The recent news that pharmaceutical giants Eli Lilly and Merck will voluntarily disclose payments to physicians represents a positive step in the area of disclosure, but much more needs to be done to help ensure that doctors' financial interests do not factor into their decisions regarding patients' health and wellbeing.

For decades, drug makers have spent huge sums plying doctors with lavish trips for presentations and lectures in which the drug companies' new products are promoted. Patients have been left to wonder whether doctors whose offices are lined with promotional items for popular prescription drugs are prescribing medicines for medical or financial reasons.

As a result of research and anecdotal evidence demonstrating that doctors are influenced by these financial relationships to the detriment of their patients, bipartisan legislation called the Physician Payments Sunshine Act is expected to be passed by Congress. The act would establish a mandatory national registry of payments to physicians, essentially requiring comprehensive reporting by pharmaceutical companies and the makers of medical devices and supplies as well as biological medicines. The companies would be required to disclose speaking and consulting fees as well as other forms of physician compensation, including stock options, profit distributions, ownership or investment interests, gifts, travel, entertainment, and payments for clinical investigations.

However, many critics believe that the proposed legislation needs to go much further and is being watered down in response to pressure from pharmaceutical industry lobbyists. The original draft of the legislation called for the firms to declare gifts of more than $25 per year, but that has since been raised to more than $500. In addition, it has also been revised to reduce fines to $1,000-$50,000 from $10,000-$100,000 per violation.

This proposed legislation appears that it probably will pass, and it is definitely an important step toward making important changes to a system that allows physicians' financial remuneration from pharmaceutical and medical device manufacturers to remain secret from their patients. Until it is enacted, patients will not have the right to know about potentially ulterior profit motives behind their doctors' recommended treatments and prescriptions.