Medicare, Medicaid, Children's Health Insurance Programs; transparency reports and reporting of physician ownership or investment interests. Final rule

This final rule will require applicable manufacturers of drugs, devices, biologicals, or medical supplies covered by Medicare, Medicaid or the Children's Health Insurance Program (CHIP) to report annually to the Secretary certain payments or transfers of value provided to physicians or teaching hospitals ("covered recipients''). In addition, applicable manufacturers and applicable group purchasing organizations (GPOs) are required to report annually certain physician ownership or investment interests. The Secretary is required to publish applicable manufacturers' and applicable GPOs' submitted payment and ownership information on a public Web site.

Access denied: institutional barriers to justice for victims of torture in Egypt

This research explores the question - how do practices in key justice institutions affect the incidence and success of prosecutions of torture perpetrators in Egypt? The research question is grounded in the theory that torture prosecutions are crucial to ending the practice of torture, and based on the judgment that the number of prosecutions of torture perpetrators in Egypt is very small compared to the widespread practice of torture. This research observes practices in three main justice institutions: the Department of Public Prosecutions, the Department of Forensic Medicine and the criminal courts. Based on international and local literature, but also on interviews conducted with lawyers, forensic doctors and human rights activists, the research observes the practices most common to the three institutions, while analyzing their impact on the incidence and success of prosecutions. The research finds that different practices, backed by Egyptian legislation, and endorsed by poor institutional capabilities, violate the international standards for investigations, and affect the incidence and outcome of prosecutions.

Key opinion leaders and the corruption of medical knowledge: what the Sunshine Act will and won't cast light on

The pharmaceutical industry, in its marketing efforts, often turns to "key opinion leaders" or "KOLs" to disseminate scientific information. Drawing on the author's fieldwork, this article documents and examines the use of KOLs in pharmaceutical companies' marketing efforts. Partly due to the use of KOLs, a small number of companies with well-defined and narrow interests have inordinate influence over how medical knowledge is produced, circulated, and consumed. The issue here, as in many other cases of institutional corruption, is that a few actors have accumulated the power to shape the information on which many others base their decisions. Efforts to address this corruption should focus on correcting large imbalances in the current political economy of medical knowledge. A sequestration of pharmaceutical research and development on one hand from pharmaceutical marketing on the other, though difficult to achieve, would address this and many other problems.

Brightening up: the effect of the Physician Payment Sunshine Act on existing regulation of pharmaceutical marketing

With the passage of the Physician Payment Sunshine Act as part of the federal health care reform law, pharmaceutical manufacturers are now required to disclose a wide range of payments made by manufacturers to physicians. We review current state regulation of pharmaceutical marketing and consider how the federal sunshine provision will affect existing marketing regulation. We analyze the legal and practical implications of the Physician Payment Sunshine Act.

Ethical concerns regarding commercialization of deep brain stimulation for obsessive compulsive disorder

The United States Food and Drug Administration's recent approval of the commercial use of Deep Brain Stimulation (DBS) as a treatment for Obsessive Compulsive Disorder (OCD) will be discussed within the context of the existing USA regulatory framework. The purpose will be to illustrate the current lack of regulation and oversight of the DBS market, which has resulted in the violation of basic ethical norms. The discussion will focus on: 1) the lack of available evidence on procedural safety and efficacy, 2) the numerous conflicts of interest held by research investigators, and 3) the ambiguity of both aforementioned categories due to an inherent lack of transparency in the research. It is argued that in order to address these issues, ethical analyses of DBS for psychiatric disorders must include the role of the industry forces that have become the primary impetus for this research. As such, DBS for OCD serves as an important case example in studies of neurotechnology and innovative surgery.

Exposing conflict of interest in psychiatry: does transparency matter?

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.

Competing interests in healthcare: a conflict of quality. Part II: regulations, transparency, and policy implications

This research explores the association of physician conflicts of interest with quality of care. Specifically, we discuss the role of some government regulations as policy alternatives. The need for further regulation has become more apparent as improprieties in the healthcare industry have come to light. The dominating theme in current and proposed legislation, as well as institutional policies, is the idea of ensuring that conflicts of interest are transparent, thereby increasing the likelihood that appropriate relationships will be maintained between healthcare providers and industry representatives. Much of the difficulty that organizations are going to have in implementing effective policies is the resistance that will be initiated by physicians. In order to decrease the frequency of negative effects from conflicts of interest, we suggest that each organization establish a committee to create and oversee strict policies governing expectations regarding conflicts of interest.