Financial Conflicts in the New Era of Sunshine

Abstract

The health care system has entered a new era of sunshine about financial conflicts. Disclosure, an increasingly favored regulatory approach, significantly expanded with enactment of the Physician Payments Sunshine Act, the first comprehensive federal legislation mandating public reporting of payments between industry and medicine. But is it making any difference? And what is all the increased disclosure actually revealing? This article critically analyzes the mixed experience with the Sunshine Act, what has been learned from the information generated, and the ramifications for health law and policy. This article also considers how, even in the new era of sunshine, many still important unknowns remain that complicate and potentially undermine successful financial conflicts regulation.One clear lesson from the Sunshine Act is that inherent implementation challenges, such as data identification and translation, can seriously undermine transparency as a regulatory tool. There are considerable doubts whether the law will significantly impact decision-making of primary audiences such as patients and physicians. At the same time, the Sunshine Act has generated valuable information about the nature and scope of financial ties between industry and medicine, such as variations by clinical specialty, type of payment, and physician gender, all of which have important implications for health law and policy and can inform future regulation. Notwithstanding greater transparency, a great deal unfortunately still remains unknown. A critical need for more evidentiary support exists in several key areas, including the actual causal impact of financial conflicts, the optimal way to disclose conflicts, what patients really think about financial relationships with industry, and the role of institutional conflict of interest committees in monitoring financial ties.