The need for ethics innovation

The Physician Payments Sunshine provisions of the Affordable Care Act require all U.S. drug and medical device manufacturers covered under Medicare, Medicaid or SCHIP to disclose payments to physicians and teaching hospitals. The government will make payment information publicly available online beginning in the fall of 2013.
The Institute of Medicine (IOM) provided the logic behind this exercise in its 2009 report on conflicts of interest in medicine. Drawing from psychological data, the IOM observed that when human beings stand to benefit from a particular conclusion, they tend to weigh more heavily data favoring that conclusion. Thus, a physician who receives payments to be on the speaker's bureau of a drug company may be biased in favor of that company's products when speaking or prescribing medications to patients. When this happens, the physician's self-interests trump those of patients.
The IOM further noted that bias is typically unintentional - we're not even aware that our self-interests are affecting our judgments. This makes bias particularly difficult to manage through personal integrity and willpower.
In 2011, I edited a special issue of the journal Narrative Inquiry in Bioethics dedicated to conflicts of interest in medicine. I solicited stories from physicians about their relationships with industry. What I received instead was a collection of stories about how new rules led to the loss of industry gifts and the demise of an interdisciplinary continuing education group; how a medical practice manager and a hospital CEO tried to interfere with physicians' judgments to increase corporate profits; how pressure to obtain government grant funding may have led to a violation of research ethics; and how physicians continued to perform highly reimbursed procedures even when data emerged indicating that medical management would be more effective. Where were the stories about negative industry influence? Were the physicians in denial? Or did they rather recognize that nearly everyone in healthcare wants to affect physicians' behavior, and perhaps more importantly, that all money affects behavior - whether this money comes from fee-for-service medicine (see Healthcare Finance News' "Busted" section), government research grants or industry.
Perhaps we need to focus less on the distinction between "clean" and "dirty" money and more on the simple fact that money motivates behavior - even when we think it does not. When we admit this, we are in a better position to evaluate honestly whether we are meeting our professional priorities. The American Medical Association (AMA) clearly states the priorities of medicine: "A physician shall, while caring for a patient, regard responsibility to the patient as paramount." For healthcare administrators, priorities can be less clear given fiduciary obligations to shareholders or even the simple need to avoid deficit spending, which affects the amount of non-reimbursed care that can be provided to patients. The entire purpose of healthcare is to serve patients through the prevention or treatment of illness and the alleviation of suffering, but doing so requires people who are motivated to dedicate time, energy and resources to innovation and the delivery of care.
I do not know what set of rules and processes would best balance the interests of competing stakeholders - at once motivating innovation and the delivery of services while ensuring that patient interests remain paramount. But I am certain it will be more sophisticated than the Physician Payment Sunshine Act