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The European Society of Cardiology (ESC) is dedicated to reducing the burden of cardiovascular disease and improving the standards of care offered to patients with cardiovascular disease. To accomplish this mission, the ESC provides support for a variety of activities in the areas of research, education, training, and advocacy. The integrity of the ESC and the activities it undertakes depend on the avoidance of conflicts of interest, or even the perception of conflicts, by the individuals involved in these activities. Such conflicts may arise directly from the declaring person but may also arise from partners or other members of a household. With this policy, the ESC continues to provide leadership for robust and unbiased science, as attested by the paper published by its Board in the European Heart Journal of March 2012, on the “Relations between professional medical Associations and the Health Care Industry, concerning scientific communication and continuing medical education” (1). As a member of the Biomed Alliance, the ESC led the task force that prepared and published the Biomed Alliance Code of Conduct, that was formally adopted by the ESC in December 2015 (2). More recently, in February 2018 the ESC issued a policy statement entitled “The future of continuing medical education: the roles of medical professional societies and the health care industry” that focuses on the need for continuing medical education in cardiovascular medicine in Europe, interaction between the medical profession and medical industry, and proposes measures to safeguard the provision of high quality, balanced medical education (3).
This “Declaration and Management of Conflict of Interest” policy is well in line with the existing paper: “Governing Policy for the writing of Clinical Practice Guidelines”. These 2 documents together with the Biomed Alliance Code of Conduct, mentioned above, represent the trilogy of policies which inspire and regulate the ESC objective of providing unbiased Clinical Practice Guidelines, and/or in general scientific and educational programmes, daily practice and advocacy, with the highest ethical standards.
Download the ESC Declaration and Management of Conflict of Interest Policy in PDF
Chapter I. Principles: that underline the commitment to managing real or perceived conflicts of interest.
Chapter II. Policies: that lay out how the ESC safeguards the integrity of the programs and activities in which its membership is engaged.
Chapter III. Declaration of Interest Form, Rules for review and Thresholds: that describe the ESC DOI form and define rules for review of various categories of conflicts of interest, using financial yardsticks.
Chapter IV. Processes: that formalize the various steps to deal with the administration, management, and enforcement of this policy.
Principle 1: The integrity of the ESC and its scientific, educational, and advocacy activities depend on the avoidance of bias arising from conflicts of interest, or from the perception of such conflicts, by the individuals involved in these activities. Personal financial considerations must never be allowed to influence physicians’ and scientists’ decisions on care of patients, evaluation and development of drugs or devices, or proper conduct of biomedical research. This includes continuing postgraduate medical education (CME) activities provided to physicians by the ESC and the development of clinical practice guidelines which must be free of bias, or perceived bias, evolving from financial arrangements or considerations.
Principle 2: A direct conflict of interest exists when an individual has material interests that could influence or could be perceived as influencing his/her decisions, actions or presentations in an inappropriate manner. These interests include employment, consultancy, equity, research funding, honoraria, patents and royalties, speakers’ bureau involvement, advisory committee or board of directors’ membership, expert testimony and financial support from a commercial entity. Conflicts of commercial interest may involve either an agent or device concerning the subject in question or an agent or device that might be in competition with the subject in question. In addition, indirect conflicts of interest may arise from institutional interests (e.g., research grants) or from interests of partners or other members in a household which may include, among others, employment in a health-care related industry or holding major shares in such companies.
The ESC recognizes that there are varying degrees of conflict. All potential conflicts must be disclosed so that the audience or a relevant committee can evaluate the relevance of the conflict to the relevant ESC activity.
Principle 3: The ESC desires a professional environment in which its officers and contributors are comfortable asking questions relating to conflict of interest and where excluding oneself from participation in discussions that might be perceived as constituting a conflict is the norm rather than the exception.
Principle 4: A member of the ESC with a conflict of interest for one specific ESC activity or task is not necessarily precluded from participation in all other ESC activities. In fact, such external relationships may enhance the value of that member to the Society. The ESC does not wish to imply that any involvement with a commercial entity prohibits a role within the ESC, but rather that the review of such relationships is appropriate and correct thereby encouraging transparency and ethical integrity.
