Potential Financial Conflict of Interest Among Physician Editorial Board Members of Orthopaedic Surgery Journals

Self-Reported Conflicts of Interests and Financial Disclosures in The Journal of Foot & Ankle Surgery: A Systematic Review

Industry, academia, and professional societies provide financial and in-kind support for physician-lead research; however, the prevalence and role remain unreported. From consultancies to leadership positions, foot and ankle surgeons receive a spectrum of support. To provide transparency between these relationships and published outcomes, journals report conflicts of interest (COI) and financial disclosures (FD). This investigation analyzes self-reported COIs and FDs in The Journal of Foot & Ankle Surgery (JFAS)®. A systematic review of manuscripts reporting COIs and FDs from the January 2008 through November 2020 issues of JFAS was conducted. Editorials, commentaries, and technique articles were excluded. Disclosure type, level of evidence, and affiliated country of authorship were collected. Trends and proportions of articles with disclosures were analyzed from before a published Open Payments Database (OPD) (2008-2013) through 2020. Among 2699 articles, 382 reported a COI or FD. The number of manuscripts with COIs and FDs increased since 2008 (p < .001). The proportion of articles with COIs or FDs was greater after the OPD was published compared to prior (p < .001). Overall, 86.35% of reported COIs were industry related while 37.09% of FDs were hospital, university, or state sponsor affiliated. International authorship was a negative predictor of COIs and FDs (p < .001). Level 3 and 4 studies were 4.60 (95%CI [0.85-24.85]) and 5.56 (95%CI [1.04-29.72]) times as likely to have self-reported a COI compared to level 1 studies, respectively. Level 2 and 5 studies were 0.33 (95%CI [0.04-3.16]) and 0.36 (95%CI [0.04-3.13]) times as likely to have self-reported a FD compared to level 1 studies, respectively. This investigation found an increase in the proportion of manuscripts with self-reported COIs and FDs since first documented in JFAS. These findings illustrate the ubiquity of author industry involvement, though future studies may examine the relevancy of these roles to published research.

Industry Payments Among Editorial Board Members of Orthopaedic Journals: An Open Payments Analysis From 2014 to 2019

INTRODUCTION

Although industry payments to physicians and surgeons remain a subject of controversy, relationships between industry and orthopaedic surgeons continue to grow. Notably, recent analyses have demonstrated significant increases in the rate and magnitude of payments among orthopaedic surgeons, despite the passing of the Physician Payments Sunshine Act in 2010. Given the concerns regarding how these relationships may affect the peer-review process, our analysis aimed to evaluate how payments among editorial board members of orthopaedic journals have changed over a contemporary time frame.

METHODS

The Clarivate Analytics Impact Factor tool was used to identify all orthopaedic journals with a 2019 impact factor of ≥1.5. Editorial board members from these respective journals were identified from each journal's website. Subsequently, the Open Payments database by the Centers for Medicare and Medicaid Services was queried to identify industry payments received by these board members between 2014 and 2019. The quantity and magnitude of payments were then evaluated and compared over this study period. All monetary values were adjusted for inflation.

RESULTS

A total of 18 orthopaedic journals were included in our analysis. Of the 1,519 editorial board members identified, 711 (46.81%) received some form of industry payment in 2019. The total, average, and median payments over this study period decreased for 6 (31.6%), 7 (36.8%), and 8 of the included journals (44.44%), respectively. Six hundred twenty board members had higher average payments in 2019 than in 2014.

CONCLUSION

Our analysis demonstrated high rates of industry payments among editorial board members of high-impact orthopaedic journals. In addition, we demonstrated marked growth in the total, average, and median magnitude of these payments since the inception of the Open Payments database. Our findings encourage a continued need for transparency in related payments to ensure a fair and unbiased peer-review process, one that is separated from undue industry influence.

