Of pens, mugs, and transparency.(COMMENTARY)

With the continuing public push for more transparency from government and corporations, three pharmaceutical companies have decided to get ahead of the game and begin online registries in 2009 that list payments to physicians who perform service to the company as educational speakers, clinical trial principal investigators, consultants, and members of advisory boards.

These advanced registries are anticipating the bill introduced in Congress by Sen. Chuck Grassley (R-Iowa) to address this issue. S. 301, the Physician Payments Sunshine Act, would require drug companies to submit a report to the Secretary of Health and Human Services detailing any payments made to physicians, as well as any food, gifts, trips, product rebates, admission to medical conferences, or any other compensation deemed appropriate. The reports would be available publicly via the Internet.

There is little argument that increased transparency in drug company-related transactions that might have ethical repercussions is a good idea given some of the significant misrepresentations reported in recent years, but the honoraria and fees paid to individual physicians, just like any other earned income, should also be a matter of some privacy. Most would agree that one's earned income is really the business only of the person who did the work and performed the service. If you serve in an advisory capacity or give educational lectures sponsored by these pharmaceutical companies, your honoraria for these activities will be listed on the Web site. How many individuals--regardless of profession--would welcome having their income displayed over the Internet?

In addition to the invasion of privacy posed by the registries, this information carries with it an enormous risk and potential for misinterpretation by the public, press, attorneys, and others. Anything posted as income generated by a physician from a pharmaceutical company probably will be viewed as a "gift" or perhaps a bribe and not for the legitimate educational activities they usually represent. The information also may potentially be used against a physician in a medical malpractice case.

When it comes to listing payments for clinical trials, the question is: Does the public really understand what goes into running a clinical trial? A physician may receive a large sum from a pharmaceutical company to perform a trial, but the physician's substantial overhead expenses for running the trial--such as additional personnel, supplies, and office-visit time expended--would, of course, come out of that amount. Only the gross amount ...