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Nearly half of the members of 18 U.S. orthopedic journal editorial boards (46.8%) received industry payments in 2019 that were worth more than $109 million in total, researchers found.

These payments have shot up overall in recent years, with the total amount jumping up by more than half at several journals since 2014, according to the study, presented at the annual meeting of the in Chicago and published in the .

Medical journal editorial board members take part in peer review, recruitment of study authors, and promotion, among other roles. They are often unpaid.

The study didn't examine whether industry payments directly impact editorial decisions about published research in the orthopedic journals, but the findings do reveal trends, lead author and Cleveland Clinic orthopedic surgeon Atul F. Kamath, MD, told MedPage Today.

"Of those receiving payments, 620 -- 87% -- received higher average payments in 2019 than in 2014," Kamath said. "A majority of journals experienced growth in the average, median, and total payments received by their editorial board members."

The researchers focused on the 1,519 editorial board members of 18 orthopedic journals with impact factors of at least 1.5. They gathered 2014-2019 financial data from the Open Payments database maintained by the Centers for Medicare and Medicaid Services.

In 2019, the highest average industry payment levels for editorial board members were at Clinical Orthopedics and Related Research ($12,290) and Spine ($11,199). The lowest averages were $548 at Orthopedics Clinic of North America, $590 at the Journal of Orthopedic Research, and $769 at Journal of Pediatric Orthopedics.

Several journals saw total payments jump from 2014-2019, including Journal of Orthopedic Research (67%), Journal of Hand Surgery (60%), Journal of Pediatric Orthopedics (58%), Journal of Shoulder and Elbow Surgery (54%), and Journal of Bone and Joint Surgery (54%).

There was an especially large gap between the journals with the biggest and smallest reach as judged by impact factor: Only 3% of the 169 editorial board members of American Journal of Sports Medicine, the journal with the highest impact factor (5.81), made more than $100,000 in industry payments in 2019. In contrast, 19% of the 110 members of Clinical Spine Surgery, which had the lowest impact factor of those studied (1.59), reached that level.

The Journal of Arthroplasty also stood apart: it had a high percentage of editorial board members receiving payments (63%) and taking in more than $100,000 (17%). And the total payments for its editorial board members reached $30.7 million in 2019, by far the highest of any journal and up 30% from 2014. It also had 205 editorial board members, by far the highest number of examined journals.

"The high number of editorial board members receiving payments of more than $100,000 -- approximately 140 -- was unexpected," Kamath said. "Although payments of this magnitude frequently are related to royalties or intellectual property, they are disproportionately higher than most members, who received less than $1,000. As data over the past few years continues to demonstrate that disclosures among physicians aren't fully accurate, seeing a higher proportion of individuals receive payments of this caliber strongly emphasizes the need for transparency."

The study authors wrote that industry payments "may represent compensation related to their contribution to the orthopedic academic community and to innovation in the field." However, they noted that "there has been an ongoing concern that even small gifts from the industry may negatively affect clinical practice," and "the leadership of journals and national orthopedic societies may consider limiting the proportion of individuals who receive payments of certain magnitudes when selecting individuals to be part of their organization."

Andrew J. Schoenfeld, MD, MSc, editor-in-chief of Spine, told MedPage Today that he cannot comment about previous years, since he just took over his role in January.

However, he said "the editorial board during the period under study is not reflective of the current board composition, which has been completely revamped along with our editorial process." Further details about the changes at the journal weren't immediately available.

The editors of Clinical Spine Surgery and Journal of Arthroplasty did not return requests from MedPage Today for comment about the study findings.

Adam Bitterman, DO, of Northwell Health Physician Partners Orthopaedic Institute in Huntington, New York, an orthopedic surgeon who's written for MedPage Today in support of an industry role in medical academia, said transparency about disclosures is key.

"It is OK to have financial relationships with industry," said Bitterman, who has studied industry payments. "This can come in many ways as noted within the database -- travel, royalties, consulting, etc. There is nothing wrong with developing a product or an implant and receiving well-deserved compensation. The important thing to note is that disclosure of this relationship is critical, especially if you are in a decision-making role for a journal or speaking about a topic where there may be relevant bias."

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