Industry Payments Among Appropriate Use Criteria Voting Panels: An Open Payments Analysis

BACKGROUND

Although multiple studies have consistently demonstrated that orthopaedic surgeons receive greater transfers of value than other specialties, the industry payments of providers who are involved in the formation of practice guidelines have not been thoroughly explored. Therefore, the purpose of our analysis was to evaluate the industry payments of the authors of the Appropriate Use Criteria (AUC) from the American Academy of Orthopaedic Surgeons (AAOS).

METHODS

The publicly available AAOS web portal (OrthoGuidelines.org) was queried for all AUCs that had been released between January 1, 2013, and December 31, 2019, regarding the management of musculoskeletal pathologies. A cross-sectional analysis of the Centers for Medicare & Medicaid Services (CMS) Open Payments database was conducted to determine the number and total value of industry payments to AUC voting committee members during the year of voting for the AUC. Industry payments for each orthopaedic surgeon voting member were compared with payments received by orthopaedic surgeons nationwide who received any payment within the same year. The proportion of orthopaedic surgeon voting members who received any industry payment was compared with the proportion of orthopaedic surgeons nationwide who received payments.

RESULTS

Our analysis included a total of 18 different AUCs with 216 voting members, 157 of whom were orthopaedic surgeons. Of the orthopaedic surgeon voting members, 105 (67%) received industry payments, a rate roughly comparable with the national average among orthopaedic surgeons (74%). For 7 of 18 AUCs (39%), the median payment per orthopaedic surgeon voting member was above the median among orthopaedic surgeons receiving payments nationwide that year. Qualitatively, orthopaedic surgeon voting members were more likely to receive payments in the form of royalties, licenses, or speaking fees than orthopaedic surgeons nationwide.

CONCLUSIONS

AUC voting members receive payments at frequencies and magnitudes that are roughly comparable with orthopaedic surgeons nationwide. Whether voting panel members receiving payments at these rates is ideal or is in the best interest of patients is a policy decision for the AAOS and society at large. Our study confirms that payments are common and, thus, continued vigilance is justified.

Ten years later: a review of the US 2009 institute of medicine report on conflicts of interest and solutions for further reform

Conflicts of interest (COIs) in healthcare are increasingly discussed in the literature, yet these relationships continue to influence healthcare. Research has consistently shown that financial COIs shape prescribing practices, medical education and guideline recommendations. In 2009, the Institute of Medicine (IOM, now the National Academy of Medicine) published Conflicts of Interest in Medical Research, Practice, and Education-one of the most comprehensive reviews of empirical research on COIs in medicine. Ten years after publication of theIOM's report, we review the current state of COIs within medicine. We also provide specific recommendations for enhancing scientific integrity in medical research, practice, education and editorial practices.

Industry Payments to Adult Reconstruction-Trained Orthopedic Surgeons: An Analysis of the Open Payments Database From 2014 to 2019

BACKGROUND

In recent time, there has been an increased push toward transparency in industry funding toward physicians. The Physician Payments Sunshine Act called for the creation of the Open Payments Database managed by the Centers for Medicare & Medicaid Services. To our knowledge, there have been no studies evaluating the trends in payments among adult reconstruction fellowship-trained orthopedic surgeons. The purpose of this study is to investigate trends in all payments to adult reconstruction-trained orthopedic surgeons from 2014 to 2019. Secondary outcomes included evaluating trends in yearly subpayment categories, regional variations, as well as characterizing the top 5 industry companies.

METHODS

A review of the Centers for Medicare & Medicaid Services Open Payments Database was performed to identify all payments to adult reconstruction-trained orthopedic surgeons. A total of 94,265 payments were made to 4911 surgeons accounting for a total of $258,865,231.20 during the study period. Our primary outcome was to assess the trend in median payment per year to individual surgeons. Secondary outcomes included evaluating payment trends with respect to subtype, location as defined by United States Census regions, as well as specifics concerning the top 5 companies.

