Reader response: Financial relationships between neurologists and industry: The 2015 Open Payments database

Drs. Ahlawat and Narayanaswami¹ detailed the extent of industry-related financial interests among neurologists captured in the Open Payments (OP) database. Industry-related conflicts of interests (COIs) widely influence neurologic education, research, and clinical practice.² Industry-funded trials often reach different conclusions than non-industry-funded trials,³ and even small gifts to physicians can influence their prescribing practices.⁴ Despite the OP database's shortcomings,⁵ it is an important step for 2 reasons. First, disclosure only mitigates COI if the disclosed information is widely and publicly available. Patients are generally not aware of their doctors' financial relationships.⁶ We hope OP will improve transparency. Second, the resulting social pressure from this transparency could lead to divestment from financial COI. Full disclosure is an important step towards mitigating COI, but does not redress subconscious biases that nearly invariably accompany financial relationships²; COI avoidance is often preferable. To investigate OP's effects on divestiture, we reviewed all neurologists in OP from 2013 to 2016. Of 9,505 neurologists in 2013 (OP's first year), 13 (0.07%) had ownership or investment interests totaling $26,610,645 (mean $2,800; median $65,975; maximum $24,949,811. In 2016, 16 of 11,105 neurologists had ownership and investment interest (0.09%) totaling $2,103,947 (mean $191; median $41,497; maximum $700,521). Perhaps OP is having an effect, but more research is required.