Originally meant to “shed light” on improprieties within the pharmaceutical industry, the Physician Payment Sunshine Act is causing a great deal of concern among physicians, industry leaders, and medical communications companies that provide public relations, advertising, and medical education support.
The Sunshine Act was included in the final version of the Patient Protection and Affordable Care Act (PPACA), and the government began collecting data for the Act’s database in January of this year. Details of physicians’ financial relationships with industry will be posted online on March 31, 2013. While this development will allow the public to make its own determinations of physicians’ credibility and independence, it will do so in the absence of context and perspective.
Will this new twist in government regulation be the end of the world as we know it, or just another hurdle in what is shaping up to be the most regulated industry on earth?
I’m generally in favor of guidelines to discourage and even prevent pharmaceutical companies from unduly exploiting their relationships with physicians. However, if the Sunshine Act results in fewer clinical publications, fewer CME and patient education programs, and less knowledge-sharing, it may leave physicians and patients with far less choice.
Some say the Sunshine Act, in its scope, creates an atmosphere of fear reminiscent of the McCarthyism of the 1950s, only this time it is doctors who may be hiding in the shadows, worried about exposure on a government website for accepting payment for something as benign as a speaking engagement. Even if such fears are exaggerated, there are legions of citizens who may object to certain procedures or treatments on ethical, political, or even religious grounds. Under the Sunshine Act, physicians who perform such procedures or engage in controversial research could be targets for criticism or even worse.
At the end of the day, credibility and objectivity are the holy grail of influence. Without credibility, both physicians and drug companies put their reputations at great risk. Physicians are still one the highest regarded groups of professionals in this country. What doctor would risk his or her reputation for a four-figure honorarium and a ham sandwich lunch?
One must wonder how the Sunshine Act’s new rules will impact a physician’s willingness to impart his or her expertise, participate in patient education initiatives, and contribute insights to publications. Oftentimes it is industry support that makes such knowledge-sharing possible; that support is at increased risk due to the specter of over-zealous government regulation.
My hope is that the best of the best will continue to contribute their knowledge and service for the good of society, but I’m not naïve. Without modest compensation for time and travel, we are likely to see a significant decrease in physicians’ willingness to take time away from their busy practices and dedicate the resources and expertise we need to allow the U.S. to keep its leadership position in global healthcare.