RESULTS

Over the study period, there was a nonsignificant increasing trend in median payment per surgeon (r = 0.49, P = .096). However, there was also a significantly increasing trend in the number of payments per year (r = 0.83, P = .014), as well as the number of surgeons receiving payments (r = 0.88, P = .019). With respect to subcategory payments, there were significantly increasing trends in the median payment per surgeon for education (1054%, r = 0.942, P < .001) and entertainment/food and beverage expenses (20.2%, r = 0.49, P = .020), as well as a significantly decreasing trend for median honoraria payments per surgeon (20.2%, r = -0.04, P = .005). No significant regional trends were identified. Of the top 5 companies, one demonstrated a significantly decreasing trend in median payment per surgeon (21.6%, r = -0.109, P < .001), whereas the others remained unchanged.

CONCLUSION

In this study, we found a nonsignificant increasing trend in payments to adult reconstruction-trained surgeons as well as an increasing number of surgeons receiving payments. There were increasing trends in median payment per surgeon for education and entertainment expenses, but a decreasing trend for honoraria payments. No significant regional trends were identified. The majority of the top 5 companies had nonsignificant trends in their payments. Further studies are needed to characterize the disclosure of payments and the impact of industry payments on clinical outcomes.

LEVEL OF EVIDENCE

IV.

Financial Conflicts of Interest Among Systematic Review Authors Investigating Interventions for Achilles Tendon Ruptures

BACKGROUND

The primary aim of our study was to evaluate the effects of undisclosed financial conflicts of interest in Achilles tendon rupture repair-focused systematic reviews.

METHODS

Following a cross-sectional study design, we searched MEDLINE and Embase for Achilles tendon rupture repair systematic reviews. We performed screening and data extraction in a blind, triplicate fashion. Each systematic review was evaluated on the individual characteristics of the study, presence of undisclosed and disclosed conflicts of interest, favorability of results and conclusions, and the relationship between conflicts of interest and the favorability of results and conclusions.

RESULTS

Our search produced 172 total systematic reviews pertaining to Achilles tendon rupture repair; of those, only 12 were included in our study. Undisclosed conflicts of interest were found in half (6/12) of the included reviews. However, no significant association was found between conflict of interest and the favorability of results and conclusions.

CONCLUSION

Undisclosed conflicts of interests were discovered in a large percentage of our sample. This lack of disclosure did not appear to increase the likelihood of the systematic review results or conclusions reporting favorability of the intervention being investigated.

LEVEL OF EVIDENCE

Level II.

Is There an Association Between Authors' Conflicts of Interest and Outcomes in Clinical Studies Involving Autologous Chondrocyte Implantation?

BACKGROUND

Autologous chondrocyte implantation (ACI) is an increasingly popular technique for the treatment of articular cartilage defects. Because several companies have financial interests in ACI, it is important to consider possible conflicts of interest when evaluating studies reporting outcomes of ACI.

PURPOSE

To determine whether there is an association between authors' financial conflicts of interest and the outcomes of ACI studies.

STUDY DESIGN

Cross-sectional study.

METHODS

A search of PubMed and MEDLINE databases for "autologous chondrocyte implantation" was performed. Clinical studies published after 2012 through May 15, 2019, and in English were included. Studies were determined to have financial conflicts of interest if any contributing author had relevant conflicts, either self-reported in the published study's disclosures section or reported online in the American Academy of Orthopaedic Surgeons Disclosure database or the Centers for Medicare & Medicaid Services Open Payments database. The outcomes of each study were rated as favorable, equivocal, or unfavorable based on predefined criteria and then tested for association with conflicts of interest through use of the Fisher exact test.

RESULTS

A total of 79 studies met the inclusion criteria. Nearly all studies were of level 3 or 4 evidence. Conflicts of interest were established in 51.90% of studies (n = 41). Conflicts that were not self-reported by the authors were discovered in 18% of studies. The level of evidence was not associated with conflict of interest. No statistically significant difference was found in the rate of favorable outcomes between studies with conflicts (92.68%) and those with no conflicts (81.58%) (P = .126). Publications by US authors were more likely to have financial conflicts of interest (P = .003).

