ETHICS IN CARDIOTHORACIC SURGERY

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anPus article is being published simultaneously in The Annals of Thoracicgery and in The Journal of Thoracic and Cardiovascular Surgery.

erican Association for Thoracic Surgery Ethics CommitteeDrsert M. Sade, Charleston, SC (Chair); Cary W. Akins, Boston, MA;mas A. DAmico, Durham, NC; James W. Jones, Houston, TX;rtin McKneally, Toronto, ON, Canada; Keith Naunheim, St. Louis,; and Andrew S. Wechsler, Philadelphia, PA; and The Society ofracic Surgeons Standards and Ethics CommitteeDrs Robert M.e, Charleston, SC (Chair); Charles R. Bridges, Philadelphia, PA;vid N. Campbell, Aurora, CO; Kathleen N. Fenton, Memphis, TN;

Mark K. Ferguson, Chicago, IL; Steven W. Guyton, Seattle, WA; JohnW. Hammon, Jr, Winston-Salem, NC; Leslie J. Kohman, Syracuse, NY;Jeffrey B. Kramer, Kansas City, KS; Sidney Levitsky, Boston, MA;Gordon F. Murray, Southport, NC; Mark B. Orringer, Ann Arbor, MI;Ross M. Ungerleider, Portland, OR; and Richard I. Whyte, Stan-ford, CA.

Address correspondence to Dr Sade, Division of Cardiothoracic Surgery,Department of Surgery, Institute of Human Values in Health Care,Medical University of South Carolina, 25 Courtenay Dr, Ste 7028, MSC295, Charleston, SC 29425; e-mail: sader@musc.edu.

2011 by The Society of Thoracic Surgeonsd the American Association for Thoracic Surgery Ann Thorac Surg 2011;92:38 0003-4975/$36.00blished by Elsevier Inc doi:10.1016/j.athoracsur.2011.03.124tandards for Relations ofrganizations With Industbert M. Sade, MD, for the American Assommittee and The Society of Thoracic Surerican Association for Thoracic Surgery, Beverly, Massachuset

ost physicians are well aware of the interest theUnited States Congress, various federal agencies,

d state legislatures have shown in the influence ofmpanies that produce drugs and devices on physi-ns use of these products. Recently, the focus onustrys influence in the health care field expanded tolude relations with professional medical societies. In9, the Institute of Medicine published a report, Con-t of Interest in Medical Research, Education, andactice [1]. Citing the growing interest in Congress andewhere, the authors state, Physicians and researchersand the institutions that carry out medical research,ucation, clinical care, and practice guideline develop-nt must recognize public concerns about conflicts oferest and take effective measures soon to maintainblic trust (p. 16) [1]. Professional societies weremed among those institutions. Also in 2009, a group ofuential physicians, medical sociologists, and bioethi-ts published a paper in the Journal of the Americandical Association that focused entirely on medical spe-lty societies and their relations with industry [2]. Thethors made a series of recommendations, several ofich were highly controversial.In response to this in-asing scrutiny, the American Association for Thoracicrgery (AATS) and The Society of Thoracic Surgeonsardiothoracic Surgical

ion for Thoracic Surgery Ethicsns Standards and Ethics Committeed The Society of Thoracic Surgeons, Chicago, Illinois

S) charged the Ethics Forum, which comprises thembers of the AATS Ethics Committee and STS Stan-rds and Ethics Committee, with developing a reportd guidelines describing how cardiothoracic societieseract with industry. As the Ethics Forum began workthe project, it came to light that the Council of Medicalecialty Societies (CMSS) was writing a document thatdressed this issue. After a process of vetting by thember societies, the CMSS Code for Interactions Withmpanies [3] was completed in the spring of 2010 andmember societies were invited to approve the docu-nt as presented. At that point, the CMSS Code con-ned several provisions that were deemed worthy ofther consideration by STS, a member organizatione AATS was not a member), and STS abstained in theproval vote. To carry out its charge from the AATS andS, the Ethics Forum used the CMSS Code as a modeld modified it to suit the needs of cardiothoracic sur-ry specialty societies. By the end of January 2011, theal version was completed, and the AATS and STSopted the Cardiothoracic Surgical Organizationsndards for Interactions With Companies. As officiallicy of both organizations, this document is beingultaneously published by The Journal of Thoracic andrdiovascular Surgery and The Annals of Thoracic Surgery.

