Opinion

How Not To Build: The Chronic Pain Circular Firing Squad & Dr. Anna Lembke

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“CreakyJoints is an organization dedicated to providing education, support, advocacy and opportunities to participate in research to all of its members. Our articles and educational events are informed by science, always. This event was cancelled as we learned more about Dr. Lembke and heard feedback from our community, demonstrating how we take seriously the perspective of our members who flagged for us their concerns. Thank you for reaching out to CreakyJoints.”
The world of chronic pain advocacy is an essential, yet admittedly, micro-sized universe. Roughly, there are at least 30 million Americans currently reliant on daily opioid pain medication for severe chronic pain, with perhaps as many as ¼ of Americans- the number of Americans with arthritis– necessitating pain meds now or in the future. However, despite the titanic-level mass of humans that belong to Team Chronic Pain, the attention stamp belonging to patients and their concerns in the news media and online is surprisingly thin. Therefore I find it perplexing when dedicated CPs try to shrink that lean attention bridge with well-meaning but detrimental efforts to control the conversation via somewhat toxic means. Using tactics that at the national level most would recognize as cancel-culture and bullying. Ultimately doing much more harm than good.
The chronic pain advocacy organization and small media outfit CreakyJoints announced last week that they had canceled an upcoming webinar “Understanding Pain and Pleasure” featuring addiction specialist Dr. Anna Lembke. CreakyJoints had invited Lembke previously to speak on her work in addiction and where it intersected pain. However, following the announcement of the upcoming webinar, members of the chronic pain community inundated the org with emails, tweets, and posts complaining about the invitation. Many of these communications pointed out Lembke’s terrible record and shared awful interviews and quotes Lembke had given over the years.
After receiving this flurry, Creaky announced they had rescinded their invitation with the following apology:
Many of us at CreakyJoints live with chronic disease and pain and we understand how some of Dr. Lembke’s previous work and comments can be problematic. Thank you for taking the time and energy to show us articles, interviews, and quotes from Dr. Lembke that are not in keeping with our mission at CreakyJoints.
 
Our hope had been that Dr. Lembke’s recent work on the connection between pain and dopamine could be helpful for many of us seeking ways to manage chronic pain. However, we failed to properly vet this speaker. We are grateful for your energy, wisdom, and support. We will always take your comments, concerns, and suggestions seriously.

