Dr Des Spence explains why the UK needs a Sunshine Act - BMJ

The United States is different. Its citizens have far too many horribly straight, white teeth. They wear checks, stripes, and bold colours all at the same time, all topped off with a baseball cap. They speak so loudly that you would swear they had a hearing impairment (probably caused by loud whooping as teenagers).

America’s style of medicine is foreign to us, too. The dogma of free enterprise allows direct to consumer advertising, which has made drug names as well known as Coca-Cola. Costs have soared, and new drugs have been widely prescribed, often off label, leading to polypharmacy, medicalisation, disease creep, and potentially the deaths of tens of thousands. The drug industry is dragging doctors down through excessive hospitality and concealed payments, and its influence has been compared to that of the tobacco industry. But never underestimate the US: it is as hard as nails when it comes to white collar crime, sentencing the investment adviser Bernard Madoff to 150 years’ imprisonment for financial fraud.

So the Obama administration introduced the Physician Payments Sunshine Act in 2009 to force the drug industry to release information about payments, gifts, travel, and education offered to doctors. We know that the industry pays key opinion leaders to act as advisers and “educators,” but the scale of payments has always been a closely guarded secret. US investigative journalists at the ProPublica public interest news agency have disclosed that $320m (£200m; €230m) was given to 18 000 doctors in 2009-10, with the top 10 receiving more that $250 000 each (“A sugared pill,” 8 March 2011,www.ft.com/cms/s/0/ae7099a0-49bc-11e0-acf0-00144feab49a.html#axzz1GZT6jkTd). These payments seem beyond excessive and poison the public professional standing of all doctors. They are rightly causing anger in the US and bringing about change through transparency.

Although the United Kingdom has been spared the worst of the free market zeal of the drug industry, we are more like our US cousins than we would like to admit. Leading experts in the UK receive direct payments from the industry as advisers and as “educators” in the marketing activity that passes as our greasy postgraduate medical education. And attempts to establish registers of payment at the trust level have failed. The General Medical Council seems incapable of tackling these important conflicts of interest. Voluntary attempts by doctors have also failed to deliver any transparency. The US has its flaws, but we should take a lesson from it in directness, openness, and grit. We need to protect the reputation and integrity of our profession from the actions of a few, so let there be sunshine in the UK too. The profession should demand that the drug industry release information about payments and hospitality paid to UK doctors.

Notes

Cite this as: BMJ 2011;342:d1647

Footnotes

• bmj.com Observations: Data sharing: let the sunshine in (BMJ2010;340:c1896, doi:10.1136/bmj.c1896); News: US drug manufacturers will have to disclose payments to doctors (BMJ 2010;340:c1648, doi:10.1136/bmj.c1648); News: Drug industry weakens US bill about disclosure of gifts (BMJ 2008;336:1268, doi:10.1136/bmj.39598.476250.DB)