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I read with interest the review by Ahlawat and Narayanaswami1 of the 2015 Open Payments database. Disclosure of potential conflicts of interest (COIs) does not imply the presence of bias, it only suggests the potential for bias. Patients or their caregivers may not understand this distinction and question the ethics and integrity of their physician. This risks breakdown of the physician–patient relationship and trust. An Open Payments program that encourages voluntary disclosures by physicians of relevant COIs with regulatory oversight by a federal agency such as the US Centers of Medicare and Medicaid Services would be ideal.
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Author disclosures are available upon request (journal{at}neurology.org).
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