With this announcement, many in chronic pain social media declared the cancellation of Lembke to be a victory. On both Twitter and Facebook, prominent advocates refer to cancellation as a win for CP’s. Included in these applauds and retweets were not just your average 100 follower Twitter accounts, but drug reporters, physicians and scientists, and even national pain organizations. A whole lot of people with more expertise than I was offering at least tacit support online for this incident of cancellation against Dr. Lembke.
I have little affection for Dr. Anna Lembke. She is for many on the issue of chronic pain, a very controversial figure. For those not in the know, Lembke is the Chief of the Stanford Addiction Medicine Dual Diagnosis Clinic at Stanford University, an addiction specialist and psychiatrist. Her big claim to fame is her work pushing a hard-nosed narrative with doctors and patients to blame for the deaths of the opioid crisis, as espoused in her subtly titled book: “Drug Dealer, MD, How Doctors Were Duped, Patients Got Hooked, and Why It’s So Hard to Stop.”
The good doctor is in the eyes of many in the pain community to be an extremist proponent of the forced opioid tapering of pain patients and a founding member of that poisonous leech on western medicine known as the Physicians for Responsible Opioid Prescribing. The same is responsible for the 2016 CDC opioids guidelines that, more than anything else, created the prescription opioid prohibition. She isn’t a Dr. Sally Satel or a Michael Schatman, experts on addiction-relevant issues that are also opioid moderates, nor even a Dr. Roger Chou; who at least knows better than being an out-and-out campaigner for prohibition. Lembke is for better or worse, a crusader. If you wanted to point to a great boogeyman in the pain-anguished nightmares of disabled patients, it’s her face they see.
Nevertheless, despite her unbalanced approach (some of her detractors describe her as a foaming at the raving anti-opioid zealot), she is one of the most prolific addiction specialists globally, featured on news programs and Netflix documentaries. In the big Netflix documentary on the problems of social media, “The Social Dilemma,” she is one of the prominently featured experts, even outshining the actual pioneering scientist on the topic, Dr. Jonathan Haidt. A large portion of the documentary waxes hallmark-style with depictions of her teenagers groaning about how cool their mom is. In a world where even a dedicated 10,000-strong audience can make a career, Lembke is someone that can solicit millions in views in bi-partisan media appearances & easily slots into the New York Times best-sellers list.
She’s even appeared on Joe Rogan.
This is where we find Anna presently, promoting her latest pop-addiction book, “Dopamine Nation: Finding Balance in the Age of Indulgence” across the news and podcast world, which is why she appears on everything from Tucker Carlson to CNN to even some of the addiction, medicine and politics podcasts that make up my daily feed. Lembke is what we term in the podcast world as ‘hot and relevant.’
Thus CreakyJoints invites the prominent author for a webinar. Lembke is a speaker within the circle of the conversations that the org talks about. Here is someone famous in the media currently talking about a topic parallel to chronic health issues. Here is an audience that might find that information interesting. While you or I may loathe having to listen to Lembke once again blame anything and everything on addiction, it’s a decision that makes sense for Creaky.
However, as they say online, CP’s ain’t having it.
Like many of us, that write and speak about these topics frequently; I  have slowly learned to my sore shame, despite the millions of patients abandoned by the opioid prohibition; the mainstream isn’t all that interested in hearing us out. What discussion does happen is earned by dedicated fact-finding and endless networking by reporters and advocates trying to get people with a little bit of influence to give a damn. I’ve personally talked to editors at publications making the case to care about these issues. While most admit it’s a real concern, few are willing to take the unpopular approach that maybe opioids are worth keeping around in newsprint. When it does come to the media depicting pain patients, it is rarely effusive.
Tired of being talked down to without being engaged, told how to live their lives without having a say in how they want to live it, patients have long lost their patience. As a pain patient myself, the condescending attitude from so many in our authoritative institutions is palpable. As writer Jonah Goldberg described a similar phenomenon in our national political culture, “it’s as if someone is pissing on you from a very great height.”
Wouldn’t you be mad?
So when the advocates, made up of pain sufferers and their loved ones, see garbage documentaries like HBO’s “Crime of the Century”, or fictional tv dramedies like Hulu’s “Dopesick”, they lash out in any way they know-how.
Bullying and haranguing by the national social justice and conservative justice crowds work precisely because they have the numbers, with support from big companies, the Twitterati, and news media on their side. They can put –at least temporarily– the fear of God into a wayward organization or get a prominent figure canceled. But CP’s, being relatively small in their digital imprint, do not have this capacity.
What they can do is make smaller organizations and individuals feel uncomfortable. And in my experienced opinion, this is almost always a mistake. An attempt to bully and control some small wayward organization for dialoguing along the wrong side of the very issues that affect CP’s. Instead of an attitude of recognizing opportunities for CP’s to engage and get their message out in a positive manner, such as hosting a debate featuring both sides or getting another interview but this time with an advocate -which is precisely what CP’s should have aimed for with CreakyJoints- they close off opportunities not just now, but in the future.
As I learned last year writing that infamous Pain News Network piece, many times when wayward individuals first attempt to engage with the chronic pain community, people who aren’t acclimated to all of CP’s ideas and taboos; such as perhaps they believe prescription opioids were overprescribed; advocates often go on the attack and make those sincere first-timers regret ever trying to talk Team Chronic Pain.
CreakyJoints – an organization with its own big problems-may say they are grateful for the comments. Still, they will be wary about doing anything that may be controversial to a small vocal contingent of chronic pain advocates, even when bringing on speakers that would be in the interest of the chronic pain community as a whole. With the webinar, there was an opportunity for CP’s to engage with Lembke and perhaps put a seed in some minds that pain patients deserve better.
Instead, pain patients proved Lembke right in her bigotry, that the chronic pain communities are hotheads and bullies that should be ignored at all costs. Do advocates honestly believe that enabling Lembke in her wrong-headed beliefs is somehow a win? Perhaps she is unwinnable, but not everyone like her is. More importantly, the people who follow Lembke’s work -the many podcast listeners, book readers, and Netflix watchers- will find that CPs are entirely unreasonable when encountering stories like these. As anyone that’s been on a first date can tell you, being limited is a major turn-off.
This isn’t about Lembke getting canceled, she is going to survive no matter what anyone in the CP community does; it’s about how CP’s can end up canceling themselves in the attempt.
The great leader Reverend Martin Luther King Jr. noted wisely when he said, “You have very little morally persuasive power with people who can feel your underlying contempt.”
I understand those feelings of frustration and anger myself. When I started writing on these topics, I had very little patience for hearing the addiction side of the issue. But over time, I learned that the only way to make progress on convincing hearts and minds to care for the plight of the chronically ill would come by engaging with both halves of the opioid crisis. Fairly and calmly.
An ideal I still sometimes fail to live up to.
To win this war of medical freedom, advocates must persuade the normies; you must grow the coalition and get more people to hear your message and take your side. There is indeed evidence much ground is being gained and advocates should clap each other on the back for it.
Every single victory that you wrack up came about by channeling that righteous anger towards something better. Whether that be convincing the writers of the tv program New Amsterdam to do the right thing or getting the state of Oklahoma to feature a report on the destructiveness’ of forced tapering. Those changes came not by tearing s#%t down, but by hard-earned persuasion, scientific efforts, and the blood, sweat, and tears of advocates and reporters telling the body politic that something horrific is happening in the now cold dark homes across America.
In one of my very favorite speeches of all time, MLK speaking after winning the Nobel Peace Prize in 1964, he shared why he felt why the work and advocacy of him and his supporters, despite all the hurdles and hate sent their way; would ultimately win. “I believe that unarmed truth and unconditional love will have the final word in reality. This is why right, temporarily defeated, is stronger than evil triumphant.”
Be better than your enemies, aim to win not just the little battles, but the war.

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