The Obamacare website is not the only thing that debuted incomplete, buggy, difficult to use and nonetheless mandated. The Open Payments Program database, also known as the Physician Payments Sunshine Act, was 12 years in the making and designed to report drug and device industry payments to physicians, but it came onto the scene with a resounding thud, burdensome to most and helping almost no one. But it is too important to dismiss before its shortcomings are addressed, say the authors of a Viewpoint in JAMA.

There is a belief that payments to doctors by drug companies - for example, if a drug company wants to talk about its new Product X, it will have a group dinner, rather than expecting that doctors want to spend their evenings talking about work - will lead to doctors engaging in quid pro quo in return for that free steak, prescribing a new expensive version of something rather than a cheaper, older version. Are doctors really so unethical? What about the scientists producing the drugs? Would that not mean that Obama voters should not trust any work done by academic scientists funded during the Bush administration? What if a scientist goes from Wyeth to Johns Hopkins? Is that scientist still unethical? 

If you believe a free dinner makes a doctor unethical, sociologists can tell a lot about you, even how you vote, and to help agenda-driven journalists and the public who believe that about doctors and pharmaceutical companies, the U.S. Department of Health and Human Services created the site, botching it rather badly, but now has tried to ease navigation and in June 2015 will add year-round data instead of just five months worth.

The database has already led to stories. The New York Times wrote an article claiming that a doctor prescribed painkillers because of ties to a pharmaceutical company. And many people would like to have more of that kind of journalism, at least until drug development all moves to China the way astronomy left the US because of the hostile climate to telescopes. 

The site produced by the Centers for Medicare and Medicaid Services was incomplete in four main respects:

• Only five months of data: Payment data were limited to August to December of 2013 because of a delay in CMS issuing its final rules.

• Incomplete vetting: Only 4.8 percent of doctors and only 29.8 percent of teaching hospitals were vetted before the site's debut. This left more than 12,000 disputed records unresolved and unpublished.

• De-identified payments: Because of possible inaccuracies, 39 percent of payments (totaling $2.2 billion) were de-identified, including 90 percent of research payments.

• Limited context: Database users may not be able to infer the proper context of payments because the field for annotation is limited to 500 characters.

"This is a bad start, but we need to give it a chance,"  say Dr. Eli Y. Adashi, former dean of medicine and biological sciences at Brown University, and Sachin Santhakumar, a student in the Warren Alpert Medical School. "It's quite amazing to realize that industry pays physicians $4 billion to $5 billion a year. It's a relationship between parties that really ought to be, on many fronts, at arm's length."

The OPP is easily taken out of context by statements implying that doctors are getting $5 billion a year in bribes. In actuality, it would be useful to patients (though journalists seemed to be the goal in creating it) if data were available within other sites that report other indicators of medical practice, so people could assess their doctors in an all-encompassing way. As it exists now, it is just a new way to abuse the general practitioners we suddenly find we need more of, yet few doctors want to be, partially because of the culture war against them.

Problems notwithstanding, they conclude, "The OPP initiative must be viewed as the most potent antidote for potential conflicts of interest engendered by financial interactions between industry and the health care delivery enterprise. As such, it should be given the benefits of doubt and time."