Abstract
This study characterizes payments by drug and medical device manufacturers to US peer reviewers of major medical journals.
Although conflicts of interest of journal editors and authors have been investigated,1,2 the traditionally opaque nature of peer review has hindered their evaluation among peer reviewers, despite their crucial role in academic publishing. While most journals have established conflict of interest policies for authors, fewer extend these policies to peer reviewers.3 In many cases, journals or editors may inquire about reviewer conflicts of interest and consider these while managing the peer review process, although publicly available reviewer conflict of interest disclosures are rare. Reviewers of leading medical journals may have industry ties due to their academic expertise.
We sought to characterize payments by drug and medical device manufacturers to US peer reviewers of major medical journals.
Methods
We identified peer reviewers for The BMJ, JAMA, The Lancet, and The New England Journal of Medicine (NEJM) using each journal’s 2022 reviewer list. These journals were selected for their high impact factor and reputation as leading publications of original general medical research. Because reviewer lists did not include affiliations, identification was conducted using Scopus and the National Plan and Provider Enumeration System, which also provided sex and specialty information. We limited our cohort to US-based physicians due to use of the Centers for Medicare & Medicaid Services Open Payments database. Two independent abstractors (A.-L.N., L.M.) performed the search strategy for each reviewer, with discrepancies resolved by a third author (D.-D.N.).
We extracted general and research payments to the identified peer reviewers between 2020 and 2022 from the Open Payments database, capturing payments from drug and medical device manufacturers to US-licensed physicians.4 We excluded ownership and investment interests because they are not equivalent to financial transfers and are less reliable than other general payments. Research payments included payments to individual physicians and institutional payments for research where they served as principal investigators. Institutional payments were divided by the number of principal investigators. Inflation-adjusted payment amounts in 2022 US dollars were calculated among those receiving payments.
We compared industry payments by sex and specialty using the Mann-Whitney U test and Kruskal-Wallis test with subsequent Dunn pairwise testing accounting for multiple testing, respectively. Analyses were performed using Stata MP version 17.0 (StataCorp). Statistical significance was defined as a 2-sided P < .05.
Ethics review was not required based on University of Toronto policy. Additional methods are available in the eAppendix in Supplement 1.
Results
Among 7021 reviewer names, including duplicates, we excluded 332 reviewers who were not searchable in Scopus, 3257 non-US reviewers, and 1325 nonphysicians. This left 1962 unique reviewers, of whom 145 (7.4%) had performed peer reviews for more than 1 journal.
Between 2020 and 2022, 1155 peer reviewers (58.9%) received at least 1 industry payment (Table 1). More than half (54.0%) of reviewers accepted general payments, while 31.8% received research payments.
Table 1. Industry Payments to US Physician Peer Reviewers (N = 1962) From 4 Major Medical Journals, 2020-2022.
| Characteristics | Value |
|---|---|
| Reviewers accepting payments, No. (%) | |
| General payments | 1060 (54.0) |
| Research paymentsa | 623 (31.8) |
| Any payments | 1155 (58.9) |
| Total payments, $ | |
| General payments | 64 181 780 |
| Research paymentsa | 1 004 488 143 |
| Overall | 1 068 669 920 |
| Payment received per physician, median (IQR), $b | |
| General payments | 7614 (495-43 069) |
| Research paymentsa | 153 173 (29 307-835 637) |
| Overall | 31 254 (2000-276 958) |
| Total payments by category, $ (%) | |
| Research payments via institutions (associated research funding)c | 999 197 635 (93.5) |
| Consulting fees | 34 313 903 (3.2) |
| Speaking compensation not related to CME program | 11 801 491 (1.1) |
| Royalty and licensing fees | 8 872 007 (0.8) |
| Direct research paymentsd | 5 290 510 (0.5) |
| Travel and lodging fees | 2 667 538 (0.2) |
| Grants not related to research | 2 172 550 (0.2) |
| Honoraria | 1 473 286 (0.1) |
| Food and beverage | 1 436 042 (0.1) |
| Speaking compensation related to CME program | 663 737 (0.1) |
| Education fees | 334 314 (<0.1) |
| Charity | 276 746 (<0.1) |
| Ownership or investment interest | 80 270 (<0.1) |
| Debt forgiveness | 75 514 (<0.1) |
| Gift | 7240 (<0.1) |
| Long-term medical supply or device loan | 5619 (<0.1) |
| Acquisition fees | 1497 (<0.1) |
| Entertainment fees | 25 (<0.1) |
Abbreviation: CME, continuing medical education.
Research payments included both research payments directly made to individual physicians and payments related to research where a physician was registered as a principal investigator (PI; defined as associated research funding in the Centers for Medicare & Medicaid Services [CMS] Open Payments database).
Median payment amounts were calculated for reviewers receiving industry payments.
Research payments via institutions are payments related to research where a physician was registered as a PI (defined as associated research funding in the CMS Open Payments Database). When more than 1 physician was registered as a PI for research payments, the payment amounts were assumed to be distributed equally among the PIs, divided by the number of PIs, and assigned to each physician PI.
Direct research payments are research payments directly provided to individual physician reviewers.
Reviewers received $1.06 billion in industry payments between 2020 and 2022, including $1.00 billion (94.0%) to individuals or their institutions and $64.18 million (6.0%) in general payments. Consulting fees and speaking compensation unrelated to continuing medical education programs accounted for $34.31 million and $11.80 million, respectively. Over the 3 years, the median general payment was $7614 (IQR, $495-$43 069) and the median research payment was $153 173 (IQR, $29 307-$835 637) among reviewers receiving such payments.
Male reviewers had significantly higher median total payments ($38 959 vs $19 586) and general payments ($8663 vs $4183) than female reviewers. Statistically significant differences in payments existed between specialties (Table 2).
