The Sunshine Act: Commercial conflicts of interest and the limits of transparency

We must create a world in which the best experts are those that are free from commercial influence. And Europe needs legislation along the lines of the US Sunshine Act to combat both real and perceived commercial influence in science and health care. Sunshine Act, which became federal law in the United States in January 2012. 2 The Act requires drug and medical manufacturers who participate in federal programs to report annually on direct payments and other transfers of value made to physicians and teaching hospitals. As part of the disclosure mandated by the Act, information on amounts received by individual physicians will be made available on a publicly accessible website beginning in September 2014. The aim of the legislation is to tackle the issue of commercial conflicts of interest (COIs), which has been a source of heated debate in the medical community for well over a decade. Media coverage of commercial conflicts within medicine focused greater public attention on the issue and raised concern about the integrity of medical information. 3 In 2009, the US Institute of Medicine weighed in with a report that described commercial COIs within medical practice and education as widespread and often hidden from public view. 4 The report stressed that financial ties can exert undue influence on physicians' judgments, research, and practice, thus jeopardizing patient care, scientific integrity, and objectivity in education. It recommended that medical education should be free of industry sponsorship and that experts on panels who establish clinical guideline practices be prohibited from having commercial COIs. Both recommendations were intended to ensure greater public trust in medicine. Another recommendation was for the implementation of policies that would make financial ties between industry and the medical community more transparent to the public. This particular recommendation was welcomed by Senator Chuck Grassley, co-author of the Sunshine Act and a champion of the view that meta-phorical sunshine—disclosure—is a powerful aid to accountability. Grassley was instrumental in heightening public concern about commercial COIs and the need for greater accountability. He spearheaded investigations that brought financial ties out of the shadows and exposed egregious violations of federal conflict-of-interest reporting requirements by influential physicians in eminent academic institutions. 5 These investigations reinforced the perception that commercial COIs were ubiquitous and poorly managed, and that they required better oversight to mitigate their effects. Against this backdrop, the Sunshine Act gained political momentum and eventually became law as part …