Financial Conflicts Of Interest Research Articles

Financial relationships between industry and principal investigators of US cooperative group randomized cancer clinical trials.

Financial conflicts of interest (FCOIs) could bias the potentially practice-changing oncologic randomized clinical trials (RCTs) of tomorrow. This investigation characterized the FCOIs of the principal investigators (PIs) of all currently accruing trials of the four (adult) cooperative groups of the National Clinical Trials Network. For our study, the PI list was first compiled, and each name was then searched in the CMS Open Payments database. For each transaction (general payments (GPs) or research funding (RF)), the amount/number/source of payments was recorded. Results showed that from 2014 to 2019, the 91 PIs collectively accepted nearly one-third of a billion dollars ($10 477 023 GPs and $320 096 233 RF). The mean and median GP was $6505 and $945, respectively, and $301 693 and $49 824 RF, respectively. Multivariable Gamma regression analysis revealed that higher GP sums were associated with RCTs involving any type of systemic therapy, and higher RF sums with medical oncologist PIs, trials with phase III components, and RCTs involving radiotherapy (P < .05 for all). Both higher-volume GPs and RF were predicted by PIs having accepted payment(s) from the manufacturer of the drug utilized in their RCT (P < .001 GP, P=.008 RF). Taken together, the main message of this investigation is that FCOIs may be particularly high in PIs of phase III systemic therapy trials, especially if the PI accepted payments from the manufacturer of the drug utilized in their trial. Such RCTs should be thoroughly scrutinized by medical journals, the FDA, and insurance companies for potential "industry bias" that could influence the integrity of their conclusions.

Conflicts of Interest in "Throwaway" Dermatology Publications: Analysis of the Open Payments Database.

Dermatology journals, periodicals, editorials, and news magazines are influential resources that are not uniformly regulated and subject to influence from the pharmaceutical industry. This study evaluates industry payments to physician editorial board members of common dermatology publications, including "throwaway" publications. The aim of this study was to characterize the extent and nature of industry payments to editorial board members of different dermatologic publications in order to ascertain differences in payments between different types of publications. A list of editorial board members was compiled from a collection of clinical dermatology publications received over a 3-month period. Data from the Open Payments database from 2013 to 2019 were collected, and analysis of payments data was performed. Ten publications were evaluated, and payments data for 466 physicians were analyzed. The total compensation across all years was US $75,622,369.64. Consulting, services other than consulting, and travel or lodging payments constituted most of the payments. A fraction of dermatologists received the majority of payments. The top payers were manufacturers of biologic medications. Payment amounts were higher for throwaway publications compared to peer-reviewed journals. Editorial board members of dermatology publications received substantial payments from the pharmaceutical industry. A minority of physicians receive the lion's share of payments from industry. "Throwaway" publications have more financial conflict of interest than do peer-reviewed journals. The impact of these conflicts of interest on patient care, physicians' practice patterns, and patient perception of physicians is noteworthy.

Historical trends in health care-related financial holdings among members of Congress.

Revelations that some members of Congress, including members of key health care committees, hold substantial personal investments in the health care industry have raised concerns about lawmakers' financial conflicts of interest (COI) and their potential impact on health care legislation and oversight. 1) To assess historical trends in both the number of legislators holding health care-related assets and the value and composition of those assets. 2) To compare the financial holdings of members of health care-focused committees and subcommittees to those of other members of the House and Senate. We analyzed 11 years of personal financial disclosures by all members of the House and Senate. For each year, we calculated the percentage of members holding a health care-related asset (overall, by party, and by committee); the total value of all assets and health care-related assets held; the mean and median values of assets held per member; and the share of asset values attributable to 9 health asset categories. During the study period, over a third of all members of Congress held health care-related assets. These assets were often substantial, with a median total value per member of over $43,000. Members of health care-focused committees and subcommittees in the House and Senate did not hold health care-related assets at a higher rate than other members of their respective chambers. These findings suggest that lawmakers' health care-related COI warrant the same level of attention that has been paid to the COI of other actors in the health care system.

Conflicts of interest in oncology expanded access studies.

