Keith at 18:40, 18 May 2026

2026-05-18T18:40:46Z

← Older revision		Revision as of 18:40, 18 May 2026
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	In May 2026, Rishi Kumar, MD, a cardiothoracic anesthesiologist who publishes a suite of free clinical reference apps at rkref.app,<ref name="rkmd-about" /> announced on his public Facebook page that he was removing '''CoagRef''', a free no-subscription iOS reference app he had written, from his websites and from the Apple App Store after receiving legal demands from lawyers representing what he described as "a large organization in anesthesiology."<ref name="kumar-fb" /> CoagRef summarized the same anticoagulation timing recommendations addressed by ASRA Coags, drawn from the publicly downloadable BMJ guideline PDFs published in ''Regional Anesthesia & Pain Medicine''.<ref name="rapm-horlocker-2018" /><ref name="rapm-kopp-2025" /> Kumar's post does not name the organization that sent the demands; the only anesthesiology organization that publishes a competing Coags-branded reference app whose underlying guidelines drive both products is ASRA, which makes the linkage circumstantial rather than confirmed by the developer.<ref name="kumar-fb" /><ref name="appstore-current" /> The CoagRef App Store listing at apps.apple.com/us/app/coagref/id1462215262 currently returns a 404 "The page you're looking for can't be found" error, confirming the takedown.<ref name="coagref-404" /> ASRA has not publicly addressed the CoagRef takedown, and its own apps page contains no statement about the matter.<ref name="asra-apps-page" />		In May 2026, Rishi Kumar, MD, a cardiothoracic anesthesiologist who publishes a suite of free clinical reference apps at rkref.app,<ref name="rkmd-about" /> announced on his public Facebook page that he was removing '''CoagRef''', a free no-subscription iOS reference app he had written, from his websites and from the Apple App Store after receiving legal demands from lawyers representing what he described as "a large organization in anesthesiology."<ref name="kumar-fb" /> CoagRef summarized the same anticoagulation timing recommendations addressed by ASRA Coags, drawn from the publicly downloadable BMJ guideline PDFs published in ''Regional Anesthesia & Pain Medicine''.<ref name="rapm-horlocker-2018" /><ref name="rapm-kopp-2025" /> Kumar's post does not name the organization that sent the demands; the only anesthesiology organization that publishes a competing Coags-branded reference app whose underlying guidelines drive both products is ASRA, which makes the linkage circumstantial rather than confirmed by the developer.<ref name="kumar-fb" /><ref name="appstore-current" /> The CoagRef App Store listing at apps.apple.com/us/app/coagref/id1462215262 currently returns a 404 "The page you're looking for can't be found" error, confirming the takedown.<ref name="coagref-404" /> ASRA has not publicly addressed the CoagRef takedown, and its own apps page contains no statement about the matter.<ref name="asra-apps-page" />

	<!-- INCIDENT_SCORE: 58. Documented physician-developed free app removed after legal pressure circumstantially linked to ASRA; affects a narrow professional user base; no lawsuit filed yet; primary evidence is Kumar's own public Facebook statement plus the live 404 on the App Store listing. -->

	=== ASRA Coags app subscription bait-and-switch ===		=== ASRA Coags app subscription bait-and-switch ===
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	The app's overall App Store rating sat at 1.3 stars across 391 ratings as of the May 2026 capture.<ref name="appstore-current" />		The app's overall App Store rating sat at 1.3 stars across 391 ratings as of the May 2026 capture.<ref name="appstore-current" />
	<!-- INCIDENT_SCORE: 55. Documented one-time-purchase-to-subscription conversion with no grandfathering for prior buyers; pricing change is small in absolute terms ($6.99/yr) but the lockout pattern hits a clinically load-bearing reference; evidence is App Store version history, two named SDN threads, named and dated App Store reviews, and a 1.3-star aggregate rating across 391 reviews; no regulatory or class-action filing on record. -->

	== See also ==		== See also ==

Louis: Create Company page for the American Society of Regional Anesthesia and Pain Medicine (ASRA), parent of the existing Incident article on the May 2026 cease-and-desist against the CoagRef app. Covers organizational history (1923 tribute society / 1975 refounding / 2021 rename), FY2024 financials from IRS 990 (~$4.87M revenue), membership tiers and pricing, the journal RAPM (BMJ partnership since 2019, hybrid open-access), three mobile reference apps, and two scored consumer-impact incidents: t...

