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

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Drs. Ahlawat and Narayanaswami1 detailed the extent of industry-related financial interests among neurologists captured in the Open Payments database (OP). 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 12,691 neurologists in 2013 (OP's first year), 2,896 had investments (22.8%) and 3,004 (23.7%) had some financial ownership. In 2016, these numbers dropped to 2,752/14,452 (19.0%) and 2,957/14,452 (20.5%), respectively. Mean value dropped from $190,310 to $174,455. Perhaps OP is having an effect, but more research is required.