CONCLUSION

Favorable results were reported in a majority of studies involving ACI. No statistical association was found between the frequency of favorable outcomes and the presence of financial conflicts of interest, country of authorship, or level of evidence. There was a trend toward more favorable outcomes in studies with conflicts of interest. Additionally, nearly 20% of publications had possible conflicts found online that were not self-reported. It is critical for orthopaedic surgeons to judiciously evaluate published studies and consider financial conflicts of interest before performing ACI techniques on patients.

Conflicts of interest in clinical guidelines, advisory committee reports, opinion pieces, and narrative reviews: associations with recommendations

BACKGROUND

Treatment and diagnostic recommendations are often made in clinical guidelines, reports from advisory committee meetings, opinion pieces such as editorials, and narrative reviews. Quite often, the authors or members of advisory committees have industry ties or particular specialty interests which may impact on which interventions are recommended. Similarly, clinical guidelines and narrative reviews may be funded by industry sources resulting in conflicts of interest.

OBJECTIVES

To investigate to what degree financial and non-financial conflicts of interest are associated with favourable recommendations in clinical guidelines, advisory committee reports, opinion pieces, and narrative reviews.

SEARCH METHODS

We searched PubMed, Embase, and the Cochrane Methodology Register for studies published up to February 2020. We also searched reference lists of included studies, Web of Science for studies citing the included studies, and grey literature sources.

SELECTION CRITERIA

We included studies comparing the association between conflicts of interest and favourable recommendations of drugs or devices (e.g. recommending a particular drug) in clinical guidelines, advisory committee reports, opinion pieces, or narrative reviews.

DATA COLLECTION AND ANALYSIS

Two review authors independently included studies, extracted data, and assessed risk of bias. When a meta-analysis was considered meaningful to synthesise our findings, we used random-effects models to estimate risk ratios (RRs) with 95% confidence intervals (CIs), with RR > 1 indicating that documents (e.g. clinical guidelines) with conflicts of interest more often had favourable recommendations. We analysed associations for financial and non-financial conflicts of interest separately, and analysed the four types of documents both separately (pre-planned analyses) and combined (post hoc analysis).

MAIN RESULTS

We included 21 studies analysing 106 clinical guidelines, 1809 advisory committee reports, 340 opinion pieces, and 497 narrative reviews. We received unpublished data from 11 studies; eight full data sets and three summary data sets. Fifteen studies had a risk of confounding, as they compared documents that may differ in other aspects than conflicts of interest (e.g. documents on different drugs used for different populations). The associations between financial conflicts of interest and favourable recommendations were: clinical guidelines, RR: 1.26, 95% CI: 0.93 to 1.69 (four studies of 86 clinical guidelines); advisory committee reports, RR: 1.20, 95% CI: 0.99 to 1.45 (four studies of 629 advisory committee reports); opinion pieces, RR: 2.62, 95% CI: 0.91 to 7.55 (four studies of 284 opinion pieces); and narrative reviews, RR: 1.20, 95% CI: 0.97 to 1.49 (four studies of 457 narrative reviews). An analysis combining all four document types supported these findings (RR: 1.26, 95% CI: 1.09 to 1.44). One study investigating specialty interests found that the association between including radiologist guideline authors and recommending routine breast cancer screening was RR: 2.10, 95% CI: 0.92 to 4.77 (12 clinical guidelines).

AUTHORS' CONCLUSIONS

We interpret our findings to indicate that financial conflicts of interest are associated with favourable recommendations of drugs and devices in clinical guidelines, advisory committee reports, opinion pieces, and narrative reviews. However, we also stress risk of confounding in the included studies and the statistical imprecision of individual analyses of each document type. It is not certain whether non-financial conflicts of interest impact on recommendations.