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4 ETHICS IN CARDIOTHORACIC SURGERY SADE Ann Thorac SurgCT SOCIETIES INTERACTIONS WITH INDUSTRY 2011;92:38markets, or distributes drugs, devices, services or thera-

apted from CMSS Code for Interactions With Companies [A1].Society/Association may engage with nonprofit organi-ions and individuals as well as with Companies.

vertisingvertising is a Business Transaction in which a Companyys a fee to the Society/Association in exchange for theciety/Associations publication of a promotional an-uncement that highlights the Company or the Compa-s products or services. For purposes of these Standards,vertiser refers to a Company that purchases Advertising.

siness TransactionBusiness Transaction is an interaction between the Soci-/Association and a Company in which a Company paysee to the Society/Association in exchange for the Society/sociations item, service, or product. Examples of Busi-ss Transactions include Company payment of fees asso-apted from Advanced Medical Technology Association (AdvaMed).de of Ethics on Interactions With Health Care Professionals [A3].

Thnonaritable ContributionCharitable Contribution is a gift, including an in-kindt, given by a Company to a qualified tax-exemptanization (eg, the Society/Association or an affiliatedanization) for use in furthering the organizationsaritable purposes and in accordance with applicablerules and legal standards.

inical Practice GuidelineClinical Practice Guideline is a systematically developedtement to assist practitioner and patient decisions aboutpropriate health care for specific clinical circumstances.used in these Standards, the term Clinical Practiceideline also refers to medical technology assessments,ical opinions, and other evidence-based clinical practicels, as well as updates to existing Clinical Practice Guide-es (Guideline Updates).The following terms are defined for purposes of thesendards. The Society/Association recognizes that some of

publications, Advertising in Society/Association publica-tions, registrations for Society/Association meetings, andARDIOTHORACIC SURGICAL ORGATERACTIONS WITH COMPANIES*

Cardiothoracic surgical organizations (Societies/sociations) play an important role in reaching out toalth professionals, patients, and other groups. Weide biomedical research, discover new therapies, andgage in high-quality surgical practice. We offer educa-nal opportunities that help translate scientific anddical progress into the efficient delivery of effectivedical care, develop resources that guide our membersadvancing the standard of care, and provide a forumpresenting new skills and scientific developments.

For-profit entities that develop, produce, market or dis-ute drugs, devices, services or therapies used to diag-se, treat, monitor, manage, and alleviate cardiothoraciceases, referred to in these Standards as Companies,o strive to help patients live longer and healthier lives. Thempanies invest resources to bring new drugs and devicest of the laboratory and to the patient while maximizingue for shareholders. Physicians and patients count on

efinitionsZATIONS STANDARDS FOR

cieties/Associations to be authoritative, independent voicesthe world of science and medicine, and we believe thatblic confidence in our objectivity is important to carryingt our mission. We believe that our interactions withmpanies must meet high ethical standards [A2].ocieties/Associations interactions with Companiesy include receiving charitable donations, applying fornts in support of programmatic activities, and con-cting a range of business transactions. In all of theseeractions, Societies/Associations are committed to act-with integrity.hese Standards embody the core principles of our

ofession, and are intended to benefit both our mem-rs and their patients, and to improve cardiothoracicrgical care. Many of the relations and activities encour-ed or required by these Standards are already in place,d those that are not will be implemented within onear after adoption.ese Standards do not address Societies/Associations interactions withprofit entities or entities outside of the health care sector.

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Continuing Medical Education (CME)Continuing Medical Education (CME) consists of educa-tiocreRecognition Award Credit, American Academy of FamilyPhysicians [AAFP] Prescribed or Elective Credit, Ameri-canegbyCoAOorforpr[AactcoPr

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5Ann Thorac Surg ETHICS IN CARDIOTHORACIC SURGERY SADE2011;92:38 CT SOCIETIES INTERACTIONS WITH INDUSTRYOsteopathic Association [AOA] Creditvarious cat-ories) based on accreditation awarded to the providera recognized accrediting body (eg, Accreditationuncil for Continuing Medical Education [ACCME],A, AAFP). CME activities serve to maintain, develop,increase the knowledge, skills, and professional per-mance and relationships that a physician uses toovide services for patients, the public, or the profession5, A6]. For purposes of these Standards, educationalivities for physicians that are not CME-accredited arensidered Non-CME Educational/Informationalograms.

rporate SponsorshipCorporate Sponsorship is an arrangement in which ampany, typically through its marketing department,ovides monetary or in-kind support for a particularciety/Association product, service, or event, and isn acknowledged in connection with the product, ser-e or event. Corporate Sponsorships are distinct fromucational Grants, and do not constitute Commercialpport of CME. For purposes of these Standards, Cor-rate Sponsor refers to a Company that provides arporate Sponsorship.

