A few tiny steps towards transparency: how the Sunshine Act shone light on industry’s influence in medicine

About 10 years ago President Barack Obama signed the Affordable Care Act. It included a small provision—called the Physician Payments Sunshine Act—that I initially drafted and then worked on for years.

At the time, I was working as an investigator for Senator Charles Grassley on the US Senate Finance Committee. Although not stated explicitly, the power of Congress to investigate is implied in the constitution. These powers have been affirmed through the courts1 and include the ability to demand access to documents held by private companies and government, and to interrogate citizens. Senate Finance has jurisdiction over Medicare and Medicaid—federal healthcare programmes—so most of my investigations involved corruption in medicine and science.

The Sunshine Act was congressional staff’s attempt to tackle many of the unseemly financial ties between physicians and industry that we kept uncovering when we examined problems with drugs and medical devices.

The push for the bill began when I walked into my boss’s office, the Finance Committee’s chief of investigations, with a story from the New York Times. It reported on a girl who was dealing with multiple side effects caused by drugs she was prescribed off label to treat bipolar disorder. The article detailed the various tricks the industry used to get doctors to prescribe drugs, including payments for research, consulting fees, and speaking gigs.2

One of the physicians mentioned in the article was at the University of Cincinnati and had received support for research from a pharmaceutical company and was paid to give promotional talks. The physician said the payments did not influence the research or the talks and when asked …