Expanded access is a treatment use of investigational drugs, biologicals or medical devices outside of clinical trials. The purpose of our study was to assess self-reported conflicts of interest (COIs) in oncology expanded access studies. One hundred fifty-eight oncology expanded access studies published from 2013 through 2020 were included. The pharmaceutical industry funded either completely or in part 94 studies (59.49%). The authors disclosed mostly financial COIs, while the number of the reported nonfinancial conflicts was relatively small (3528 and 57 COIs, respectively). The number of articles in which at least one author had a financial COI was 118 (74.68%). The most common financial COI types included advisory board membership/consulting (1471 COIs; 41.7%), followed by honoraria (570 COIs; 16.16%) and research funding (441 COIs; 12.5%). Logistic regression was performed to identify predictors of disclosing financial COIs and positive study's conclusions. On univariate analysis, financial COIs were more likely to occur in studies with at least one center located in the United States (odds ratio [OR], 5.62; 95% confidence interval [CI], 1.57-35.98; P=.02). We also found that positive conclusions about the studied treatments were less likely in studies without industry funding (OR, 0.26; CI, 0.08-0.77; P=.01). Most of the research on COIs in oncology performed to date focused on other types of studies, especially clinical trials. To our knowledge, our study is the first to evaluate COIs in oncology expanded access studies.

Accuracy of post-publication Financial Conflict of Interest corrections in medical research: A secondary analysis of pharmaceutical company payments to the authors of the CREATE-X trial report in the New England Journal of Medicine.

In June 2017, Japanese and Korean authors published the results of the CREATE-X trial in the New England Journal of Medicine (NEJM). After we identified their inadequate disclosures of Financial Conflict of Interests (FCOIs), the authors made a post-publication correction of their FCOIs. The purpose of this study is to evaluate the accuracy of the post-publication corrections by the Japanese authors of the CREATE-X trial. All the Japanese authors of the CREATE-X trial were included in the study. We determined the payments received by these authors in 2016 using publicly available data published by 78 pharmaceutical companies based on the stipulated Japanese transparency guidelines. We retrieved the original and revised versions of the FCOI disclosures as published on the NEJM website, and compared the payments reported by the pharmaceutical companies and the original and revised FCOI disclosures of the authors. Of the 12 authors, nine received payments made by the drug manufacturer involved in the CREATE-X trial. Of these nine, only three (33.3%) originally disclosed their relationships, and another three (33.3%) later disclosed such relationships in the post-publication corrections. Similarly, of the 11 receiving at least one payment from other manufacturers of breast cancer products, none correctly disclosed the payments in the original or the revised disclosure. In the CREATE-X trial, FCOIs with pharmaceutical companies were not properly disclosed by 11 of the 12 Japanese authors, even after the post-publication corrections, which highlights the need to pay more attention to the accuracy of FCOI disclosures in academic publications.

Personal Payments from Pharmaceutical Companies to Authors of Oncology Clinical Practice Guidelines.

Oncologists who author clinical practice guidelines frequently have financial relationships with the pharmaceutical industry. It is unknown whether participation on clinical practice guideline committees is associated with differences in the amounts of industry money received. We conducted a nested case-control study from August 2013 to December 2018. We manually abstracted membership records of National Comprehensive Cancer Network (NCCN) Guidelines committees for the 20 most common cancers and linked to Open Payments. The study sample included medical oncologists selected to join an NCCN Guidelines committee ("joiners") during the study period. Joiners were matched 1:2 to medical oncologists who had no participation on NCCN committees (controls) by gender, NCCN institution, and medical school graduation year. We performed difference-in-differences (DiD) estimation to assess whether selection to an NCCN committee was associated with the dollar value of payments received from industry, using generalized estimating equations to address correlation between matched pairs and between repeated observations of the same pair. During the study period, 54 physicians joined an NCCN Guidelines committee. These physicians received more payments than matched controls in the year prior to joining ($11,259 vs. $3,427; p=.02); this difference did not increase in the year after joining (DiD=$731; p=.45). Medical oncologists selected to NCCN Guidelines committees had greater financial ties to industry than their peers. The potential influence of industry in oncology clinical practice guidelines may be reduced through the selection of committee members with fewer ties to industry. Oncologists who author clinical practice guidelines frequently have financial conflicts of interest with the pharmaceutical industry. This creates concern about the potential for industry influence on guidelines. However, it is unknown whether oncologists who author guidelines have greater industry relationships than their peers. This study compared medical oncologists who were newly selected to join a National Comprehensive Cancer Network (NCCN) Guidelines panel with medical oncologists at the same institutions and at similar career stages. At the time they joined, oncologists joining NCCN Guidelines panels had received more than three times the dollar value of industry payments than their peers. The potential for industry influence may be reduced by the selection of less-conflicted panel members.