2026-05-18T18:39:31Z

Create Company page for the American Society of Regional Anesthesia and Pain Medicine (ASRA), parent of the existing Incident article on the May 2026 cease-and-desist against the CoagRef app. Covers organizational history (1923 tribute society / 1975 refounding / 2021 rename), FY2024 financials from IRS 990 (~$4.87M revenue), membership tiers and pricing, the journal RAPM (BMJ partnership since 2019, hybrid open-access), three mobile reference apps, and two scored consumer-impact incidents: t...

New page

{{CompanyCargo
|CompanyName=American Society of Regional Anesthesia and Pain Medicine
|Industry=Medical professional society, Clinical guideline publisher
|Founded=1923 (original); 1975 (re-founded)
|Headquarters=Pittsburgh, Pennsylvania, United States
|Type=Non-Profit
|CompanyAlias=ASRA, ASRA Pain Medicine
|Website=https://asra.com/
|Description=Converted previously paid Coags reference app to a $6.99 annual subscription; the developer of a free competing app reported that legal demands from a large anesthesiology organization caused him to remove it from the App Store in 2026
}}

'''The American Society of Regional Anesthesia and Pain Medicine''' (ASRA, also branded as ASRA Pain Medicine) is a 501(c)(3) medical professional society headquartered in Pittsburgh, Pennsylvania, with more than 5,000 members in 66 countries.<ref name="asra-about" /><ref name="propublica-asra" /> ASRA publishes the evidence-based guidelines that physicians in North America use to time regional anesthesia procedures around anticoagulant medication, and it monetizes access to those guidelines through annual meeting registrations, journal article processing charges, and a paid mobile reference app.<ref name="rapm-horlocker-2018" /><ref name="rapm-authors" /><ref name="asra-apps-page" /> In April 2025 the society converted its '''ASRA Coags''' mobile app from a one-time $3.99 purchase to a $6.99 annual subscription, locking out prior buyers.<ref name="appstore-current" /><ref name="appstore-wayback-2024" /><ref name="sdn-1508690" /> In May 2026, a free physician-built reference app called '''CoagRef''' that summarized the same publicly downloadable guidelines was pulled from the Apple App Store after its developer received legal demands from lawyers representing what he described as "a large organization in anesthesiology"; ASRA is the only anesthesiology organization that publishes a competing Coags-branded reference app.<ref name="kumar-fb" /><ref name="coagref-404" /><ref name="appstore-current" />

== Background ==

An earlier society of the same name was founded in 1923 as a tribute to Gaston Labat.<ref name="asra-past-leaders" /> The current society was founded in 1975, led by Alon P. Winnie, MD, and is also associated with founding members L. Donald Bridenbaugh, Harold Carron, Jordan Katz, and P. Prithvi Raj.<ref name="asra-past-leaders" /> On November 18, 2021, the society added "Pain Medicine" to its short name, accompanied by a refreshed brand logo and visual identity.<ref name="asra-rename-2021" />

The society is headquartered in Pittsburgh, Pennsylvania.<ref name="asra-contact" /> It is registered with the IRS under Employer Identification Number 51-0163222 and has been tax-exempt since October 1975 as a 501(c)(3) public charity.<ref name="propublica-asra" /> The official journal, ''Regional Anesthesia & Pain Medicine'' (RAPM), was first published in 1976 and has been published in partnership with BMJ since early 2019.<ref name="inpublishing-bmj" /> As of 2025-2026 the journal's editor-in-chief is Brian D. Sites, MD.<ref name="asra-rapm-page" /> The society's president is Steven P. Cohen, MD, and its executive director is Elizabeth Smith, CAE, who took the role on June 26, 2023.<ref name="asra-about" /><ref name="asra-ed-announcement" />