Variations in surgical peer-reviewed publications among editorial board members, associate editors and their respective journal: Towards maintaining academic integrity

Background

Physician scientists who are also Editorial Board members or Associate Editors may prefer publishing in their own journal and therefore create an environment for conflicts of interest to arise.

Objectives

To assess the relationship between the number of peer-reviewed publications in surgical journals in which authors serve as Editorial Board Members and Associate Editors and their total number of annual publications.

Materials and methods

A cross-sectional study utilizing PubMed was performed regarding the total annual number of peer-reviewed publications by Editorial Board Members/Associate Editors and the number published in their respective affiliated journals from 2016 to 2019. Significance defined as p < 0.05.

Results

80 Associate Editors and 721 Editorial Board Members (n = 801 total) were analyzed from 10 surgical journals. The mean number of total annual peer-reviewed publications varied from 5.19 to 17.18. The mean number of annual peer-reviewed publications in affiliated journals varied from 0.06 to 2.53. Multiple significant associations were discovered between the total number of annual peer-reviewed publications and number of peer-reviewed publications in affiliated journals for all authors/surgical journals evaluated, except for the International Journal of Surgery (p > 0.05).

Conclusions

We found significant associations between the total number of annual peer-reviewed publications by Editorial Board Members/Associate Editors and number of annual peer-reviewed publications by their affiliated surgical journals. The implementation and enforcement of a standardized double-blind review process and mandatory reporting of any potential conflicts of interest can reduce possible bias and promote a fair and high-quality peer-review process.

Relationships among commercial practices and author conflicts of interest in biomedical publishing

Recently, concerns have been raised over the potential impacts of commercial relationships on editorial practices in biomedical publishing. Specifically, it has been suggested that certain commercial relationships may make editors more open to publishing articles with author conflicts of interest (aCOI). Using a data set of 128,781 articles published in 159 journals, we evaluated the relationships among commercial publishing practices and reported author conflicts of interest. The 159 journals were grouped according to commercial biases (reprint services, advertising revenue, and ownership by a large commercial publishing firm). 30.6% (39,440) of articles were published in journals showing no evidence of evaluated commercial publishing relationships. 33.9% (43,630) were published in journals accepting advertising and reprint fees; 31.7% (40,887) in journals owned by large publishing firms; 1.2% (1,589) in journals accepting reprint fees only; and 2.5% (3,235) in journals accepting only advertising fees. Journals with commercial relationships were more likely to publish articles with aCOI (9.2% (92/1000) vs. 6.4% (64/1000), p = 0.024). In the multivariate analysis, only a journal’s acceptance of reprint fees served as a significant predictor (OR = 2.81 at 95% CI, 1.5 to 8.6). Shared control estimation was used to evaluate the relationships between commercial publishing practices and aCOI frequency in total and by type. BCa-corrected mean difference effect sizes ranged from -1.0 to 6.1, and confirm findings indicating that accepting reprint fees may constitute the most significant commercial bias. The findings indicate that concerns over the influence of industry advertising in medical journals may be overstated, and that accepting fees for reprints may constitute the largest risk of bias for editorial decision-making.

Editors Should Declare Conflicts of Interest

Editors have increasing pressure as scholarly publishing tries to shore up trust and reassure academics and the public that traditional peer review is robust, fail-safe, and corrective. Hidden conflicts of interest (COIs) may skew the fairness of the publishing process because they could allow the status of personal or professional relationships to positively influence the outcome of peer review or reduce the processing period of this process. Not all authors have such privileged relationships. In academic journals, editors usually have very specialized skills and are selected as agents of trust, entrusted with the responsibility of serving as quality control gate-keepers during peer review. In many cases, editors form extensive networks, either with other professionals, industry, academic bodies, journals, or publishers. Such networks and relationships may influence their decisions or even their subjectivity towards a set of submitting authors, paper, or institute, ultimately influencing the peer review process. These positions and relationships are not simply aspects of a curriculum, they are potential COIs. Thus, on the editorial board of all academic journals, editors should carry a COI statement that reflects their past history, as well as actual relationships and positions that they have, as these may influence their editorial functions.

