Many doctors sitting on the boards of major medical associations regularly receive large payments from pharmaceutical companies, which may result in undue influence on policies or recommendations, according to the findings of a new report.

In a study published last week in the medical journal The BMJ, Australian researchers report that roughly 80% of U.S. doctors serving on the boards of medical associations or contributing to medical societies received payments from major drug companies, raking in $130 million in such payments from 2017 t0 2019.

The data on the payments raises questions about the independence of associations, which medical providers rely on for recommendations and treatment guidance. However, substantial contributions made by pharmaceutical companies to doctors leading those associations may be impacting the direction of treatment, and resulting in greater sales for the drug makers.

In 2010, the Sunshine Act was passed as part of the Affordable Care Act, giving access to data on the financial relationships between doctors and the drug industry in the United States. As a result, the Open Payments database was created to report financial benefits paid to doctors from April 2013 to present.

Researchers conducted a cross-sectional study of the industry relationships between physician leaders of professional medical associations and societies across the top 10 costliest disease areas in the U.S. The study focused on 328 leaders in 10 professional medical associations.

Overall, 80% of U.S. doctor’s leading medical associations, or with ties to medical associations or medical societies, had financial links to the pharmaceutical industry.

The average total payment during the study was $31,805. However, payments varied among the associations considerably. Leaders of the American Society of Clinical Oncology received an average of $518,000. Comparatively, leaders of the American Psychiatric Association received only $212.

Overall, leaders of the American Society of Clinical Oncology received the most money in research payments, totaling $54 million.

More than 93% of doctors with industry ties to the Orthopedic Trauma Association and Infectious Diseases Society of America received payments from pharmaceutical companies. Conversely, only about 37% of doctors with industry ties to the American Psychiatric Association received money from drug companies.

Doctors with ties to the Orthopedic Trauma Association and North American Spine Society received the most general payments for consultancies and hospitality; more than $9.5 million, which included payments for travel, food, and other items.

An editorial published alongside the study in The BMJ, advocated for five steps that associations and groups should take to prevent conflicts of interest and achieve financial oversight of doctors.

The editorial, written by resident orthopedic surgeon Jake Checketts and clinical assistant professor Matt Vassar, both of Oklahoma State University, recommended each association evaluate the Open Payments system for conflicts of interest. They also said associations should alter the recruitment process to recruit doctors free from financial conflicts of interest and create standards to reduce conflicts of interest.

Similarly, they recommended associations rely on the Sunshine Act and Open Payments system to eliminate the “honor system” and self-disclosure, instead focusing on oversight. Finally, they called for all medical associations to provide links directly to the Open Payments system data for each doctor contributing to the association.

“Financial relationships between the leaders of influential US professional medical associations and industry are extensive, although with variation among the associations,” the study’s authors concluded. “The quantum of payments raises questions about independence and integrity, adding weight to calls for policy reform.”