ucational GrantEducational Grant is a sum awarded by a Company,ically through its grants office, for the specific purposesupporting an educational or scientific activity offeredthe Society/Association. Educational Grants awardeda Company to support a CME activity are referred tothe ACCME Standards for Commercial Support asommercial Support of CME [A7]. An Educationalant may also be in-kind.

andards for Interaction

Independence From Company Influence

1.1. The Society/Association develops all educationalivities, scientific programs, products, services and ad-cacy positions independent of Company influence, and

velops and adopts policies and procedures that fosterependence.

neNon-CME Informational/Educational Program isprogram offered by the Society/Association, Com-ny or other third party that provides educational oromotional information and does not offer CMEdit.

search GrantResearch Grant is an award that is given by theciety/Association to an individual, institution or prac-e to fund the conduct of scientific research. Companiesy provide the Society/Association with programmaticpport (eg, an Educational Grant or Charitable Contri-tion) designated for the specific purpose of fundingsearch Grants.

tellite CME SymposiumSatellite CME Symposium is a Company-supportedE program held as an adjunct to the Society/

sociation meeting where CME credit for the Sympo-m is provided by a third party CME provider, and forich the Society/Association receives a fee.

ciety/Association CMEciety/Association CME refers to CME programs thatplanned by the Society/Association and for which the

ciety/Association, as an accredited CME provider, pro-es CME credit.

ciety/Association Journale Society/Association journal is a peer-reviewed sci-tific journal published by the Society/Association or byublisher on the Society/Associations behalf.

1.2. The Society/Association separates its efforts to seekucational Grants, Corporate Sponsorships, Charitablentributions, and support for Research Grants from itsgrammatic decisions, assessing the availability of fundsly after independently determining that a program isnal activities for which the attendee may receive CMEdit (American Medical Association [AMA] Physicians

may designate.s used to diagnose, treat, monitor, manage, and alle-te health conditions [A3, A4]. This definition is notended to include nonprofit entities, entities outside ofhealth care sector, or entities through which physi-

ns provide clinical services directly to patients.y Society/Association Leaderse Key Society/Association Leaders include officers inPresidential line of succession (eg, the President-

ct, the President, and the Immediate Past President) ofSociety/Associations membership organization, theeded (eg, to address gaps in care or knowledge).1.3. The Society/Association has identified the high-

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6 ETHICS IN CARDIOTHORACIC SURGERY SADE Ann Thorac SurgCT SOCIETIES INTERACTIONS WITH INDUSTRY 2011;92:38el group responsible for guiding Society/Associationeractions with Companies.1.4. The Society/Association uses written agreementsth Companies for Educational Grants, Corporateonsorships, Charitable Contributions, Business Trans-ions, and support of Research Grants. These agree-nts specify the purpose of the funds, the amounten, the term of the agreement, and the separate rolesthe Company and the Society/Association. Such agree-nts show that a transaction is arms length, establishar parameters for the use of funds, and affirm theependence of the Society/Association.

Transparency2.1. The Society/Associations conflict of interest poli-s and forms are available to its members and theblic.2.2. The Society/Association discloses Company sup-rt, including Educational Grants, Corporate Sponsor-ips, Charitable Contributions, and support of Researchants, making this information available to its membersd the public..3. The Society/Association has written disclosurelicies for Key Society/Association Leaders, Boardmbers, committee members and others who serve onbehalf, and uses the disclosed information to managenflicts of interest in decision making. The Society/sociation requires volunteers to update disclosure in-mation at least annually and when material changescur..4. The Society/Association discloses all financial andcompensated relationships that Key Society/sociation Leaders and members of the Board of Direc-s of the Society/Associations membership organiza-n have with Companies, making this informationailable to its members and the public.

Accepting Charitable Contributions3.1. The Society/Association controls the use of Chari-le Contributions in a manner that is aligned with theciety/Associations strategic plan and mission.3.2. The Society/Association accepts reasonable re-irements for reporting on the uses of the donatedds and reasonable restrictions on the purposes forich Charitable Contributions will be used, but de-nes Charitable Contributions if donor restrictionsuld influence Society/Association programs or advo-y positions in a manner that is inconsistent with theciety/Associations mission.3.3. The Society/Association has policies for consistentd appropriate recognition of donors.