For fiscal year 2024, ASRA reported total revenue of approximately $4.87 million and total expenses of approximately $4.51 million on its IRS Form 990.<ref name="propublica-asra" /> Executive director compensation for the same filing was reported as $156,275 in base pay plus $11,797 in other compensation, for total compensation of $168,072.<ref name="propublica-asra" />

== Consumer impact summary ==

ASRA controls the canonical North American evidence-based guidelines for timing neuraxial procedures in patients on anticoagulants, and those guidelines are clinically load-bearing because mistiming a dose can produce spinal epidural hematoma and permanent paralysis.<ref name="rapm-horlocker-2018" /><ref name="nysora-hematoma" /> The full-text PDFs of the guidelines are hosted under a "FREE" access tier on the BMJ journal site, but the underlying copyright is retained by the society and the publisher, with reuse routed through the Copyright Clearance Center.<ref name="rapm-horlocker-2018" /><ref name="rapm-kopp-2025" /> Despite that free-to-read posture for the journal article, ASRA monetizes a guideline-derived mobile reference app at $6.99 per year and has used legal demands to remove at least one free, no-subscription competing reference app from the Apple App Store.<ref name="appstore-current" /><ref name="kumar-fb" /><ref name="coagref-404" /> Prior one-time purchasers of the ASRA Coags app were not grandfathered when the app shifted to a subscription in April 2025, prompting refund requests, App Store reviews calling the change a "bait and switch," and a 1.3-star aggregate rating across 391 reviews as of May 2026.<ref name="appstore-current" /><ref name="sdn-1508690" />

== Organizational structure and pricing ==

ASRA's membership categories and annual dues are published on its categories-of-membership page.<ref name="asra-membership" /> Regular and international physician members pay $422 per year.<ref name="asra-membership" /> Joint members with the African (AFSRA), Asian-Oceanic (AOSRA-PM), European (ESRA), and Latin American (LASRA) sister societies pay $70 per year.<ref name="asra-membership" /> Affiliates pay $165 per year.<ref name="asra-membership" /> Young Professionals memberships are tiered: $200 for one year, $267 for two years, and $334 for three years.<ref name="asra-membership" />

The 51st Annual Regional Anesthesiology and Acute Pain Medicine Meeting, scheduled for April 2026, is priced at $1,055 for members and $1,630 for non-members for in-person attendance.<ref name="asahq-asra-meeting" />

''Regional Anesthesia & Pain Medicine'' operates as a hybrid open-access journal.<ref name="rapm-authors" /> Authors who select a Creative Commons open-access license pay an article processing charge of $2,800 if they are ASRA members and $3,890 if they are not.<ref name="rapm-authors" /> The journal encourages author deposit of preprints on not-for-profit servers such as medRxiv and does not treat preprint posting as prior publication.<ref name="rapm-authors" /> A subscription to RAPM is bundled with ASRA Pain Medicine membership.<ref name="asra-rapm-page" />

== Products and services ==

ASRA's principal products sold to consumers are its mobile reference apps, its journal, and its annual meeting. The society publishes three iOS reference apps that summarize its clinical guidelines:

* '''ASRA Coags''' summarizes the anticoagulation timing guidelines (Horlocker et al. 2018, fourth edition; Kopp et al. 2025, fifth edition).<ref name="rapm-horlocker-2018" /><ref name="rapm-kopp-2025" /> The app has been distributed since at least 2014 and was developed at Vanderbilt University Medical Center under Rajnish Gupta, MD and Matthew McEvoy, MD, with code by Mustard Seed Software, LLC.<ref name="appstore-wayback-2024" /> A December 14, 2024 Wayback Machine capture of the App Store listing shows the app priced at $3.99 with no subscription.<ref name="appstore-wayback-2024" /> On April 21, 2025, ASRA shipped version 4.0, which converted the app to a $6.99 annual subscription or free-with-membership access model.<ref name="appstore-current" /> See [[#Incidents|Incidents]] below.
* '''ASRA LAST''' implements the society's local anesthetic systemic toxicity (LAST) checklist for treatment of an emerging local-anesthetic overdose.<ref name="asra-apps-page" /><ref name="sparc-last" />
* '''ASRA Timeout''' provides a procedural pre-block checklist.<ref name="asra-apps-page" />