Principle 5: The ESC subscribes to the view that research and development sponsored by the biomedical industry play an important role in biomedical research and development of better health care and that academic-industrial relationships have developed useful and life-saving products.
Principle 6: The mission of ESC does not include marketing of pharmaceutical or biomedical products. While the ESC offers opportunities for renting of space for commercial exhibitions at the ESC annual meeting and various sub-specialty meetings and while the Society’s publications sell advertising pages, the revenues generated are devoted to the support of the Society’s mission.
Principle 7: The ESC policies are congruent with the general positions of European standards of accreditation of CME activities which include: (a) support from a commercial entity for CME must be acknowledged, (b) no employees or consultants in the supporting company can be involved in the development of the CME activities and (c) attendees should be encouraged to report on their perceptions of any possible bias.
Principle 8: The considerations of conflict of interest are relevant not only to clinical research but may extend to all phases of biomedical research, including pre-clinical research.
The requirements of the ESC to declare conflicts of interest apply to all:
Policy 1: Some individuals serve as expert witnesses, officers, directors or members of scientific advisory boards of companies, participate in company-sponsored speakers’ bureaus, or accept subsidies from a commercial entity for the costs of travel and/or hospitality to an ESC activity. All of these activities must be declared and will be reviewed to identify potential conflicts of interest in a particular ESC activity.
Policy 2: The ESC holds its volunteers serving in governance positions (the ESC Management Group, ESC Board Members, ESC Association Presidents and Boards, ESC Council Chairmen and Board members and ESC Working Group Chairmen and Nucleus members) to certain standards with regard to conflict of interest.
Specifically, when an ESC volunteer has been identified as having a conflict of interest in a particular activity, he/she will not:
The ESC strongly recommends that its Officers (i.e. President, President-Elect, immediate Past-President, Vice Presidents, Secretary/Treasurer) refrain from simultaneously serving the Society and holding an officer position with another international medical organization, without prior approval from the ESC. The ESC also strongly discourages the Officers from simultaneous service in any position on the board of organizations with significant overlap with the ESC without prior approval from the ESC.
Policy 3: The ESC has the right to take action regarding ESC members and contributors to ESC activities who have exhibited biased behaviour or action. These actions may include:
Policy 4: No donor, commercial or otherwise, can select speakers or awardees or be involved in the production of ESC educational and/or scientific content, with the exception of satellite or industry organised symposia or session clearly denoted as such.
Policy 5: Commercial support for post-graduate education (or post-graduate CME) must be acknowledged and no employees or consultants of the interested company can be involved in the development of the content of CME of the ESC. Meeting attendees are provided with a formal opportunity to report on their perceptions of any possible bias in their review of the sessions for CME credit.
Policy 6: Special precautions are taken to safeguard against an undue influence with regard to the ESC Research and Training Grants which are targeted at helping trainees.
Policy 7: The ESC sponsors the development of evidence-based clinical practice guidelines. Special policies intended to prevent bias from conflicts of interest apply to participants in the ESC guideline development. These policies are described in the published document “Relations between professional medical associations and the health-care industry, concerning scientific communication and continuing medical education: a Policy Statement from the European Society of Cardiology,” published in European Heart Journal (2012) 33, 666–674.(1)
To manage eventual conflicts of interest, the ESC is adopting a system of checks and balances that, for example, give relevance to topics and categories of conflicts. In this way, when confronted with potentially conflictual situations, the unbiased behavior is protected and enhanced.
The in-depth review could eventually establish the existence of conflict(s) of interest. If so, this could result in a proposal of exclusion which necessitates the validation of the Senior Compliance Council.
These two categories (b, c) apply to payments received for activities based on a personal contract between the declaring person and a given company, whether received in person or administered by an institution. Payments received by an institution based on a contract between said institution and a health care-related industry is considered as indirect and will be evaluated independently of these categories on a case-by-case basis.
Annex 1 - Declaration of Interest Form
Annex 2 - Rules for the review of DOI
Annex 3 - Rules for assessment of conflicts
Questions and comments regarding the ESC conflict of interest principles and policies can be directed to
Our mission: To reduce the burden of cardiovascular disease.
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