Obama's healthcare reform package was finally signed into law on March 23. And while Obamacare will have a huge impact (in my view, a positive one) on health care in the U.S. over the next few decades, one component, the Physician Payments Sunshine provisions, may improve medicine even more profoundly.
You might recall that the Sunshine Act was first introduced almost three years ago by Senator Charles Grassley. I've blogged about it several times before, here for example.
The Sunshine act is the culmination of a Herculean effort by Grassley, his staffer Paul Thacker, and many others to disinfect the culture of corruption and commercial influence that has permeated medicine. Click here for a series of links on Grassley's website offering a meandering trip down a memory lane of conflicts of interests. Almost all of the sights along the way pertain to my own field of psychiatry, which consistently provided the lowest-hanging fruit among ethically challenged researchers.
At any rate, now that the Sunshine Act is officially the law of the land, what, exactly, are its provisions, and how might it affect medicine? You can download a concise fact sheet on the act from the Pew Prescription Project website here. Essentially, the law requires that all drug and device companies report all payments made to physicians and teaching hospitals. This includes money for marketing activities, such as promotional talks and consultation, but also includes research grants, "charitable" contributions (which usually come with some promotional strings attached), and funding for conferences, whether CME or otherwise.
Given that so many drug companies have already published registries of physician payments, one might reasonably ask whether this act was actually needed, and whether it will really accomplish anything new. It was, and it will, and here's why.
As noted by Eric Milgram on his Pharma Conduct Blog, the existing company sponsored disclosures provide few details and are formatted in such a way that they are "translucent" rather than "transparent." As a patient, physician payment registries are important because they would presumably allow me to easily look up my doctor, and find out if he or she has been paid to push that new and expensive drug that was just prescribed for me. The current registries don't provide that level of detail, and they make it hard or impossible to conduct efficient searches.
The Sunshine Act fixes this problem. Companies will be required to report names, addresses, the amount of the payment, the date of the payment, and the precise nature of the "service" provided by the doctor. Not only that, but if the payment was for a promotional talk, the company will have to disclose the name of the drug the doctor was pushing. Thus, for example, Eli Lilly's current registry would allow you to find out that a doctor made $50,000 in 2009 performing what is vaguely (translucently) described as "healthcare professional education programs." But the Sunshine Act registry will tell you that your doctor made $50,000 for marketing Zyprexa in 2009. In fact, the Zyprexa speaker's payments will be broken down by date, so you might be able to discover that your doctor got a fat check exceeding your annual salary on the day before he wrote out a Zyprexa prescription for you.
It is this kind of granularity of information that will truly make doctors think twice before pursuing careers as hired guns.