The society's apps page describes the suite as part of its educational mission and lists the Coags pricing as "Subscription-based app: $6.99/annually or free with ASRA Pain Medicine membership."<ref name="asra-apps-page" />

In addition to the mobile apps, ASRA publishes the peer-reviewed digital newsletter ''ASRA Pain Medicine News'' (formerly ''ASRA News'') and operates its annual meeting program.<ref name="asra-newsletter-history" />

== Incidents ==

=== Cease-and-desist against the CoagRef app ===

{{Main|ASRA cease and desist against CoagRef}}

In May 2026, Rishi Kumar, MD, a cardiothoracic anesthesiologist who publishes a suite of free clinical reference apps at rkref.app,<ref name="rkmd-about" /> announced on his public Facebook page that he was removing '''CoagRef''', a free no-subscription iOS reference app he had written, from his websites and from the Apple App Store after receiving legal demands from lawyers representing what he described as "a large organization in anesthesiology."<ref name="kumar-fb" /> CoagRef summarized the same anticoagulation timing recommendations addressed by ASRA Coags, drawn from the publicly downloadable BMJ guideline PDFs published in ''Regional Anesthesia & Pain Medicine''.<ref name="rapm-horlocker-2018" /><ref name="rapm-kopp-2025" /> Kumar's post does not name the organization that sent the demands; the only anesthesiology organization that publishes a competing Coags-branded reference app whose underlying guidelines drive both products is ASRA, which makes the linkage circumstantial rather than confirmed by the developer.<ref name="kumar-fb" /><ref name="appstore-current" /> The CoagRef App Store listing at apps.apple.com/us/app/coagref/id1462215262 currently returns a 404 "The page you're looking for can't be found" error, confirming the takedown.<ref name="coagref-404" /> ASRA has not publicly addressed the CoagRef takedown, and its own apps page contains no statement about the matter.<ref name="asra-apps-page" />



=== ASRA Coags app subscription bait-and-switch ===

On April 21, 2025, ASRA shipped version 4.0 of the ASRA Coags iOS app.<ref name="appstore-current" /> The App Store version history records the v4.0 release notes only as "Update the ui and contents," with no disclosure that the app would now require an annual subscription.<ref name="appstore-current" /> Before that update, an archived December 14, 2024 Wayback capture of the App Store listing showed the app priced at $3.99 as a one-time purchase with no subscription component.<ref name="appstore-wayback-2024" /> After the update, prior purchasers reported being locked out of content they had previously paid for and required to enroll in a $6.99 annual subscription or in ASRA Pain Medicine membership to regain access.<ref name="sdn-1508690" /><ref name="appstore-current" /> On May 1, 2025, a Student Doctor Network thread titled "ASRA Coags App now Membership Only" documented the lockout; one poster in that thread wrote that they had asked ASRA for a refund "as my paid for app was no longer functional" and had been offered "a year free" instead.<ref name="sdn-1508690" /> A July 21, 2025 follow-up thread documented that the policy remained in place "despite the backlash."<ref name="sdn-1511800" /> App Store reviewer Blahghg posted on the App Store on June 12, 2025:

<blockquote>''I paid for this app (one time fee) and now they are charging a yearly subscription fee to use it. This is a bait and switch.''</blockquote><ref name="appstore-current" />

The app's overall App Store rating sat at 1.3 stars across 391 ratings as of the May 2026 capture.<ref name="appstore-current" />


== See also ==

* [[ASRA cease and desist against CoagRef]]
* [[Click-to-cancel]]
* [[Bait-and-switch]]

