Who can argue with sunshine?
A little-known section of Obamacare called the Physician Payments Sunshine Act will start being enforced this year. The Act treats all doctors who collaborate with the pharmaceutical industry as potential criminals whose private financial affairs must be exposed to the world by government order.
Just recently the federal agency in charge of enforcement released a 285-page set of regulations and explanations, detailing which payments and benefits to doctors must be reported by pharmaceutical companies. All the info will be posted on a government website, with hefty fines for non-compliance.
The background here is this: Over the years, physician-industry collaboration — which often involves substantial payments of money to highly skilled doctors — has not only helped in the development of effective new drugs, but also in marketing those drugs to the doctors whose patients need them, and in teaching those doctors how to prescribe and use the drugs. But critics have pointed to a few doctors who allowed conflicts of interest to undermine their patients’ welfare.
Now all doctors, innocent and guilty, are expected to endure in perpetuity the medical equivalent of an airport TSA search, on the premise that they, too, could be betraying their patients. “Sunshine is said to be the best of disinfectants,” said future Supreme Court Justice Louis Brandeis in 1914. In a similar vein, Senator Charles Grassley, one of the Sunshine Act’s authors, stated: “This bill is about letting the sun shine in so that the public can know.”
What does the “sunshine” metaphor imply? That physician-industry collaboration is inherently a dirty business, “infected” by financial self-interest. That the physician of integrity, who refuses to allow any conflicts of interest in his practice, is just a myth — or, if a few exist, they should not resent being forced by government edict to allow their financial affairs to be scrutinized by every nosy reporter, plaintiff’s lawyer, and government regulator in search of a criminal or civil case.
Innocent until proven guilty? That’s so old-fashioned.
This article in The Atlantic makes it all sound so natural and uncontroversial. Of course, maybe that’s because the author interviewed only supporters of the Act. “Why would a doctor resist having payments made public?” the article asks. Who better to answer that question than the author of Bad Pharma: How Drug Companies Mislead Doctors and Harm Patients. It turns out all he can think of is that doctors are “embarrassed” to be exposed, and: “That in itself is enough to tell you that this is something that needs to be in the open.”
Embarrassment, guilt—are these the only reasons a conscientious doctor might resist coercive disclosure of his financial relations with industry? I suggested another reason here.
What do you think?