Accepting Corporate Sponsorships4.1. The Society/Association declines Corporate Spon-rship of an item or program if the item or program isonsistent with the Society/Associations strategic pland mission.

4.2. The Society/Association does not place the nameslogos of Companies or products on Society/

arethesociation-distributed reminder items (eg, tote bags,yards, highlighters, notebooks, and luggage tags).

4.3. Corporate Sponsors of Society/Association dataistries are not allowed to participate in the manage-nt of such registries in any way.

Society/Association Meetings

. Educational Grants and Society/AssociationE

5.1.1. The Society/Association complies with all ACCMEndards for Commercial Support, including by adopt-policies and procedures designed to identify and

nage conflicts of interest in Company-supported So-ty/Association CME programs.

5.1.2. The Society/Association retains control over the useEducational Grants and implements safeguards de-ned to ensure that educational programs are nonpromo-nal and free from commercial influence and bias.5.1.3. The Society/Association appoints its own plan-g committees to select the objectives, content, faculty,d format of educational activities in a manner that isnsistent with the Society/Association mission.5.1.4. The Society/Association does not solicit supportersgestions about program topics, speakers, or content.

5.1.5. The Society/Association prohibits presentersm using slides with Company logos.

5.1.6. The Society/Association requires presenters inciety CME programs to give a balanced view of ther-eutic options, and encourages presenters to use ge-ric names in place of product trade names.5.1.7. The Society/Association does not seek supportproduct-specific topics.

5.1.8. The Society/Association makes reasonable effortsachieve a balanced portfolio of support for eachciety/Association CME program.

. CME-Accredited Satellite Symposia5.2.1. The Society/Association requires Satellite CMEmposia to undergo an application process.

5.2.2. The Society/Association requires Satellite CMEmposia to comply with ACCME Standards.5.2.3. The Society/Association distinguishes SatelliteE Symposia from Society/Association CME in meetinggrams and promotional materials and requires thirdrty organizers of Satellite CME Symposia to do the same.5.2.4. The Society/Association does not permit Keyciety Leaders to participate in Satellite CME Symposiafaculty members, presenters, chairs, consultants, or in

e Pharmaceutical Research and Manufacturers of America (PhRMA)de on Interactions With Health Care Professionals [A8] and thevanced Medical Technology Association (AdvaMed) Code of Ethics oneractions With Health Care Professionals [A3] do not permit Compa-s to give promotional, noneducational reminder items directly tolth care professionals.

e Definition of Satellite CME Symposium. Based on the definition ofellite CME Symposium, Section 5.2 of these Standards does not applyrograms that are held adjunct to Society/Association meetings but (1)

not Company-supported; (2) are not CME accredited; or (3) for whichSociety/Association does not receive a fee.

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7Ann Thorac Surg ETHICS IN CARDIOTHORACIC SURGERY SADE2011;92:38 CT SOCIETIES INTERACTIONS WITH INDUSTRYy other role besides that of an attendee who receiveshonoraria or reimbursement.

. Non-CME Informational/Educationalograms5.3.1. The Society/Association requires Non-CME In-mational/Educational Programs to be clearly distin-ished from Society/Association CME.5.3.2. Key Society/Association Leaders may not partic-te as leaders or presenters in Company promotional/rketing events.

. Exhibits5.4.1. The Society/Association has written policies thatvern the nature of exhibits and the conduct of exhibi-s, including requiring exhibitors to comply with appli-le laws, regulations, and guidance.

Awarding of Research Grants6.1. The Society/Association does not permit Compa-s to select (or influence the selection of) recipients ofsearch Grants.6.2. The Society/Association appoints its own commit-s to select recipients of Research Grants based on peeriew of grant applications.

6.3. The Society/Association does not require recipi-ts of Research Grants to meet with Companypporters.6.4. The Society/Association does not permit Companiest support Research Grants to receive intellectual propertyhts or royalties arising out of the grant-funded research.6.5. The Society/Association does not permit Compa-s that support Research Grants to control or influencenuscripts that arise from the grant-funded research.

6.6. The Society/Association discloses Company pro-mmatic support (eg, an Educational Grant or Chari-le Contribution) for the Societys own research. Theciety/Association acts independently in selecting re-rch topics and conducting the research itself.

Clinical Practice Guidelines7.1. The Society/Association bases Clinical Practiceidelines on scientific evidence.

7.2. The Society/Association follows a transparent Clinicalctice Guideline development process that is not subject tompany influence. For Clinical Practice Guidelines andideline Updates developed after adoption of these Stan-rds, the Society/Association will publish a description of itsideline development process, including its process forntifying and managing conflicts of interest.