== References ==

<references>
<ref name="asra-about">{{Cite web |url=https://asra.com/about-asra |title=About ASRA |publisher=American Society of Regional Anesthesia and Pain Medicine |access-date=2026-05-18}}</ref>
<ref name="asra-contact">{{Cite web |url=https://asra.com/about-asra/contact-us |title=Contact Us |publisher=American Society of Regional Anesthesia and Pain Medicine |access-date=2026-05-18}}</ref>
<ref name="asra-ed-announcement">{{Cite web |url=https://asra.com/news-publications/asra-update-item/asra-updates/2023/06/29/asra-pain-medicine-announces-new-executive-director |title=ASRA Pain Medicine Announces New Executive Director |publisher=American Society of Regional Anesthesia and Pain Medicine |date=2023-06-29 |access-date=2026-05-18}}</ref>
<ref name="asra-membership">{{Cite web |url=https://asra.com/the-asra-family/joinrenewpage/categories-of-membership |title=Categories of Membership |publisher=American Society of Regional Anesthesia and Pain Medicine |access-date=2026-05-18}}</ref>
<ref name="asra-past-leaders">{{Cite web |url=https://asra.com/about-asra/past-leaders |title=Past Leaders |publisher=American Society of Regional Anesthesia and Pain Medicine |access-date=2026-05-18}}</ref>
<ref name="asra-rename-2021">{{Cite web |url=https://asra.com/news-publications/asra-update-item/asra-updates/2021/11/18/asra-is-now-asra-pain-medicine |title=ASRA Is Now ASRA Pain Medicine |publisher=American Society of Regional Anesthesia and Pain Medicine |date=2021-11-18 |access-date=2026-05-18}}</ref>
<ref name="asra-apps-page">{{Cite web |url=https://asra.com/guidelines-articles/asra-apps |title=ASRA Apps |publisher=American Society of Regional Anesthesia and Pain Medicine |access-date=2026-05-18}}</ref>
<ref name="asra-rapm-page">{{Cite web |url=https://asra.com/news-publications/regional-anesthesia-pain-medicine-journal |title=Regional Anesthesia & Pain Medicine Journal |publisher=American Society of Regional Anesthesia and Pain Medicine |access-date=2026-05-18}}</ref>
<ref name="asra-newsletter-history">{{Cite web |url=https://asra.com/news-publications/asra-newsletter/newsletter-item/asra-news/2025/05/06/the-asra-pain-medicine-newsletter-then-and-now |title=The ASRA Pain Medicine Newsletter Then and Now |publisher=American Society of Regional Anesthesia and Pain Medicine |date=2025-05-06 |access-date=2026-05-18}}</ref>
<ref name="propublica-asra">{{Cite web |url=https://projects.propublica.org/nonprofits/organizations/510163222 |title=American Society Of Regional Anesthesia Surgery Obstetrics And, Nonprofit Explorer |publisher=ProPublica |access-date=2026-05-18}}</ref>
<ref name="rapm-authors">{{Cite web |url=https://rapm.bmj.com/pages/authors |title=Authors |publisher=BMJ, Regional Anesthesia & Pain Medicine |access-date=2026-05-18}}</ref>
<ref name="inpublishing-bmj">{{Cite web |url=https://www.inpublishing.co.uk/articles/bmj-to-publish-leading-anesthesiology-journal-202 |title=BMJ to publish leading anesthesiology journal |publisher=InPublishing |date=2018-12-06 |access-date=2026-05-18}}</ref>
<ref name="rapm-horlocker-2018">{{Cite web |url=https://rapm.bmj.com/content/43/3/263 |title=Regional Anesthesia in the Patient Receiving Antithrombotic or Thrombolytic Therapy: American Society of Regional Anesthesia and Pain Medicine Evidence-Based Guidelines (Fourth Edition) |last=Horlocker |first=Terese T. |last2=Vandermeuelen |first2=Erik |last3=Kopp |first3=Sandra L. |last4=Gogarten |first4=Wiebke |last5=Leffert |first5=Lisa R. |last6=Benzon |first6=Honorio T. |date=2018 |journal=Regional Anesthesia & Pain Medicine |volume=43 |issue=3 |pages=263-309 |doi=10.1097/AAP.0000000000000763 |access-date=2026-05-18}}</ref>
