Professional societies, which advocated for increased opioid use, received funding from the pharmaceutical industry. 2 In 2012 alone, over 250 million prescriptions were written for opioids. 3,4 From 1999 to 2011, the use of prescription opioids, oxycontin, oxycodone, and hydrocodone, skyrocketed, as did deaths due to opioid-related overdoses. 5 Policy changes beginning at individual State levels began to reduce the availability of prescription opioids, resulting in a dramatic increase of the price on the illegal market, and a switch to lower-cost alternatives of heroin and more recently, fentanyl. The goal of the Sunshine Act was to increase financial transparency and to reveal potential conflicts of interest. 10 Data collection began on 1 August 1 2013; the process is now supported the Open Payments system run by CMS (https://openpaymentsdata.cms.gov/) and includes a tool for searching the database. In 2019, using data from CMS Open, ProPublica reported that more than 2500 physicians had received at least half a million dollars apiece from the pharmaceutical and medical device industries in the prior 5 years. 11 In the medical device industry, Rachal and Lim reported that in the 5 years since the Sunshine Act came into effect, contributions to doctors from the 20 top-spending medical technology companies more than tripled. 12,13 In our own profession, Marshall et al. have reported that payments to radiation oncologists have actually increased since the Open Payments system was implemented and suggested that increased emphasis on financial conflicts of interest is needed. 14 Lexchin and Fugh-Berman performed an exhaustive review of the literature and concluded that “… there is no evidence that physician behavior regarding conflicts of interest has changed,” and that disclosure is “…not sufficient to address the damage that industry relationships causes to medical knowledge and public health.” Additionally, the perverse incentives created can lead to wasteful health spending, with studies suggesting 25%−30% of overall health care spending could be considered waste. 16 And as we witnessed from the opioid crisis, perverse incentives can have profound public health consequences.