Show us the money: lessons in transparency from state pharmaceutical marketing disclosure laws

To assess legislation requiring drug companies to report gifts to providers, and to evaluate the information obtained.

Data included legislation in Vermont, Minnesota, Maine, Massachusetts, West Virginia, and the District of Columbia, and company disclosure data from Vermont.

We evaluated the strengths and weaknesses of state legislation. We also analyzed 4 years of company disclosures from Vermont, assessing the value and distribution of industry-provider exchanges and identifying emerging trends in companies' practices.

State legislation is publically available. We obtained Vermont's data through requests to the state's Attorney General's office.

Of the state laws, only Vermont's yielded robust, publically available data. These data show gifting was dominated by a few major corporations, and <2 percent of Vermont's prescribers received 69 percent of gifts and payments. Companies were especially generous to specialists in psychiatry, endocrinology/diabetes/metabolism, internal medicine, and neurology. Companies increasingly used loopholes in the law to avoid public scrutiny.

Disclosure laws are an important first step in bringing greater transparency to physician-industry relationships. But flaws and weaknesses limit the states' ability to render physician-industry exchanges fully transparent. Future efforts should build on these lessons to render physician-industry relationships fully transparent.