Powered by sunshine: Next steps for making transparency matter.

We appreciate the thoughtful commentaries about our study of physicians’ views of the Physician Payments Sunshine Act (PPSA; H.R. 3590 2010) and the Open Payments database. A common theme emerges: the limits, even perils, of transparency generally and PPSA specifically. Ross, for example, rightly notes that PPSA has failed to bring full transparency to industry–prescriber exchanges (Ross 2017). So too, transparency alone cannot mitigate conflicts of interest (COIs) (Adashi 2017; DuBois 2017; Hurst 2017; Koch et al. 2017; Sinha and Kesselheim 2017; Krimsky 2017). Worse, transparency by itself may have ill effects, such as misleading patients to believe that COIs have been resolved, or freeing conflicted physicians to exaggerate their biases (Chambers 2017). These critiques point to the urgent need to make transparency matter— to build upon PPSA so as to effectively address COIs