Intensive Care Medicine

, Volume 44, Issue 10, pp 1657–1668 | Cite as

White paper: statement on conflicts of interest

  • Julian Bion
  • Massimo Antonelli
  • LLuis Blanch
  • J. Randall Curtis
  • Christiane Druml
  • Bin Du
  • Flavia R. Machado
  • Charles Gomersall
  • Christiane Hartog
  • Mitchell Levy
  • John Myburgh
  • Gordon Rubenfeld
  • Charles Sprung
Conference Reports and Expert Panel



Conflicts of interest are a normal part of human social intercourse. They become problematic when there is a power differential between participants in the setting of relationships requiring a high degree of trust, as in healthcare. In this white paper we consider how these conflicts may be detected and mitigated.


Following Medline search and reference chaining, we undertook a narrative review of the literature with iterative discussion.


Conflicts of interest may be financial, professional or personal, and may operate at the level of the individual or the organisation. Unmanaged, they become a source of bias which places the interests of the professional or the organisation before those of the patient. Reported with increasing frequency, conflicts damage trust, harm patients, and defraud the health system. We make 15 recommendations for minimising conflicts of interest.


Nationally funded open-access registries should be established to permit complete disclosure of financial, professional, and personal relationships with the potential for driving bias in research, clinical practice, or health management. Governance of disclosure should be the responsibility of employing organisations through annual staff appraisals, audited by national research integrity committees. Research fraud should incur suspension of the license to practice. Organisations should monitor staff perceptions of ethical climate to enhance awareness of staff behaviours and the potential for misconduct driven by academic pressures. Clear separation of advisory and voting roles is needed in best practice guideline panels. Professional societies and scientific journals should display conflict of interest policies for their own staff and officers as well as for speakers and authors. Undergraduates should not be exposed to pharmaceutical promotions masquerading as education. Undergraduate and postgraduate training programmes should include teaching about managing conflicts of interest and identifying research misconduct.


Conflict of interest Bias Professionalism Research governance Medical education 


Compliance with ethical standards

Conflict of interest

Names and title


Affiliation, address


Professor Julian Bion


University Department of Intensive Care Medicine, University of Birmingham, Ground Floor East Wing, Queen Elizabeth Hospital (Heritage Site) Birmingham B15 2GW

Professor Massimo Antonelli


2 Department of Intensive Care Medicine, Anesthesiology and Emergency Medicine, Fondazione Policlicnico Universitario A.Gemelli IRCCS-Università Cattolica del Sacro Cuore, Rome Italy

Professor LLuis Blanch


Parc Tauli University Hospital. CIBER Enfermedades Respiratorias. Institut de Investigació i Innovació Parc Taulí. Universitat Autònoma de Barcelona. Sabadell. Spain

Professor J. Randall Curtis


J. Randall Curtis, MD, MPH Professor of Medicine Director, Cambia Palliative Care Center of Excellence at UW Medicine; A. Bruce Montgomery - American Lung Association Endowed Chair in Pulmonary and Critical Care Medicine Harborview Medical Center, University of Washington 325 Ninth Avenue, Box 359762 Seattle, WA 98104

Professor Christiane Druml


UNESCO Chair on Bioethics of the Medical University of Vienna, Ethics, Collections and History of Medicine Waehringerstrasse 25 1090 Vienna

Professor Bin Du


Medical Intensive Care Unit, Peking Union Medicine Collage Hospital, 1 Shuai Fu Yuan, Beijing, 100730, China

Professor Flavia R Machado


Anesthesiology, Pain, and Intensive Care Department, Universidade Federal de São Paulo, São Paulo, Brazil

Professor Charles Gomersall

BSc, MBBS, MRCP (UK), FRCA, FCICM, FHKCA (Intensive Care), FHKAM, FRCP (Glasg)

Department of Anaesthesia and Intensive Care

The Chinese University of Hong Kong

Professor Christiane Hartog


Department of Anaesthesiology and Intensive Care Medicine, Centre for Sepsis Care and Control, Jena University Hospital, D-07747 Jena, Germany

Professor Mitchell Levy


Professor of Medicine and Division Chief, Pulmonary and Critical Care Medicine Alpert Medical School of Brown University, Rhode Island Hospital, Providence, USA

Professor John Myburgh


The George Institute for Global Health | AUSTRALIA

Level 5, 1 King St | Newtown NSW 2042 Australia

Professor Gordon Rubenfeld


Professor of Medicine Interdepartmental Division of Critical Care Medicine, University of Toronto 2075 Bayview Avenue, Room D108c Toronto, ON M4N 3M5

Professor Charles Sprung


Department of Anesthesiology and Critical Care Medicine, Hadassah Hebrew University Medical Center, Jerusalem, Israel






Research advisor, Nestle Pharmaceuticals. £1000 per annum paid to hospital charity.

