Article Text

Download PDFPDF
Mandatory disclosure of all pharmaceutical and medical device companies’ payments to healthcare providers: learning from the USA
  1. Sidney Wolfe
  1. Public Citizen's Health Research Group, Washington, District of Columbia, USA
  1. Correspondence to Dr Sidney Wolfe, Public Citizen's Health Research Group, Washington, District of Columbia, USA; swolfe{at}

Statistics from

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.


Throughout history, people have attempted to influence others by offering money, goods or services. If such influence-peddling had not been so successful, it might have vanished long ago. However, following Darwinian principles, it has progressively evolved, becoming more prevalent, complicated, extremely successful and, too often, damaging to people who, unaware of influence-peddling schemes, become their victims.

The most succinct argument for transparency of influence-intended financial transactions was made over 100 years ago when former US Supreme Court Justice Louis Brandeis said, ‘Publicity is justly commended as a remedy for social and industrial diseases. Sunlight is said to be the best of disinfectants’.1

What is the problem?

As the practice of medicine evolved into what former New England Journal of Medicine editor Arnold Relman called the ‘new medical–industrial complex’ (a term first used by health policy experts Barbara and John Ehrenreich in the November 1969 issue of the Bulletin of the Health Policy Advisory Center in an article entitled ‘The Medical Industrial Complex’ and in a subsequent book, The American Health Empire: Power, Profits, and Politics 2) with increasing use of private companies to supply healthcare services to patients for a profit, a larger percentage of health expenditures are spent on pharmaceuticals and medical devices.2 Not content with merely influencing physicians and other health professionals via advertising, these industries also offer free meals, vacations and, more expensively, well-paying speaking and consultant fees. Such conflict of interest has been described as ‘a set of circumstances that creates a risk that professional judgement or actions regarding a primary interest will be unduly influenced by a secondary interest’.3

By the end of the first 6 years of government-mandated industry Open Payments Database (OPD) disclosure (2014–2019), US physicians, also defined as including dentists, podiatrists, optometrists and chiropractors,4 had been given more than $18 billion of ‘general payments’, …

View Full Text


  • Competing interests None declared. Refer to the online supplementary files to view the ICMJE form(s).

  • Provenance and peer review Commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.