<ref name="rapm-kopp-2025">{{Cite web |url=https://rapm.bmj.com/content/early/2025/10/16/rapm-2024-105766 |title=Regional anesthesia in the patient receiving antithrombotic or thrombolytic therapy: American Society of Regional Anesthesia and Pain Medicine Evidence-Based Guidelines (fifth edition) |last=Kopp |first=Sandra L. |last2=Vandermeulen |first2=Erik |last3=McBane |first3=Robert D. |last4=Perlas |first4=Anahi |last5=Leffert |first5=Lisa |last6=Horlocker |first6=Terese |date=2025-10-16 |journal=Regional Anesthesia & Pain Medicine |doi=10.1136/rapm-2024-105766 |access-date=2026-05-18}}</ref>
<ref name="appstore-current">{{Cite web |url=https://apps.apple.com/us/app/asra-coags/id858796572 |title=ASRA Coags on the App Store |publisher=Apple Inc. |access-date=2026-05-18}}</ref>
<ref name="appstore-wayback-2024">{{Cite web |url=https://web.archive.org/web/20241214065922/https://apps.apple.com/us/app/asra-coags/id858796572 |title=ASRA Coags on the App Store (archived December 14, 2024) |publisher=Internet Archive Wayback Machine |date=2024-12-14 |access-date=2026-05-18}}</ref>
<ref name="coagref-404">{{Cite web |url=https://apps.apple.com/us/app/coagref/id1462215262 |title=CoagRef on the App Store (page not found) |publisher=Apple Inc. |access-date=2026-05-18}}</ref>
<ref name="kumar-fb">{{Cite web |url=https://www.facebook.com/rishikumarmd/posts/coagref-is-being-removed-from-my-websites-and-apples-app-store-as-i-comply-with-/1515413240212180/ |title=CoagRef is being removed from my websites and Apple's App Store as I comply with the demands outlined by lawyers for a large organization in anesthesiology |last=Kumar |first=Rishi |website=Facebook |date=2026-05-15 |access-date=2026-05-18}}</ref>
<ref name="rkmd-about">{{Cite web |url=https://rkref.app/ |title=Home - RK.MD Reference Apps |website=rkref.app |access-date=2026-05-18}}</ref>
<ref name="sdn-1508690">{{Cite web |url=https://forums.studentdoctor.net/threads/asra-coags-app-now-membership-only.1508690/ |title=ASRA Coags App now Membership Only |first=TeslaCoil |website=Student Doctor Network Forums |date=2025-05-01 |access-date=2026-05-18}}</ref>
<ref name="sdn-1511800">{{Cite web |url=https://forums.studentdoctor.net/threads/asra-coag-app-subscription.1511800/ |title=ASRA Coag App subscription |first=Baron S |website=Student Doctor Network Forums |date=2025-07-21 |access-date=2026-05-18}}</ref>
<ref name="nysora-hematoma">{{Cite web |url=https://www.nysora.com/topics/complications/diagnosis-management-spinal-peripheral-nerve-hematoma/ |title=Diagnosis and Management of Spinal and Peripheral Nerve Hematoma |publisher=NYSORA |access-date=2026-05-18}}</ref>
<ref name="sparc-last">{{Cite web |url=https://www.sparc360.com/wp-content/uploads/2019/04/Checklist_LAST.pdf |title=Checklist for Managing Local Anesthetic Systemic Toxicity |publisher=American Society of Regional Anesthesia and Pain Medicine; SPARC |date=2018 |access-date=2026-05-18}}</ref>
<ref name="asahq-asra-meeting">{{Cite web |url=https://www.asahq.org/meetings/calendar/2026/04/asra-pain-medicines-51st-annua-az-20260416 |title=ASRA Pain Medicine's 51st Annual Regional Anesthesiology and Acute Pain Medicine Meeting |publisher=American Society of Anesthesiologists |date=2026-04-16 |access-date=2026-05-18}}</ref>
</references>

[[Category:Companies]]
[[Category:Non-profit organizations]]
[[Category:Medical professional societies]]
[[Category:Clinical guideline publishers]]

American Society of Regional Anesthesia and Pain Medicine - Revision history

Keith at 18:40, 18 May 2026