Association Between Conflicts of Interest and Authors\u2019 Positions on Harms of Varenicline: a Cross-Sectional Analysis

BackgroundFew studies have investigated the relationship between industry funding/conflicts of interest and authors’ positions in opinion pieces on drug safety. Harmful effects of varenicline, a treatment for smoking cessation, have been highly contested.ObjectiveTo examine the association between pharmaceutical industry funding/authors’ financial conflicts of interest and position on varenicline in opinion articles, especially in relation to the minimization of harms; to assess whether opinion pieces on drug safety issues written by authors with conflicts of interest are more frequently cited in the news or social media.DesignCross-sectional analysis.ParticipantsEnglish language opinion pieces and narrative reviews about varenicline published between May 2006 and February 2019.Main MeasuresOdds ratios and 95% confidence intervals; the Mann-Whitney two-sample statistic was used to test for differences in Altmetric scores, a measure of media attention.Key ResultsOf the 221 included articles, 30.3% (67) disclosed the funding source and 62.9% (139) disclosed authors’ conflicts of interest. Authors of opinion pieces on varenicline who reported financial ties to the pharmaceutical industry (as a conflict of interest or funding source) were more likely to minimise the cardiovascular and psychiatric risk of varenicline compared to those without conflicts of interest or industry funding (OR: 4.00; 95% CI: 1.32 to 12.16 for cardiovascular risk; OR: 8.51; 95% CI: 3.79 to 19.11 for psychiatric risk). These associations persisted in sensitivity analyses. No statistically significant difference in Altmetric score was found between articles with (mean 15.83, median 3) and without (mean 11.90, median 1) conflicts of interest, indicating similar media attention (p-value=0.11).ConclusionsWe found that authors with financial ties to drug companies were more likely to publish opinion pieces that minimised harms of varenicline. These results raise questions about journals’ editorial policies to accept reviews of treatments from authors with financial relationships with manufacturers.

Improving financial disclosures in oncology.

e18642 Background: The Physician Payments Sunshine Act, as part of the Affordable Care Act, was enacted in 2010 to improve transparency of payments from drug and medical device manufacturers to physicians, which are easily accessible in a public database (OpenPayments CMS). However, in a review conducted of clinical drug trials in oncology, one-third of oncologist authors did not disclose their industry payments. Failure to disclose financial conflicts of interest can lead to a loss of public trust and in some cases may lead to legal liability. The American Society for Clinical Oncology and our institutional polices require all faculty to fully report financial conflicts of interest (COI). This pilot project aims to evaluate the accuracy of financial COI disclosures among our oncologists at the University of Chicago, and improve subsequent disclosures. Methods: This project was approved through the institutional quality improvement process. In May 2020, we crossmatched COI disclosures on journal publications for 37 practicing clinical hematologists/oncologists in our institution with 2017 and 2018 records on OpenPayments. We then conducted a department-wide Grand Rounds to review omissions, and to remind faculty of ASCO and University COI policies. In addition, we privately contacted individual oncologists to review any COI omissions. We reminded faculty that at the end of 2020 we would again review the accuracy of their disclosures. Results: We examined a total of 37 practicing hematologists/oncologists’ disclosure forms. At initial review, 6/37 (16.2%) of oncologists had incomplete or missing disclosures. A total of $569,182.95 in payments was not disclosed in 2018. 2 of these 6 oncologists did not disclose relevant payments from pharmaceutical companies whose drugs were referred to in publications. Several disclosure errors appeared to be inadvertent omissions as they were disclosed in other publications. Reasons given for disclosure omissions were: “oversight”, “did not believe to be relevant to publication”, “confusion over journal COI policies”, “unnecessary due to low payment amount”, "too many journals to update disclosures in". At the final review, only 2 of the 6 oncologists with disclosure omissions had updated disclosures at the end of the year despite education provided at multiple grand rounds and private communications. Conclusions: This pilot project demonstrated that education sessions and individual feedback improved adherence to COI disclosure policies, but not fully. Additional feedback and enforcement mechanisms may be required for full compliance. In addition, a centralized disclosure form (such as ASCO’s disclosure form) that journals can easily access may improve disclosure adherence.

The B Reader Program, Silicosis, and Physician Workload Management: A Niche for AI Technologies.

