dsm-iv psychiatric disorders had or previously had financial relationships with the pharmaceutical industry. in the us, starting in 2013, under the physician financial transparency reports (part of the sunshine act), the centers for medicare & medicaid services has to collect information from applicable manufacturers and group purchasing organizations in order to report information about their financial relationships with physicians and hospitals. data are made public in the centers for medicare & medicaid services website. the expectation is that relationship between doctors and pharmaceutical industry will become fully transparent. in a report conducted by opensecrets, there were more than 1,100 lobbyists working in some capacity for the pharmaceutical business in 2017. in the first quarter of 2017, the health products and pharmaceutical industry spent $78 million on lobbying members of the united states congress. medication pricing further information: medication costs § factors the pricing of pharmaceuticals is becoming a major challenge for health systems. a november 2020 study by the west health policy center stated that more than 1.1 million senior citizens in the u.s. medicare program are expected to die prematurely over the next decade because they will be unable to afford their prescription medications, requiring an additional $17.7 billion to be spent annually on avoidable medical costs due to health complications. regulatory issues ben goldacre has argued that regulators – such as the medicines and healthcare products regulatory agency (mhra) in the uk, or the food and drug administration (fda) in the united states – advance the interests of the drug companies rather than the interests of the public due to revolving door exchange of employees between the regulator and the companies and friendships develop between regulator and company employees. he argues that regulators do not require that new drugs offer an improvement over what is already available, or even that they be particularly effective. others have argued that excessive regulation suppresses therapeutic innovation and that the current cost of regulator-required clinical trials prevents the full exploitation of new genetic and biological knowledge for the treatment of human disease. a 2012 report by the president's council of advisors on science and technology made several key recommendations to reduce regulatory burdens to new drug development, including 1) expanding the fda's use of accelerated approval processes, 2) creating an expedited approval pathway for drugs intended for use in narrowly defined populations, and 3) undertaking pilot projects designed to evaluate the feasibility of a new, adaptive drug approval process. pharmaceutical fraud