The introduction of the Sunshine Act in the USA means that almost all direct financial relationships worth more than $10 between doctors and drug or medical device companies are required to be made public. By increasing transparency the Act is intended to reduce the influence of drug companies over doctors who may favor the products of companies to which they have financial ties. However, in an essay published in PLOS Medicine, Genevieve Pham-Kanter from Drexel University School of Public Health, Philadelphia, notes that the Act will be ineffective unless the public or other interested parties take actions to penalize physicians who accept payments.
In her essay Dr Pham-Kanter examines some of the ways in which the Sunshine Act might succeed or fail. She highlights how the reporting of payments may not be as transparent as hoped, either because of tacit collusion or firms shifting payments to non-physician prescribers whose financial ties do not need to be reported. She also notes that the general public may not respond negatively to knowing that their doctor has financial ties to a drug or medical device company.
Dr Pham-Kanter argues that in order for the Sunshine Act to work, financial relationships most likely to harm the health of the doctor-patient relationship will need to be clearly identified and tied to some form of sanctioning. “Historical experience tells us that disclosure without sanctioning mechanisms lead us to transparency without teeth” says Pham-Kanter, citing the example of political campaign contributions in the US. The Sunshine Act is a bold step in the right direction in improving transparency around physician payments and she argues that it is not too early to begin thinking about Act II.
Act II of the Sunshine Act, Pham-Kanter G, PLoS Med, doi:10.1371/journal.pmed.1001754, published 4 November 2014.
No funding was supplied for this work.
The author has declared that no competing interests exist.