The National Institute for Occupational Safety and Health (NIOSH) has operated its B Reader Program for over fifty years. Originally intended as a screening program for black lung disease, it has since received a broadened mandate to cover other occupational pneumoconioses, such as silicosis. At the same time, the B Reader Program itself has witnessed a consistently declining pool of participating physicians, alongside high levels of subjectivity and possible financial conflicts of interest. This supply-demand mismatch will exacerbate the burden upon current B Readers and complicate employer compliance with federal screening requirements. This represents a particular niche for AI-enabled radiology tools, which stand to ease physician workload, enhance diagnostic accuracy, and further the public health objectives of routine screening. NIOSH should consider establishing a pilot program for these applications within its existing technology development infrastructure and utilize its rulemaking authority to facilitate scaling.

Death, taxes and uncertainty: Economic motivations in end-of-life decision making

Economic motivations are key drivers of human behavior. Unfortunately, they are largely overlooked in literature related to medical decisionmaking, particularly with regard to end-of-life care. It is widely understood that the directions of a proxy acting in bad faith can be overridden. But what of cases in which the proxy or surrogate appears to be acting in good faith to effectuate the patient’s values, yet doing so directly serves the decision-maker’s financial interests? Such situations are not uncommon. Many patients care as deeply about economic wellbeing of their families as they do for their own lives and health. This brief work examines three scenarios that raise ethical issues regarding the role of pecuniary motives in making critical medical decisions. Each scenario presents a potential financial conflict of interest between an incapacitated patient and a third-party decision-maker and offers a framework for integrating ethical and legal concerns into clinical care. It is our hope that this work prepares physicians for unexpected ethical conflicts of interest and enables them to further the interests of his or her patients.

Sustained long-term benefits of patient support program participation in immune-mediated diseases: improved medication-taking behavior and lower risk of a hospital visit.

BACKGROUND: Patient support programs (PSPs) improve medication-taking behavior in the first 12 months of treatment for patients with immune-mediated diseases, but it is unknown if these benefits ar...

Industry payments to US physicians for cancer therapeutics: An analysis of the 2016–2018 open payments datasets

BackgroundMany oncologists who lead guidelines and clinical trials have financial conflicts of interest (fCOI) with industry. However, the extent to which fCOI reaches all cancer care providers is not known. Here we describe industry payments across all cancer care specialties by specific drug. MethodsThis observational, retrospective cohort study used Open Payments to describe general payments (i.e. consulting fees, meals, travel) to all US physicians for any cancer medicine during 2016–2018. Endpoints included number and value of payments by specialty, drug, and year. ResultsDuring 2016–2018, industry made general payments to 52 441 physicians for 137 unique cancer drugs. Annual number of payments (465 655 in 2018) and total value ($98.5 million in 2018) increased over the study period (20 % and 31 % increase since 2016). Medical/hematologic oncologists, surgical oncologists and radiologists received the highest total value of payments, accounting for $65.7 million (67 % of total), $13.4 million (14 % of total) and $10.8 million (11 % of total) in 2018. In 2018, 5 % of physicians (n = 1660) received >$10 000 in annual payments and 0.6 % (n = 209) received >$100 000. Pembrolizumab and Nivolumab, were associated with the highest total payment in each year, accounting for 12 % and 6 % (2018) of total value, respectively. ConclusionsWhile prior work has identified fCOIs among oncology leaders, these data suggest that payments extend across the cancer system. Policy summaryPre-existing data suggest a strong relationship between industry payments and physician prescribing. The current study demonstrates that fCOIs among oncology prescribers are pervasive. The oncology community must consider the extent to which these relationships influence clinical practice and regulatory policies.

Discrepancies in self-reported financial conflicts of interest disclosures by physicians: a systematic review

BackgroundThere is a high prevalence of financial conflicts of interest (COI) between physicians and industry.ObjectivesTo conduct a systematic review with meta-analysis examining the completeness of self-reported financial COI disclosures by...

Association between Financial Conflicts of Interest and International Labor Office Classifications for Black Lung Disease.

