Professor Tong Guo explains how mandated transparency didn't reduce pharmaceutical payments to physicians—instead, it taught companies to optimize them.

When the federal government mandated that pharmaceutical companies publicly disclose every payment to physicians—from conference sponsorships to consulting fees—policymakers expected transparency to reduce potential conflicts of interest. Instead, the payments kept flowing, and companies learned to optimize them.

In this episode, Professor Tong Guo, an associate professor of Marketing at Duke University’s Fuqua School of Business, discusses her study of the Sunshine Act—a federal law requiring pharmaceutical and medical device companies to publicly disclose payments to healthcare providers. Published in the Journal of Marketing Research (2021), Guo's research using advanced machine learning methods called causal forests analyzed $100 million in payments between 16 antidiabetic brands and 50,000 physicians. Her findings reveal a nuanced reality: while total payments did not decline significantly, they shifted toward physicians who prescribe more expensive drugs and generate higher ROI for firms.

As Guo explains, most disclosed payments are legal, including sponsorships for events, conference travel, and educational presentations. "Much of these expenditures are considered legal," she notes, "so it's natural that it doesn't come with much pressure to cut it down."

"For firms, the number one rule for them to run their business is always to think about their ROI model," she explains. The transparency regulation gave firms information about which competitors were reaching out to which physicians and when, allowing them to optimize their existing relationships for maximum return. When transparency gives all competitors access to the same information, firms don't retreat—they optimize.

For MBA students and professionals, Guo's findings offer critical lessons extending beyond healthcare. Transparency doesn't always lead to restraint. Understanding who benefits from newly available information—and how—is essential across industries, from healthcare to digital marketing. As Guo points out, similar disclosure regulations now apply across industries —from TikTok influencers required to disclose brand sponsorships to financial services and beyond. "Transparency regulations would not necessarily lead to drastic changes of how people practice their business," she says. Different parties have different capabilities to leverage disclosed information, potentially creating new competitive advantages rather than leveling the playing field.

Duke Fuqua Insights features digestible conversations with our faculty about the most impactful research from their careers, including studies they teach in Fuqua classes. New episodes every other week in season.

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