The Sunshine Act–How Bad Can It Get?

Industry Insights from Paul Meade, M. Sc, MPH

For every transaction over ten dollars paid to a physician by a pharmaceutical manufacturer, the Physician Payments Sunshine Provision demands disclosure to a database that will be made public in 2013.

Notwithstanding the absurdity of collecting such an enormous amount of information, someone will undoubtedly spend a lot of time sifting through this data to create lists of “worst offenders.” These lists will be publically promulgated with the sole purpose of bestowing shame on these so-called “offenders.”

Of course, these lists may be perceived as tantamount to publishing a list of child molesters moving into a new neighborhood, or those people charged with driving under the influence of alcohol over the weekend listed in the Monday newspaper. Some of the most brilliant and renowned physicians in this country will be brought to shame for consulting with some manufacturers.

So, how bad can it get? Well, let’s imagine the following scenario, which I refer to as Grinding to a Halt. Leaders in the medical community who are respected for their research and experience may become so concerned about being publically exposed for consulting with various manufacturers that they may decide to cease all interactions going forward.

There will be no more advising pharmaceutical companies about the unmet medical needs for new molecules discovered in their research laboratories. There will be no more helping companies design clinical studies to bring new medicines to the market. There will be no more presenting their research results of some breakthrough product at a medical conference. In fact, it could even go so far as to have physicians refusing to participate in manufacturer-sponsored clinical studies.

And if the scenario of physicians declining to interact with manufacturers isn’t enough, the institutions they work for will jump on the bandwagon. Academic Medical Centers, afraid of negative publicity, will place severe restrictions on their physicians as to the interactions permitted with manufacturers. This measure is already being implemented by several institutions across the United States, and it has resulted in many leading physicians being limited, or even prohibited, from interacting with companies.

But wait, there’s more! The manufacturers themselves could become so publically flogged for their interactions with physicians that they, too, place self-imposed restrictions on interacting with these physicians. Continuing Medical Education may slow to a trickle, and many large medical associations may have funding dry up to support their annual meetings. Manufacturers will become too afraid to work with leading physicians for fear of being ridiculed, or worse yet, have their products boycotted by patients. And those companies that continue to work with physicians without any serious regard to public outcry become the victims of patient advocacy groups openly protesting these companies. Everyone becomes afraid of everyone else.

If this sounds a bit too crazy, it is! Could it happen? Well, certainly elements of this scenario will undoubtedly happen, such as the current restrictions being placed on physicians by medical institutions. But a full-blown implementation of this doomsday scenario is unlikely. The question really comes down to how far we will let it get out of hand before someone hits the brakes. So the answer to the question of how bad it can get is really up to all of us in healthcare—manufacturers, physicians, and medical centers. Dealing with reactionary absurdities is better done proactively than by waiting to the train to derail.  We can’t let this horse get out of the barn.

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