Rationale: The U.S. Department of Labor administers the Federal Black Lung Program (FBLP), an administrative system charged with managing claims by coal miners for workers' compensation for totally disabling coal mine dust lung disease. Specific case reports have raised concern that financial conflicts of interest (COIs) may systematically bias physicians when they are classifying chest X-rays (CXRs) for the absence, presence, and severity of pneumoconiosis. Objectives: To evaluate the direction and magnitude of association between financial COIs of physicians participating in the FBLP and international standards for the classification of radiographs of pneumoconiosis. Methods: An epidemiologic assessment of black lung claims filed to the FBLP from 2000 to 2013 was conducted to determine physician classifications of radiographs. FBLP court decisions from 2002 to 2019 (n = 7,656) were used to evaluate financial COIs of each physician. The main outcome measures used were classifications of radiographs for the absence of pneumoconiosis (small opacity classifications of 0/0 or 0/1), simple pneumoconiosis (small opacity classifications of 1/0 through 3/+), and progressive massive fibrosis (PMF) (large opacities with classifications of A, B, or C). Results: Of 63,780 radiograph classifications made by 264 physicians, 31.4% were read positive for simple pneumoconiosis and 3.6% were read as having PMF. There were 52 physicians who classified CXRs as having no evidence of pneumoconiosis in 99%+ of their readings and 18 physicians who classified CXRs as positive for simple pneumoconiosis in 99%+ of their readings. The adjusted odds of a negative classification of pneumoconiosis was 1.46 (95% confidence interval [CI], 1.44-1.47) per 10% increase in the proportion of court records demonstrating that a physician was hired by the employer. Per 10% increase in court records indicating a physician was hired by the miner/claimant, the adjusted odds ratio for classifying simple pneumoconiosis was 1.51 (95% CI, 1.49-1.52), and the adjusted odds ratio for finding PMF was 1.28 (95% CI, 1.26-1.30). Conclusions: There was a strong association between source of payment and radiograph classification, suggesting the importance of eliminating financial COIs in what should be an objective determination of eligibility for Black Lung Workers' compensation benefits.

Rapid and efficient generation of T-cell receptor-like antibodies using chip-based single-cell analysis.

Generation of TCR-like monoclonal antibodies using conventional methods is markedly laborious and inefficient. We have proposed improvements of ISAAC (chip-based Ab-secreting cell [ASC] screening method), allows comprehensive analysis of ASCs at the single-cell level to obtain TCR-like antibodies; blocking procedure enables us to avoid the detection of non-TCR-like antibodies.

How prevalent are financial conflicts of interest in dermatology randomized controlled trials? A cross‐sectional study

Several countries have introduced transparency databases since the last assessment of conflicts of interest (COIs) in dermatology randomised controlled trials (RCTs) in 2004. We assessed the prevalence of financial COIs in dermatology RCTs and quantified payments from study sponsors to academic/clinical authors using transparency databases. Transparency databases are available in the US, France, Australia, Belgium, and the Netherlands. The UK has a non-compulsory database. We included RCTs from the top seven general medical journals and top ten dermatology journals published in 2019. The study included 83 RCTs, and COIs were identified in 69%. The highest prevalence was in exclusively industry-funded trials (46/47, 98%), which consisted of personal payments to an academic/clinical author (96% of trials) and employees/stockholders as authors (96%). Payments were identified for 31/56 (55%) academic/clinical first/final authors (median payment $28 746 US dollars, maximum $597 299, interquartile range $128 570), and 24/31 payments (77%) payments totalled >$10 000.

Neuraminidase inhibitors for treatment of influenza.

Neuraminidase inhibitors (NAIs) are commonly used in the prevention and treatment of influenza. Previous studies and reviews have demonstrated a questionable and modest benefit of their use while demonstrating potential adverse effects.1,2.

Reimagining Bias: Making Strange With Disclosure.

Academic presentations in health professions continuing professional development (CPD) often begin with a declaration of real or potential conflicts utilizing a three-slide template or a similar standardized display. These declarations are required in some constituencies. The three-slide template and similar protocols exist to assure learners that the content that follows has been screened, is notionally bias free, and without financial or other influence that might negatively affect health provider behavior. We suggest that there is a potential problem with this type of process that typically focusses in on a narrow definition of conflict of interest. There is the possibility that it does little to confront the issue that bias is a much larger concept and that many forms of bias beyond financial conflict of interest can have devastating effects on patient care and the health of communities. In this article, we hope to open a dialogue around this issue by "making the familiar strange," by asking education organizers and providers to question these standard disclosures. We argue that other forms of bias, arising from the perspectives of the presenter, can also potentially change provider behavior. Implicit biases, for example, affect relationships with patients and can lead to negative health outcomes. We propose that CPD reimagine the process of disclosure of conflicts of interest. We seek to expand reflection on, and disclosure of, perspectives and biases that could affect CPD learners as one dimension of harnessing the power of education to decrease structural inequities.

