Nearly every large drug maker based in the United States had at least one academic medical center official on its board, raising questions about their independence.

Pharmaceutical company payments to doctors extend far beyond rank-and-file clinicians—and deep into the leadership of America's teaching hospitals, according to a study published this week in the Journal of the American Medical Association.

A team of researchers at the University of Pittsburgh Medical Center examined the boards of the 50 largest drug companies by global sales (excluding three companies that were not publicly traded). The researchers found that 40 percent—19 companies—had at least one board member who also held a leadership role at an academic medical center. Sixteen of the 17 companies based in the United States had at least one. Several had more than one.

Beginning this fall, under a provision of the 2010 Affordable Care Act, all pharmaceutical and medical device companies will have to publicly report payments to physicians.

All told, the research team found that 41 of the companies' 2012 board members held leadership positions at academic medical centers. Six of the 41 were pharmaceutical company executives who served on hospital boards of directors or held other leadership posts.

Excluding the industry executives, the academics earned an average of nearly $313,000 that year for their board service.

ProPublica has been chronicling conflicts of interest in medicine for several years by looking at drug makers' payments to individual medical practitioners for consulting, speaking, and more. Our Dollars for Docs database currently collects information on payments by 15 companies that publicly report them, most as a condition of lawsuit settlements with the federal government.

Beginning this fall, under a provision of the 2010 Affordable Care Act, all pharmaceutical and medical device companies will have to publicly report payments to physicians. The first report is expected to be released in September and will cover payments made from August to December 2013.

In the study published today, the authors wrote that when academic medical leaders serve on pharmaceutical company boards, it can lead to conflicts not only for individuals, but for the critically important health care institutions they guide.

As board members of drug companies, academic leaders take on a fiduciary duty to those companies' success. That can "conflict or compete" with their other responsibilities, the study says.

"Given the magnitude of competing priorities between academic institutions and pharmaceutical companies, dual leadership roles cannot simply be managed by internal disclosure," the authors conclude. "These relationships present potentially far-reaching consequences beyond those created when individual physicians consult with industry or receive gifts."

Among the academic leaders serving as drug-company board members was the dean of the University of Illinois College of Medicine, whose institution was criticized recently when members of its surgery department appeared in an ad for the daVinci surgical robot.

This post originally appeared on ProPublica as “Leaders of Teaching Hospitals Have Close Ties to Drug Companies, Study Shows” and is republished here under a Creative Commons license.