Show us the money: lessons in transparency from state pharmaceutical marketing disclosure laws.

OBJECTIVE: To assess legislation requiring drug companies to report gifts to providers, and to evaluate the information obtained. DATA SOURCES: Data included legislation in Vermont, Minnesota, Maine, Massachusetts, West Virginia, and the District of Columbia, and company disclosure data from Vermont. STUDY
DESIGN: We evaluated the strengths and weaknesses of state legislation. We also analyzed 4 years of company disclosures from Vermont, assessing the value and distribution of industry-provider exchanges and identifying emerging trends in companies' practices. DATA COLLECTION
METHODS: State legislation is publically available. We obtained Vermont's data through requests to the state's Attorney General's office. PRINCIPAL
FINDINGS: Of the state laws, only Vermont's yielded robust, publically available data. These data show gifting was dominated by a few major corporations, and <2 percent of Vermont's prescribers received 69 percent of gifts and payments. Companies were especially generous to specialists in psychiatry, endocrinology/diabetes/metabolism, internal medicine, and neurology. Companies increasingly used loopholes in the law to avoid public scrutiny.
CONCLUSIONS: Disclosure laws are an important first step in bringing greater transparency to physician-industry relationships. But flaws and weaknesses limit the states' ability to render physician-industry exchanges fully transparent. Future efforts should build on these lessons to render physician-industry relationships fully transparent.