A161 PREVALENCE OF FINANCIAL CONFLICTS OF INTEREST (FCOI) AMONG PROPENSITY-SCORE MATCHED RETROSPECTIVE STUDIES EVALUATING BIOLOGIC THERAPEUTICS FOR IBD

Abstract Background Inflammatory Bowel Disease (IBD) studies have commonly relied on real-world evidence to evaluate different therapies. An emerging idea has been the use of propensity score matching as a statistical method to account for baseline characteristics in IBD patients. In retrospective studies, propensity score matching of patients helps reduce treatment assignment bias and mimic the effects of randomization. Recently, propensity-score matching has become an important tool in IBD studies comparing biologic therapeutics. Biologic medications are among the highest-grossing drugs worldwide, and their pharmaceutical producers make considerable payments to physicians to market them. In spite of this, there is a lack of evidence examining the role of undue industry influence among propensity-score matched comparative studies evaluating biologic therapeutics for IBD. Aims Given the documented association between IBD biologics and FCOI, we hypothesize a high burden of FCOI in propensity-score matched studies. The aim of this study was to evaluate the prevalence of disclosed &amp; undisclosed financial conflicts of Interest (FCOI) in propensity-score matched comparison studies evaluating biologics for IBD. Methods We developed &amp; ran a librarian-reviewed systematic search on EMBASE, MEDLINE, and Cochrane Library databases for all propensity-score matched retrospective studies comparing biologics for the treatment of IBD. Full-text retrieval &amp; screening was performed on all studies in duplicate. 16 articles were identified. Industry payments to authors were only considered FCOI if they were made by a company producing a biologic that was included in the comparison study. Disclosed FCOI were identified by authors’ interests disclosures in full-texts. Any undisclosed FCOI among US authors were identified using the Centre for Medicare and Medicaid Services (CMS) Open Payments Database, which collects industry payments to physicians. Results Based on a preliminary analysis of 16 studies, there was at least one author with a relevant FCOI in 14 (88%) of the 16 studies. 14 studies (88%) had at least one disclosed FCOI, while 6 studies (37.5%) had at least one undisclosed FCOI. Among studies with disclosed FCOI, a mean of 40.2% (SD = 23.4%) of authors/study reported FCOI. Among studies with undisclosed FCOI, a mean of 18.8% (SD = 7.0%) of authors/study reported FCOI. The total dollar value of FCOIs was $1,974,328.3. The median conflict dollar value was $5,576.6 (IQR: $321.6 to $36,394.9). Conclusions We found a high burden of undisclosed FCOI (37.5%) among authors of propensity-score matched studies evaluating IBD biologics. Given the potential for undue industry influence stemming from such payments, authors should ensure better transparency with industry relationships. Funding Agencies None

Financial Conflicts of Interest of United States-Based Authors in Neurology Journals: Cross-Sectional Study Using the Open Payments Database.

To detail the scope, nature, and disclosure of financial conflicts of interest (COI) between the pharmaceutical and medical device industries (Industry) and authors in high-impact clinical neurology journals. Using the Centers for Medicare and Medicaid Services Open Payments Database (OPD), we retrieved information on payments from Industry to 2,000 authors from randomly selected 2016 articles in 5 journals. We categorized payments by type (research, general, and associated research/institutional), sponsoring entity, and year (from 2013 to 2016). Each author's self-disclosures were compared to OPD-listed Industry relationships to measure discordance. Payments were manually reviewed to identify those from manufacturers of products that were directly tested or discussed in the article. We also quantified the prevalence and value of these nondisclosed, relevant COI. Two hundred authors from 158 articles had at least 1 OPD payment. Median/mean annual payments per author were $4,229/$19,586 (general); $1,702/$5,966 (research); and $67,512/$362,102 (associated research). Most neurologists received <$1,000/y (74.6%, 93.0%, and 79.5% for general, research, and associated research, respectively), but a sizeable minority (>10% of authors) received more than $10,000 per year, and several received over $1 million. Of 3,013 payments deemed directly relevant to the article, 50.9% were not self-disclosed by the authors, totaling $5,782,197 ($1,665,603 general; $25,532 research; $4,091,062 associated research). Industry-related financial relationships are prevalent among United States-based physicians publishing in major neurology journals, and incomplete self-disclosure is common. As a profession, academic and other neurologists must work to establish firm rules to ensure and manage disclosure of financial COI.