Table 2. Industry Payments to US Physician Peer Reviewers, 2020-2022, by Reviewer Sex and Specialty.
| Characteristics | Eligible reviewers, No. (%) | Payments | ||||||||
|---|---|---|---|---|---|---|---|---|---|---|
| All categories | General | Research | ||||||||
| Reviewers receiving payments, No. (%) | Total payment amounts, $ | Payments per reviewer, median (IQR), $a | Reviewers receiving payments, No. (%) | Total payment amounts, $ | Payments per reviewer, median (IQR), $a | Reviewers receiving payments, No. (%) | Total payment amounts, $ | Payments per reviewer, median (IQR), $a | ||
| Sex | ||||||||||
| Female | 565 (28.8) | 284 (50.3) | 125 561 923 | 19 586 (1032-188 517)b | 257 (45.5) | 7 651 914 | 4183 (173-23 241)c | 145 (25.7) | 117 910 009 | 149 873 (27 110-723 230) |
| Male | 1397 (71.2) | 871 (62.4) | 943 107 997 | 38 959 (2616-308 526)b | 803 (57.5) | 56 529 866 | 8663 (701-51 720)c | 478 (34.2) | 886 578 135 | 154 762 (30 400-835 637) |
| Specialtyd | ||||||||||
| Primary caree | 522 (26.6) | 196 (37.6) | 112 673 661 | 12 833 (522-162 841)f | 170 (32.6) | 6 984 980 | 2658 (124-30 295)f | 96 (18.4) | 105 688 682 | 110 556 (17 308-816 476)g |
| Hospital-based specialtyh | 215 (11.0) | 102 (47.4) | 43 905 519 | 5211 (344-87 484)f | 94 (43.7) | 2 152 447 | 2123 (149-12 960)f | 38 (17.7) | 41 753 073 | 104 244 (22 003-454 211)g |
| Medical specialtyi | 747 (38.1) | 549 (73.5) | 790 331 563 | 86 392 (8663-523 047)f | 507 (67.9) | 36 372 862 | 15 971 (2997-73 117)f | 360 (48.2) | 753 958 703 | 209 400 (40 115-1 254 868)g |
| Surgical specialtyj | 225 (11.5) | 161 (71.6) | 67 223 575 | 4834 (276-44 997)f | 158 (70.2) | 14 853 239 | 2130 (207-15 862)f | 46 (20.4) | 52 370 336 | 60 201 (21 955-182 330)g |
| Obstetrics and gynecology | 120 (6.1) | 61 (50.8) | 15 226 223 | 3726 (134-85 823)f | 55 (45.8) | 1 210 510 | 800 (97-12 303)f | 25 (20.8) | 14 015 714 | 173 232 (16 304-383 630)g |
| Psychiatry and neurology | 133 (6.8) | 86 (64.7) | 39 309 378 | 42 417 (4975-266 595)f | 76 (57.1) | 2 607 742 | 10 539 (1673-29 109)f | 58 (43.6) | 36 701 636 | 96 567 (16 797-517 773)g |
| Overall | 1962 | 1155 (58.9) | 1 068 669 920 | 31 254 (2000-276 958)f | 1060 (54.0) | 64 181 780 | 7614 (495-43 069)f | 623 (31.8) | 1 004 488 143 | 153 173 (29 307-835 637)g |
Median payment amounts were calculated for reviewers receiving each category of industry payments.
P < .01.
P < .001.
Reference group for pairwise testing for specialties was primary care. P values were calculated with Dunn pairwise testing with Bonferroni adjustment.
Primary care includes family medicine, general internal medicine, general practice, geriatric medicine, pediatrics, and preventive medicine.
P < .001 for differences between the specialty groups.
P < .01 for differences between the specialty groups.
Hospital-based specialty includes anesthesiology, critical care medicine, emergency medicine, medical genetics, nuclear medicine, pain medicine, pathology, physical medicine and rehabilitation, and radiology.
Medical specialty includes addiction medicine, allergy and clinical immunology, cardiology, dermatology, endocrinology, gastroenterology, hematology, infectious diseases, nephrology, oncology (medical oncology and hematology/oncology), pulmonology, rheumatology, and sleep medicine.
Surgical specialty includes colon and rectal surgery, general surgery, neurological surgery, ophthalmology, orthopedic surgery, otolaryngology, plastic surgery, surgical oncology, thoracic surgery, transplant surgery, trauma surgery, vascular surgery, and urology.
Discussion
More than half of the 1962 US physicians included in this study who peer reviewed for the most influential medical journals received industry payments in 2020-2022, with most payments for research. Research payments, especially those provided to an institution, may have different implications than general payments for conflicts of interest. Peer reviewers in this study received $64.18 million in general payments between 2020 and 2022, representing a median general payment of $7614, larger than the median general payment to all physicians in 2018 of $216.5 Additional research and transparency regarding industry payments in the peer review process are needed. Limitations include that it was not known if existing relationships were relevant to the reviewed articles; that reviewers who were not US-based physicians and payments from other entities such as insurance and technology companies were not captured, underestimating industry payments to reviewers of these major journals; and that the findings may not be generalizable to other journals.
Section Editors: Kristin Walter, MD, and Jody W. Zylke, MD, Deputy Editors; Karen Lasser, MD, MPH, Senior Editor.
eAppendix. Supplemental Methods: Detailed Methodology
eReferences
Data Sharing Statement
References
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Associated Data
This section collects any data citations, data availability statements, or supplementary materials included in this article.
Supplementary Materials
eAppendix. Supplemental Methods: Detailed Methodology
eReferences
Data Sharing Statement
