Republican senator Chuck Grassley has made it his mission to shake up the cosy relationship between doctors, researchers and the pharmaceutical industry. Now he is introducing legislation to force drugs companies to disclose the payments they make to doctors. He tells Jim Giles why he has chosen to be a troublemaker

Does it really matter that some academics and doctors "forget" to declare their income from drug companies?

The public relies on the advice of doctors and has a right to know about financial relationships between those doctors and the companies that make the pharmaceuticals they prescribe. The same goes for leading researchers, as they influence the practice of medicine. If the payments are transparent, I believe that people who have close connections with a company will be a little more cautious about the extent to which they push one drug over another. US taxpayers should also know as they spend billions of dollars on prescription drugs and devices through Medicare and Medicaid.

Last year, you made claims about a psychiatrist using grants from the National Institutes of Health (NIH) to test a drug. You alleged he had not properly disclosed the stock he held in the company that owned the drug - claims which he has denied and which his employer has cleared him of. Can you tell me about that?

I am not able to comment on the specifics of any cases. But I can say that my discovery of undisclosed financial relationships between drug companies and researchers has put pressure on the NIH. It's a trustee of $24 billion in federal grants each year. It needs to make sure that those receiving its grants manage conflicts of interest.

What would you like the NIH to do about such conflicts?

It has a lot of power and it isn't using that power. It has a responsibility to make sure that information about conflicts of interest is disclosed and dealt with. The NIH is responsible for making sure universities collect this information. It says it cannot keep track of every university. Well, I say suspend a grant and you'll get everyone's attention.

I met with Elias Zerhouni before he stepped down as NIH director last year and he seemed concerned. But I'd like to see the agency looking for every opportunity to bring about disclosure, instead of looking for every reason not to do anything.

You also revealed that the presenter of a medical show on US National Public Radio had received substantial sums from companies whose products he covered.

We know the drug companies have been throwing huge amounts of money at medical researchers, and there's no clear-cut way to know how much and exactly where. Now it looks like the same thing is happening in journalism, with no accountability. The lack of transparency breeds cynicism and leads to legitimate questions about the effect on research and the practice of medicine. The public has got to wonder who it can trust for an independent point of view.

Are there any specific investigations that you can tell me about?

A whistleblower called Andrew Mossholder, who was a doctor at the US Food and Drug Administration, came to me because he had been muzzled by bureaucracy. It was about five years ago and he was due to present a paper in Paris that raised questions about the suicides of teenagers taking antidepressants, but the FDA wouldn't let him. The agency didn't like it because it had approved these drugs. How right he was: a little while later the FDA started putting a warning about suicide risk on the labels of antidepressant drugs.

Is this how things work in these agencies?

At the FDA, they had got to the point where the culture was not to follow the scientific process. There was also a cosy relationship between the drug companies and the agency. The result was the suppression of dissident points of view on whether or not a drug was safe. But it's not just the FDA. Recently I had FBI director Robert Mueller in my office. We talked about what is wrong with the culture of the FBI, the fact that they don't want information made public and always pester whistleblowers. I think this is a culture that spreads throughout bureaucracies. It's been unchecked too long and I'm kind of a check on it.

Healthcare professionals make up some of your top donors. Don't you have a conflict of interest yourself?

In the last year I've received donations from a lot of the organisations I've been investigating. They contribute because they believe in my philosophy of government. If someone needs to be oversighted, I oversight them.

Tell me about the legislation you introduced this year that would require companies to publicly report payments to doctors and scientists.

It's called the Physician Sunshine Act. We had a Supreme Court justice almost 100 years ago, Louis Brandeis, who said that when the sun shines in, it's a good disinfectant. Pharmaceutical companies or medical equipment manufacturers who use doctors as consultants will have to report how much they pay them. The information will go on the internet in a user-friendly way so that consumers can see it.

Four states collect this information but only one makes it public. I want to make this national. I want every client of every doctor to know if there is any possible prejudice in doctors' prescriptions.

But is disclosure enough? The payments will still continue and may affect the treatment decisions that doctors make.

We're trying to answer that question. I believe that transparency brings about changes of behaviour. If it doesn't, we'll consider other steps.

Isn't this going to be unpopular with some of your colleagues? Aren't you swimming against the tide of your party?

Yes. But oversight is non-partisan, it's a constitutional function. When I was doing defence oversight under the Bush and Reagan administrations I had a lot of support from the Democrats. When Clinton got to be president a lot of people who had been egging me to do more weren't quite so enthusiastic about investigating Democrats.

Are you saying that it doesn't matter so much which party you're a member of as which party is in power?

Yes. I don't want to say Democrats are better than Republicans, but I accept that I get people mad at my party. I still want to be doing the same thing now that Barack Obama is president.

Do you think it will be easier to force disclosure over conflicts of interest under Obama?

President Obama has made multiple pledges for transparency. Time will tell if these pledges will be kept.

Profile

Chuck Grassley was a sheet-metal shearer, an assembly line worker and a farmer before entering Congress as a Republican in 1974. Since then he has gone on to head the highly influential Senate Finance Committee. With Grassley's backing, the committee has investigated the abuse of tax-exempt status by non-profit organisations and the links between drug companies and physicians.