7.3. The Society/Association does not permit directmpany support of the development of Clinical Practiceidelines or Guideline Updates.

7.4. The Society/Association does not permit direct Com-

e Society/Association does not accept Corporate Sponsorship, Edu-ional Grants, Charitable Contributions, support of Research Grants, orother direct Company support of Guideline development activities.mpany support of the overall mission-based activities of The Society/ociation is not considered direct support of Guideline development.

of ipatny support for the initial printing, publication, and dis-ution of Clinical Practice Guidelines or Guideline Up-tes. After initial development, printing, publication andtribution is complete, the Society/Association may ac-t Company support for the Society/Associations furthertribution of the Guideline or Guideline Update, transla-n of the Guideline or Guideline Update, or repurposingthe Guideline content.7.5. The Society/Association requires all Guideline devel-ment panel members to disclose relevant relationshipsor to panel deliberations, and to update their disclosuresoughout the Guideline development process.7.6. The Society/Association has procedures for deter-ning whether financial or other relationships betweenideline development panel members and Companiesnstitute conflicts of interest relevant to the subjecttter of the Guideline, as well as management strate-s that minimize the risk of actual and perceived bias ifnel members do have conflicts.#

7.7. The Society/Association requires that a majority ofideline development panel members are free of con-ts of interest relevant to the subject matter of theideline.**.8. The Society/Association requires the panel chairat least one chair if there are co-chairs) to be free of

nflicts of interest with respect to topics covered withinGuideline, and to remain free of conflicts of interestat least one year after Guideline publication.

7.9. The Society/Association requires that Clinicalactice Guideline recommendations be subject to mul-le levels of review, including rigorous peer review by age of experts. The Society/Association does not selecta reviewer any individual employed by or engaged toresent a Company.

7.10. The Society/Associations Clinical Practice Guide-e recommendations are reviewed and approved beforebmission for publication by at least one Society/sociation body beyond the Guideline developmentnel.7.11. Guideline manuscripts are subject to independentitorial review by a journal or other publication wherey are first published.

7.12. The Society/Association publishes Clinical Prac-e Guideline development panel members disclosure

r example, The Society/Association may decide not to permit panelmbers with conflicts of interest to draft text or vote on panel recom-ndations.

Guideline development panel members and chairs (see Section 7.8)e conflicts of interest at the time of adoption of these Standards, theiety/Association may permit these individuals to remain activelyolved in drafting the Guideline. However, each panel for which thiseption is made must meet the requirements of Section 7.7 by the timehe next Guideline Update. For the minority of panel members who arefree of conflicts, The Society/Association will apply procedures for

closure and conflict of interest management developed in accordanceh Sections 7.5 and 7.6.

addition to minimizing potential conflicts, remaining free of conflicts

nterest helps to ensure that a panel chair remains eligible to partici-e in subsequent Guideline Updates.

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8 ETHICS IN CARDIOTHORACIC SURGERY SADE Ann Thorac SurgCT SOCIETIES INTERACTIONS WITH INDUSTRY 2011;92:38ormation adjacent to each Clinical Practice Guidelined identifies voting abstentions.7.13. The Society/Association requires all Clinical Prac-e Guideline contributors, including expert advisors oriewers who are not officially part of a developmentnel, to disclose financial or other substantive relation-ips that may constitute conflicts of interest, and man-es such conflicts of interest.7.14. Clinical Practice Guideline development panelmbers must decline offers from positively or nega-ely affected Companies to speak about the Guidelinebehalf of the Company for one year after publication.

7.15. Clinical Practice Guideline development panelmbers and staff must not discuss a Guidelines devel-ment with Company employees or representatives,st not accept unpublished data from Companies, andst not permit Companies to review Clinical Practiceidelines in draft form.

The Society/Associations Journal8.1. The Society/Associations journal maintains edito-l independence from the Society/Association and fromvertisers.

8.2. The journal requires all authors to disclose allancial and other relationships with Companies in anyy related to the content of the article. This disclosureould appear on the first page of the article.8.3. The journal requires editors and reviewers toclose financial and other relationships with Compa-s, and these are made available to the public.

8.4. The journals Editor-in-Chief has the ultimateponsibility for determining when a conflict of interestould disqualify an editor or reviewer from reviewing anuscript, according to established policies.

