheers Joe

          1. No problem and thanks for fighting the good fight. Sometimes I feel all alone in this one.

          2. rest assured you are not. work comp PBMs and payers are doing good work every day on this front. working with regulators too. but a very long way to go.

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Joe Paduda is the principal of Health Strategy Associates



A national consulting firm specializing in managed care for workers’ compensation, group health and auto, and health care cost containment. We serve insurers, employers and health care providers.



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