A Closer Look at the Relationship Between Industry and Orthopaedic Sports Medicine Surgeons

Background:

A recent study demonstrated that discrepancies exist between disclosures reported by authors publishing in The American Journal of Sports Medicine and disclosures listed in the Physician Payments Sunshine Act–initiated Open Payments database, managed by the Centers for Medicare & Medicaid Services (CMS). However, no study to date has explored the relationship between the biopharmaceutical and device industry (industry) and the membership base of the American Orthopaedic Society for Sports Medicine (AOSSM).

Purpose:

To critically examine the relationship between orthopaedic sports medicine surgeons and industry.

Study Design:

Cross-sectional study.

Methods:

The publicly available CMS Open Payments database website was accessed to search for sports medicine orthopaedic surgeons in the United States who were members of the AOSSM. Financial data, specifically general, research, and ownership payments for 2015, were recorded for each surgeon. The American Academy of Orthopaedic Surgeons (AAOS) disclosures of each surgeon were then obtained. Descriptive statistics and simple proportions were calculated to summarize the collected data, including years in practice and amount of payment. Median values for general payments were compared to provide a more accurate reflection of payments transferred to a “typical” sports medicine surgeon.

Results:

A total of $58,113,561 in general payments, $3,996,051 in research payments, $72,481,814 in money invested, and $144,552,383 in interest earned from money invested were identified as being paid to 2274 surgeons (all amounts in US$). The distribution of total general payments received was skewed: 10% of surgeons received 95.4% ($55,463,183) of the total general payments. A total of 1433 surgeons had completed, up-to-date AAOS disclosures. Although 44% (635 surgeons) self-reported no financial conflict to the AAOS, the Open Payments database indicated some level of industry support to these surgeons. Unreported general payments totaled $1,393,212, or a median of $561 per surgeon (interquartile range, $10-$200,048).

Conclusion:

Although orthopaedic sports medicine surgeons received substantial payments from industry, most of the total general payments were given to a small proportion of people. The regional distribution of these payments did not differ significantly. Summary reports of data are largely skewed by outliers and should be interpreted with caution. However, a large percentage of these surgeons failed to reveal industry support of any kind in their AAOS disclosures, including meals and educational funding, demonstrating the importance of transparency and accuracy when completing financial disclosures.

Academic Influence and Its Relationship to Industry Payments in Orthopaedic Surgery

BACKGROUND

The Hirsch index (h-index) quantifies research publication productivity for an individual, and has widely been considered a valuable measure of academic influence. In 2010, the Physician Payments Sunshine Act (PPSA) was introduced as a way to increase transparency regarding U.S. physician-industry relationships. The purpose of this study was to investigate the relationship between industry payments and academic influence as measured by the h-index and number of publications among orthopaedic surgeons. We also examined the relationship of the h-index to National Institutes of Health (NIH) funding.

METHODS

The h-indices of faculty members at academic orthopaedic surgery residency programs were obtained using the Scopus database. The PPSA web site was used to abstract their 2014 industry payments. NIH funding data were obtained from the NIH web site. Mann-Whitney U testing and Spearman correlations were used to explore the relationships.

RESULTS

Of 3,501 surgeons, 78.3% received nonresearch payments, 9.2% received research payments, and 0.9% received NIH support. Nonresearch payments ranged from $6 to $4,538,501, whereas research payments ranged from $16 to $517,007. Surgeons receiving NIH or industry research funding had a significantly higher mean h-index and number of publications than those not receiving such funding. Surgeons receiving nonresearch industry payments had a slightly higher mean h-index and number of publications than those not receiving these kinds of payments. Both the h-index and the number of publications had weak positive correlations with industry nonresearch payment amount, industry research payment amount, and total number of industry payments.

