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The Sunshine Act: Increasing Transparency or Opening Pandora’s Box?

Almost two years ago the Centers for Medicare and Medicaid Services (CMS) proposed a new rule that would incorporate the Physician Payments Sunshine Act into health care reform, with the underlying goal of enhancing transparency between drugmakers, physicians and the public. Since then, the healthcare and pharma industries have been buzzing with speculation, questions and concerns over how this mandate will impact patient care, but no one really knows for certain how the bill will impact healthcare and to what extent a little sunshine might change things. Will we enter a new period of transparency and patient awareness, or will the unintended consequences make us wish this Pandora’s Box was never opened?

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  • I wonder how long it might be before we start seeing transparency in patient medical records. Privacy as we all once knew and expected is currently a losing battle. Police and intelligence agencies are on the verge of almost total access to every aspect of an individual's life, from their emails to their entire activity on the internet and even at the library and bookstore.

    The proponents of this kind of transparency use a kind of bonehead logic to the effect that it might help to prevent some terrible terrorist crime. One the one hand, almost anything "might" prevent some terrorist crime, including pre-emptively locking up anyone who "might be a possible suspected terrorist sympathizer," a standard used to direct drone hits in Afghanistan, although this intelligence probably wasn't compiled from internet, library or medical records -- only the accident of proximity, a kind of guilt by association. I wonder why they call it "intelligence?"

    Back to medical transparency. Access to medical information could raise all kinds of issues, especially for employers and all kinds of economic relationships. Why should a company hire someone who is taking any kind of medication for depression, moods or anxiety? They might do something odd on the job and cause some kind of liability situation. How about medications that might affect "possible driving behavior" in the case of a truck driver? This might show up in a driving accident investigation. Certainly plaintiff attorneys would ask for the information if it would help their case. Imagine "You let him drive after you knew he was taking a drug that slowed attention response, even by a millisecond?" You can use your own imagination to extend this list for several pages.

    So, transparency and the related privacy issues is a double-edged sword. It's going to be difficult to make medical corporations transparent and keep the ultimate customer base of the medical profession -- the patients -- completely private and secure, in spite of what the Obamacare backers have said. Once all medical records go into an electronic database, and we all know what hacking is and what lawyers do, there really isn't much hope.


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