BACKGROUND: No one has been more effective than U.S. Senator Charles Grassley in promoting transparency in medicine. His investigations into undisclosed physician-industry ties culminated in the Physician Payments Sunshine Act (PPSA), which will make drug and device companies' payments to physicians a matter of public record. Yet it is unclear whether PPSA will resolve the problems that Grassley's campaign for it revealed. METHODS AND FINDINGS: We analyzed five signal cases, all involving psychiatrists, that Grassley presented to the U.S. Senate as examples of why PPSA was needed. We sought to determine the impact of the information Grassley brought to light on the physicians who failed to report their industry ties and on the medical institutions responsible for overseeing their conduct. Despite the clarity of the violations and the powerful actors and institutions involved, the consequences of exposure were slow to materialize and limited in their impact. CONCLUSIONS: Our findings demonstrate both the need for transparency and its limitations. The medical profession and the government should use the PPSA data to verify disclosures, but they must also implement stronger conflict of interest policies to help ensure that physicians' industry ties, however transparent, do not compromise scientific integrity or patient care.
BACKGROUND: No one has been more effective than U.S. Senator Charles Grassley in promoting transparency in medicine. His investigations into undisclosed physician-industry ties culminated in the Physician Payments Sunshine Act (PPSA), which will make drug and device companies' payments to physicians a matter of public record. Yet it is unclear whether PPSA will resolve the problems that Grassley's campaign for it revealed. METHODS AND FINDINGS: We analyzed five signal cases, all involving psychiatrists, that Grassley presented to the U.S. Senate as examples of why PPSA was needed. We sought to determine the impact of the information Grassley brought to light on the physicians who failed to report their industry ties and on the medical institutions responsible for overseeing their conduct. Despite the clarity of the violations and the powerful actors and institutions involved, the consequences of exposure were slow to materialize and limited in their impact. CONCLUSIONS: Our findings demonstrate both the need for transparency and its limitations. The medical profession and the government should use the PPSA data to verify disclosures, but they must also implement stronger conflict of interest policies to help ensure that physicians' industry ties, however transparent, do not compromise scientific integrity or patient care.