8.5. The journals policy prohibits submission ofhost-written manuscripts prepared by or on behalf ofmpanies.

Standards for Advertising9.1. The journal has written policies governing adver-ing in the journal.

. Standards for Licensing10.1. The Society/Association does not permit the mis-e or unauthorized modification of its licensed materi-, and prohibits use of Society/Association trademarksimply Society/Association endorsement of Companyoducts or services.

ditorial independence should be consistent with accepted standardsmedical publishing, such as those established by the Internationalmmittee of Medical Journal Editors (ICMJE) [A9] and the Worldociation of Medical Editors (WAME) [A10].

hen establishing these policies, Society Journals may find it helpful tosult accepted standards for medical publishing, such as those estab-

ed by ICMJE [A11] and WAME [A12].andards Bibliography

1. Council of Medical Specialty Societies (CMSS). CMSS codefor interactions with companies. Available at http://www.cmss.org/uploadedFiles/Site/CMSS_Policies/CMSS%20Code%20for%20Interactions%20with%20Companies%204-19-10.pdf. Accessed April 13, 2011.

2. Lo B, Field MJ, eds. Conflict of Interest in Medical Re-search, Education, and Practice. Institute of Medicine,Washington, DC: National Academy Press; 2009.

3. Advanced Medical Technology Association (AdvaMed).Code of ethics on interactions with health care profession-als. Available at http://www.advamed.org/MemberPortal/About/code/. Accessed April 13, 2011.

4. Accreditation Council for Continuing Medical Education(ACCME). Definition of commercial interest. Available athttp://www.accme.org/index.cfm/fa/Policy.policy/Policy_id/9456ae6f-61b5-4e80-a330-7d85d5e68421.cfm. AccessedApril 13, 2011.

5. Accreditation Council for Continuing Medical Education(ACCME). CME content. Available at http://www.accme.org/index.cfm/fa/Policy.policy/Policy_id/16f1c694-d03b-4241-bd1a-44b2d072dc5e.cfm. Accessed April 13,2011.

6. American Medical Association (AMA). The Physician Recog-nition Award and credit system. Available at http://www.ama-assn.org/ama1/pub/upload/mm/455/pra2006.pdf.Accessed April 13, 2011.

7. Accreditation Council for Continuing Medical Education(ACCME). Standards for commercial support. Available athttp://www.accme.org/dir_docs/doc_upload/68b2902a-fb73-44d1-8725-80a1504e520c_uploaddocument.pdf. AccessedApril 13, 2011.

8. Pharmaceutical Research Manufacturers of America(PhRMA). Code on interactions with health care profes-sionals. Available at http://www.phrma.org/about/principles-guidelines/code-interactions-healthcare-professionals. Accessed April 13, 2011.

9. International Committee of Medical Journal Editors(ICMJE). Uniform requirements for manuscripts submittedto biomedical journals: Ethical considerations in the con-duct and reporting of research: Editorship. Available athttp://www.icmje.org/ethical_2editor.html. Accessed April13, 2011.

0. World Association of Medical Editors (WAME). The re-sponsibilities of medical editors. Available at http://www.wame.org/resources/policies#responsibilities. Ac-cessed April 13, 2011.

1. International Committee of Medical Journal Editors(ICMJE). Uniform requirements for manuscripts submittedto biomedical journals: Ethical considerations in the con-duct and reporting of research: Conflict of interest. Avail-able at http://www.icmje.org/ethical_4conflicts.html. Ac-cessed April 13, 2011.

2. World Association of Medical Editors (WAME). Conflict ofinterest in peer-reviewed medical journals. Available athttp://www.wame.org/conflict-of-interest-in-peer-reviewed-medical-journals. Accessed April 13, 2011.

ferences

Lo B, Field MJ, eds. Conflict of Interest in Medical Research,Education, and Practice. Institute of Medicine, Washington,DC: National Academy Press; 2009.Rothman DJ, McDonald WJ, Berkowitz CD, et al. Profes-sional medical associations and their relationships withindustry. J Am Med Assoc 2009;301:136772.Council of Medical Specialty Societies (CMSS). CMSS code forinteractions with companies. Available at http://www.cmss.org/uploadedFiles/Site/CMSS_Policies/CMSS%20Code%20for%20Interactions%20with%20Companies%

204-19-10.pdf. Accessed April 13, 2011.

Standards for Relations of Cardiothoracic Surgical Organizations With IndustryCARDIOTHORACIC SURGICAL ORGANIZATIONS` STANDARDS FOR INTERACTIONS WITH COMPANIES