CONCLUSIONS

There are large differences in industry payment size and distribution among academic surgeons. The small percentage of academic surgeons who receive industry research support or NIH funding tend to have higher h-indices. For the overall population of orthopaedic surgery faculty, the h-index correlates poorly with the dollar amount and the total number of industry research payments. Regarding nonresearch industry payments, the h-index also appears to correlate poorly with the number and the dollar amount of payments. These results are encouraging because they suggest that industry bias may play a smaller role in the orthopaedic literature than previously thought.

Conflict-of-Interest Disclosures to The Journal of Bone & Joint Surgery: The Relevance of Industry-Reported Payments

BACKGROUND

Academic journals such as The Journal of Bone & Joint Surgery (JBJS) require disclosures of financial relationships that authors report as potential conflicts of interest. Because industry payments can take various forms, including food and beverage, consulting, or research payments, the purpose of this study was to determine which categories of industry-reported payments were most frequently considered by authors as irrelevant to their specific publication, and therefore not included in their journal disclosures.

METHODS

Author disclosures were collected from scientific articles published in JBJS in 2016. Payments reported by authors as relevant to the published article were compared with industry-reported payments from the Centers for Medicare & Medicaid Services Open Payments Database (OPD), which includes all payments to eligible physicians in the United States. The number of authors with payments found in the OPD and appearing in publication-specific disclosures was determined for each payment type. Of note, OPD data are not indicative of relevance to a particular publication; therefore, the accuracy of author disclosures could not be determined in this study.

RESULTS

A total of 747 eligible authors were included; 60.5% of authors did not report at least 1 payment from their OPD report in their publication-specific disclosures, most frequently representing industry payments for food and beverage (55.7%), followed by travel and lodging (26.9%). Payments for consulting (16.3%), royalties (8.2%), research (8.4%), and ownership interests (1.5%) were not considered to be relevant disclosures for specific journal articles by authors at lower rates than those for food and beverage and for travel and lodging.

CONCLUSIONS

Authors publishing in JBJS were more likely to conclude that industry-reported payments in the OPD for food and beverage and for travel and lodging were irrelevant for specific publications (as disclosed to the journal) than payments for consulting, royalties, research, and ownership interests.

Payments by US pharmaceutical and medical device manufacturers to US medical journal editors: retrospective observational study

Objective To estimate financial payments from industry to US journal editors.Design Retrospective observational study.Setting 52 influential (high impact factor for their specialty) US medical journals from 26 specialties and US Open Payments database, 2014.Participants 713 editors at the associate level and above identified from each journal's online masthead.Main outcome measures All general payments (eg, personal income) and research related payments from pharmaceutical and medical device manufacturers to eligible physicians in 2014. Percentages of editors receiving payments and the magnitude of such payments were compared across journals and by specialty. Journal websites were also reviewed to determine if conflict of interest policies for editors were readily accessible.Results Of 713 eligible editors, 361 (50.6%) received some (>$0) general payments in 2014, and 139 (19.5%) received research payments. The median general payment was $11 (£8; €9) (interquartile range $0-2923) and the median research payment was $0 ($0-0). The mean general payment was $28 136 (SD $415 045), and the mean research payment was $37 963 (SD $175 239). The highest median general payments were received by journal editors from endocrinology ($7207, $0-85 816), cardiology ($2664, $0-12 912), gastroenterology ($696, $0-20 002), rheumatology ($515, $0-14 280), and urology ($480, $90-669). For high impact general medicine journals, median payments were $0 ($0-14). A review of the 52 journal websites revealed that editor conflict of interest policies were readily accessible (ie, within five minutes) for 17/52 (32.7%) of journals.Conclusions Industry payments to journal editors are common and often large, particularly for certain subspecialties. Journals should consider the potential impact of such payments on public trust in published research.