The management of conflicts of interest (COI) in healthcare is a fundamental topic that goes to the heart of trust in medicine, research and scientific societies such as the European Society of Cardiology (ESC). 

In recent weeks, several publications reported a major conflict of interest case from 20 years ago involving former ESC President, Professor Kim Fox, and an ESC Guideline. While the circumstances reported relate to a different period and governance framework, the reports have prompted renewed discussion regarding conflict-of-interest management. The ESC’s approach to disclosure and management of conflicts of interest has evolved considerably since then and we want to be fully transparent with our members and contributors about how the ESC manages these responsibilities today. 

This is important, because healthcare professionals, scientists, patients, policymakers and funders rely on the ESC’s activities; from data science and, education to guidelines, publications and public health. We therefore have a responsibility to uphold the integrity of what we do through clear standards, transparent processes and accountable decision-making. 

How we work 

We operate through structured governance, the foundation of which is the ESC’s Statutes and Bylaws. Any changes to our Statutes must be made through a vote of our member National Cardiac Societies, Associations, Councils and Working Groups, helping to ensure these principles represent and belong to our whole community.  

Our Ethical Conduct Policy and Declaration and Management of COI Policy are core pillars of our governance. These policies define our requirements for transparency and accountability across the organisation, support the declaration and management of real or perceived conflicts of interest, and provide a framework for responding to concerns when they arise.   

As standards and expectations evolve, these safeguards are regularly reviewed through our Ethics Committee, Audit Committee and Declaration of Interest Committee. These committees safeguard the application of our governance processes, make recommendations to the ESC Board, and report to the General Assembly. For example, the Declaration of Interest Committee recommended additional transparency measures. As a result, in 2024 the Board voted to publish DOI reports for the ESC Board and Association Board members, which are now easily accessible on our website.  

How we develop guidelines  

ESC Guidelines are central to our mission and are used by healthcare professionals worldwide. They are developed through a rigorous process designed to minimise bias and ensure that recommendations reflect the best available evidence.  

ESC Guideline Task Forces bring together experts with diverse perspectives, and every document undergoes multiple rounds of double-blind peer review by more than 100 independent reviewers, including representatives of ESC National Cardiac Societies.  

Strict conflict of interest rules apply throughout the process and to anyone involved in the development of guidelines. Industry-related payments are capped at €10,000 per year and voting restrictions may apply. This year, the ESC established further restrictions on financial interests in the healthcare industry, including prohibiting ownership of shares, stock options, or similar holdings.  

What’s next? 

Our current governance frameworks are substantially stronger than those in place 20 years ago. Nevertheless, maintaining trust requires ongoing scrutiny and improvement, and we remain committed to both. 

We will continue to be open about how we manage conflicts of interest, to listen when concerns are raised, and to strengthen our processes where needed. This is essential to maintaining the confidence of our community and supporting the best possible care for patients. 

If you have any questions regarding our COI management and DOI policy, please do not hesitate to contact us.