Co-chaired ESICM-SCCM Task Force on competing interests 2007

President ESICM 2006-8

Foundation Dean UK Faculty of Intensive Care Medicine 2010-13

Chief Investigator, NIHR-funded HiSLAC project (

Chief Investigator, NIHR-funded PEARL Project



GE Research Grant, honoraria from Orion and Fresenius, Board participation for Air Liquide

Co chair Surviving Sepsis Campaign 2018

President of the ESICM



L.Blanch is inventor of one Corporació Sanitaria Parc Taulí owned US patent: “Method and system for managed related patient parameters provided by a monitoring device,” US Patent No. 12/538,940 and founder of BetterCare S.L. which is a research and development company, spin off of Corporació Sanitària Parc Taulí

Past President of the Spanish Society of Intensive and Critical Care Medicine (SEMICYUC)




Past President of the American Thoracic Society








Past President of Chinese Society of Critical Care Medicine (CSCCM)

Past President of Asia Pacific Association of Critical Care Medicine (APACCM)




Co-author of Surviving Sepsis Guidelines; Scientific Director of Associação de Medicina Intensiva Brasileira



Chair of BASIC Collaboration which has received unrestricted educational grants from Maquet, Drager Medical, Hamilton Medical, Fisher Paykel, Pfizer, Vygon.

Chair of the Asian Critical Care Clinical Trials Group




Co-author of Consensus statement of the ESICM task force on colloid volume therapy in critically ill patients 2012




Past President of the Society of Critical Care Medicine




His institution, the George Institute for Global Health, Sydney Australia, has received unrestricted grants and logistic support from CSL Bioplasma, Fresenius Kabi and Baxter Healthcare to conduct investigator-initiated trials in fluid resuscitation between 2002–2014 through the Australian and New Zealand Intensive Care Society Clinical Trials Group

Past-President of the College of Intensive Care Medicine of Australia and New Zealand

Research activities are supported by a Senior Practitioner Fellowship from the National Health and Medical Research Council of Australia

Non-conflicted author of the 2016 Surviving Sepsis Guidelines




Co-author of Surviving Sepsis Guidelines




Co-author of Surviving Sepsis Guidelines; Past- Treasurer ESICM, Co-author of Consensus statement of the ESICM task force on colloid volume therapy in critically ill patients 2012, Co-author Prospectively defined indicators to improve the safety and quality of care for critically ill patients: a report from the Task Force on Safety and Quality of the ESICM, 2012; International Sepsis Forum Council, Data Safety and Monitoring Committee, Asahi Kasei Pharma America Corporation Phase III sepsis trial.



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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature and ESICM 2018

Authors and Affiliations

  • Julian Bion
    • 1
  • Massimo Antonelli
    • 2
  • LLuis Blanch
    • 3
  • J. Randall Curtis
    • 4
  • Christiane Druml
    • 5
  • Bin Du
    • 6
  • Flavia R. Machado
    • 7
  • Charles Gomersall
    • 8
  • Christiane Hartog
    • 9
  • Mitchell Levy
    • 10
  • John Myburgh
    • 11
  • Gordon Rubenfeld
    • 12
  • Charles Sprung
    • 13
  1. 1.University Department of Intensive Care MedicineUniversity of BirminghamBirminghamUK
  2. 2.Department of Intensive Care Medicine, Anesthesiology and Emergency MedicineFondazione Policlicnico Universitario A. Gemelli IRCCS-Università Cattolica del Sacro CuoreRomeItaly
  3. 3.Parc Tauli University Hospital, CIBER Enfermedades Respiratorias, Institut de Investigació i Innovació Parc TaulíUniversitat Autònoma de BarcelonaSabadellSpain
  4. 4.Cambia Palliative Care Center of Excellence at UW Medicine, A. Bruce Montgomery-American Lung Association Endowed Chair in Pulmonary and Critical Care Medicine Harborview Medical CenterUniversity of WashingtonSeattleUSA
  5. 5.UNESCO Chair on Bioethics of the Medical University of Vienna, Ethics, Collections and History of MedicineViennaAustria
  6. 6.Medical Intensive Care UnitPeking Union Medicine College HospitalBeijingChina
  7. 7.Anesthesiology, Pain, and Intensive Care DepartmentUniversidade Federal de São PauloSão PauloBrazil
  8. 8.Department of Anaesthesia and Intensive CareThe Chinese University of Hong KongHong KongChina
  9. 9.Department of Anaesthesiology and Intensive Care MedicineCentre for Sepsis Care and Control, Jena University HospitalJenaGermany
  10. 10.Pulmonary and Critical Care Medicine Alpert Medical School of Brown UniversityRhode Island HospitalProvidenceUSA
  11. 11.The George Institute for Global HealthNewtownAustralia
  12. 12.Interdepartmental Division of Critical Care MedicineUniversity of TorontoTorontoCanada
  13. 13.Department of Anesthesiology and Critical Care MedicineHadassah Hebrew University Medical CenterJerusalemIsrael

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