Paid to Peer-Review: Physicians Reviewing Top Medical Journals Received Billions from Big Pharma

More than half of physicians who peer-reviewed major medical journals received payments from pharmaceutical companies and the medical device industry.

More than half of physicians who peer-reviewed research for the most influential medical journals received substantial payments from pharmaceutical and medical device companies, according to a new analysis. These undisclosed financial ties raise concerns over whether reviewers can remain impartial when evaluating industry-backed studies, the very studies that shape modern healthcare guidelines and treatment standards.

A research letter published on Oct. 10 in the Journal of the American Medical Association found that $1.06 billion in total payments were made to 1,962 peer reviewers between 2020 and 2022. Of this amount, $1 billion was allocated directly to physicians or went to institutional research where the physician served as a principal investigator, while $64.18 million was classified as a general payment. 

A general payment is any payment made by a pharmaceutical or medical device company to a healthcare provider that isn’t tied directly to research activities, such as consulting fees, speaking fees, travel and lodging, or meals and entertainment.  

The Scope of Influence

The analysis utilized data from the Open Payments database, a federal transparency program established in 2013, to reveal financial relationships between healthcare providers and the industry. Initially intended to shed light on potential conflicts of interest in clinical care, the database now also serves as a window into peer review.

A peer reviewer is a professional, usually an expert in a specific field, who evaluates the quality, credibility, and accuracy of research submitted for publication in scientific or academic journals. This review process ensures that only high-quality, reliable studies are published, maintaining the integrity of scientific literature.

Peer reviewers examine aspects like the study’s methodology, the accuracy of data, the validity of conclusions, and the overall contribution to the field. They may also check for ethical concerns, potential biases, or conflicts of interest. Based on their assessment, reviewers recommend whether a study should be accepted, revised, or rejected. Their role is crucial because they act as gatekeepers, upholding the standards of scientific evidence that guide medicine, policy, and further research.

But this analysis tells a different story, revealing that the very individuals entrusted to vet industry-funded research are frequently on the receiving end of industry money.

Using the OpenPayments database, researchers analyzed industry payments made to peer reviewers of leading medical journals, including The Lancet, New England Journal of Medicine, JAMA, and the BMJ from 2020 to 2022.

In particular, payments were heavily concentrated among specialists whose work directly impacts treatment protocols and pharmaceutical recommendations. 

For example, allergists, immunologists, and cardiologists received more than $790 million combined, followed by primary care physicians ($113 million), surgeons ($67 million), and psychiatrists and neurologists ($39 million). These specialties wield substantial influence over the direction of medical guidelines, which heightens the implications of these financial ties.

Big Numbers, Big Implications

To put it in perspective, the median general payment per peer reviewer during this period was $7,614, a striking leap from the $216 median general payment in 2018. Research-specific payments averaged a substantial $153,173. 

Consulting and speaking fees contributed an additional $34 million, and another $12 million went to fees unrelated to continuing medical education. This influx of industry money into peer review is unprecedented, underscoring the sheer scale of financial relationships that may subtly shape which studies are published—and which are not.

Questions of Objectivity and Bias

With male reviewers receiving more payments than female reviewers, some are questioning not just the fairness of these financial distributions but their impact on the quality of peer review itself. Are these financial relationships clouding the objectivity of research evaluations? Critics argue that the rise in median payment amounts and the overall concentration of funds among influential specialists are red flags that demand closer scrutiny.

Without transparency, readers are left to assume that peer-reviewed studies are impartial and guided solely by scientific merit. However, when those who validate these studies receive significant financial backing from the same industry that benefits from favorable results, it calls into question the credibility of these medical publications. Should journals begin requiring reviewers to disclose industry payments in their review notes? Some would argue that transparency measures need a substantial overhaul.

Moving Forward: What’s at Stake?

This study’s findings reignite debates on the ethics of industry involvement in the scientific review process. As the gatekeepers of scientific validity, peer reviewers hold immense power over which studies influence clinical practice and healthcare policy. When reviewers are financially tied to the industry, readers and practitioners alike are left wondering: Can peer-reviewed journals truly serve as an unbiased source of truth?

Ultimately, these revelations underscore the need for reform, either by implementing disclosure requirements in peer review or establishing more stringent rules to ensure the impartiality of scientific research. The stakes are high, as lives are directly impacted by the treatments and protocols derived from these publications. Ensuring transparency and objectivity in peer-reviewed journals is not just about ethics—it’s about the very foundation of trust in modern medicine.