Sunshinism: Protecting Patients or Further Destroying Physician Trust?

Yesterday, Dan posted about the new rules mandating the reporting of all physician payments from drug and device manufacturers. Generally, I've been in favor of increased transparency if, as Dan said, the "information is detailed and accurate." However, I think any system like this can and will be gamed and I suspect the results will be more destructive than constructive. For example, funding for "research" is thought to be less conflicting than direct payments to physicians for giving canned talks.  However, what about "research" support that pays for each patient enrolled and what if that payment goes directly to the enrolling physicians pocket, as would be the case in private practice? Is this such a bad thing that it needs to be constrained?

I suspect there are many other examples of how we won't be able to interpret the reports that are generated from these new rules.  I even suspect that the eventual approach to determining financial conflicts will be through opening up every physician's tax return.  That way, we can look at the true financial impact to the individual.  Pharmaceutical research that goes to a university and doesn't directly increase a physician's deans-approved salary would thus not appear on a tax return.  What about physicians that own stock in Pharma?  Wouldn't that be a more important conflict? You can see where this is going.  So someday soon, all physicians will have to share their tax returns with their patients perhaps by posting them in their waiting rooms or websites.

However, do you really think this will help root out conflicts?  What are the negative externalities of such an approach?  I suspect it will root out the caring physicians who don't want to appear to be in the pocket of pharma even if they are involved in highly important clinical studies. Which gets me to why I've been moved to write this post...

In today's NYT, David Brooks and Gail Collins debate the call to release Mitt Romney's tax return.  In the column, Brooks makes some important points, which I think are worth at least pondering in regards to the new payment disclosure rules and other examples of "sunshinism."

Brooks: "...there is a misbegotten ideology haunting the land, the ideology of sunshinism. This is the belief that everything should be made public. Sunshinism is a destructive ideology. Forcing people to financially undress in public is just one of those incursions that repels decent people..."

Could these new rules further mistrust of the medical community?  Is society better off when a patient doesn't want see an ID doc because she made $5000 enrolling patients in a trial of a new antibiotic? If she won't enroll patients, who will?

Which is a greater conflict for a physician? (a) $50,000 investigator initiated grant to a University (b) $5000 direct payment for giving a canned talk (c) $5000 for enrolling patients in a trial or (d) $50,000 stock in a pharmaceutical company that won't be disclosed under the new rules?

OK, so I think I've built a solid enough straw man.