If the "Physician Payments Sunshine Act" Is a Solution, What Is the Problem?

The article by Chimonas and colleagues (Chimonas, DeVito, and Rothman 2017) uses focus groups to explore the attitudes of 42 physicians from three cities on the Physician Payments Sunshine Act (PPSA). The PPSA is a federal program mandated by the Affordable Care Act that collects information from pharmaceutical and medical device companies on their payments to physicians and teaching hospitals for travel, speaking fees, research gifts, meals, and equity holdings that they or their families have in these companies. The data collected are maintained on public websites. PPSA became active on August 1, 2013. Between 2013 and 2015 a total of 1,455 companies reported making payments to 618,000 physicians and 1,111 teaching hospitals. The total U.S. dollar value of the payments was $7.33 billion. The very small number of physicians in the study (0.007%) is not designed to provide a sampling of the entire physician population impacted by PPSA. Other studies and anecdotal reports are consistent with the results found by the authors. For the year 2014 the study data from the Center for Medicare & Medicaid Services indicated that 32% of the payments were from royalties and licenses and 25% for promotional speaking. The article is largely focused on educating physicians about the law and promoting their awareness of the value of the law to patients. The PPSA was passed in response to the growing public and media attention to financial conflicts of interest in the medical field. The New England Journal of Medicine and the Journal of the American Medical Association began requesting authors of papers in their journals to disclose their financial interests relevant to the subject matter of their publication. Subsequently, the Public Health Service and the National Science Foundation issued requirements to all institutions receiving federal research dollars from those agencies to report on their sources of external funding to their institution. If their institution found that in such disclosures there were financial conflicts of interest (COIs), they were required to manage them. The purpose of these regulations was to promote objectivity in science and reduce bias in federally funded research or at least make such biases transparent. There is a series of assumptions about the PPSA that, if true, could justify the requirement, at least somewhat. Weighing what the PPSA does achieve with the burden it places on the regulated parties would also be relevant to its success. In the case of financial COIs in journals, there were empirical studies that justified transparency. It was found that studies funded by for-profit institutions, compared to nonprofit institutions or government, were more likely to reach conclusions about risk or efficacy that were concordant with the financial interests of those institutions. Editors of leading medical and science journals felt that their readers and journalists reporting on their publications should be aware of the financial interests of the papers’