 The long-time editor of prestigious medical journal started his editorial on physician conflicts of interest, describing a fantasy that doctors treat patients using simply the best evidence and experience rather than being influenced by money or self-interest. This is, of course, nonsense. There's a reason pharmaceutical companies spend billions of dollars on the influencing, education, and entertainment of doctors around the world. The vast majority of physicians in the United States take gifts from the pharmaceutical industry, and ironically cardiologists whose practice centers around diseases that can be largely prevented and treated with lifestyle changes receive the most payments of all. A previous compilation of surveys from the 80s and 90s found that on average doctors met with drug industry representatives face-to-face about once a week. Today, your family doctor may meet with drug company employees on average 16 times a month. Basically, there's only 20 workdays a month, so that's nearly every day. What does the public think about this? Only about half even appear to know what's going on. So if 83% of doctors receive gifts, it's likely that significant percentage of patients are not aware that their personal physician receives industry gifts. And we're not just talking like a Viagra paperweight or soap dispenser. For marketing, pharmaceutical companies spend $15,000 per physician every year, making conflicts of interest one of the most pressing problems in American healthcare. How do doctors feel about it? Most generally approve of the gifts. However, tellingly, physicians do not want gift relationships made public. Physicians disagree that it's inappropriate to accept gifts, but their reluctance to disclose this gift relationship to the public suggests that they must recognize that the public would not appreciate the practice. To analyze how physicians resolve this contradiction, researchers conducted a series of physician-focused groups. It turns out physicians use a variety of denials and rationalizations. They avoided thinking about it, denied responsibility. Doctors readily acknowledged the inherent conflict of interest, but this didn't stop them. In fact, some complained that the gifts were getting more modest. Us doctors tend to deny that we personally have any conflict of interest if a pharmaceutical company buys us a nice dinner, for example. We tend to insist that it won't affect our judgments in any way, as if drug companies just like wasting money on purpose. Most physicians contend that their colleagues are susceptible to industry's influence, but not them. Though physicians don't want these gift relationships to be public, that's just too bad, because thanks to Republican Senator Chuck Grassley, the Sunshine Act was inserted into Obamacare. And so for the first time, patients will now be able to see what, if any, financial ties their own doctor has. Doctors can't hide anymore. This will give patients some insights when choosing a provider, and once the database goes live, law enforcement agencies can also see who's getting money from industry to investigate illegal kickback cases. Right now, it might just be embarrassing, but this could allow Attorney Generals to go after doctors to see the kinds of incentives they may be getting for writing lots of prescriptions. And the database is live right now. If you go to openpaymentsdata.cms.gov slash search, or for a more user-friendly version, pro-publica's dollars-for-docs page, the industry, the drug industry spends billions trying to influence doctors, and for the first time, you can see if your physician, or any physician, has their hand out. Senator Grassley hoped that this would help save our nation money. It could reduce healthcare costs, if patients view such doctors less trustworthy, or choose doctors less in bed with industry, or could change physician behavior, who may want to avoid financial relationships with companies to guard against this patient distrust, or becoming the target of an expose or investigation. Or they could just try to cover it up. This is from the American Academy of Family Physicians, advising physicians how to avoid getting burned by the Sunshine Act. For example, drug companies now have to report when they give doctors free meals valued at over $10. So should family physicians just stop accepting free food from drug companies? No way! You just have to give the drug sales reps the right headcount, so the per-person meal cost dips below $10. The former longtime editor of the New England Journal of Medicine said it best. Although the spotlight has been on disclosing doctors' financial relationships with industry, the problem with conflicts of interest is not the lack of disclosure, but the existence of the conflict itself. Rather than just disclosing them, the best approach to financial conflicts is to have none.