The Society of Thoracic Surgeons Standards for Interactions with Companies

This policy is adapted from the CMSS Code for Interactions with Companies (April 2026 version)

The Society of Thoracic Surgeons (“STS”) plays an important role in engaging and connecting health professionals, patients, and other groups.  We guide biomedical research, discover new therapies, and engage in high quality surgical practice.  We offer educational opportunities and publications and develop resources that help translate scientific and medical progress into the efficient delivery of effective medical care. STS provides a forum for presenting new skills and scientific developments. Through rigorous peer review and management of potential conflicts of interest, STS enables researchers to publish and present trustworthy and credible new knowledge. STS’ policies are intended to support evidence-based recommendations.

Entities whose primary business is to develop, produce, market, sell, re-sell, or distribute products, drugs, devices, services, or therapies used to diagnose, treat, monitor, manage, or alleviate cardiothoracic diseases, referred to in these Standards as “Companies,” also strive to help people live longer and healthier lives. Companies invest resources to bring new or improved drugs, devices, products and services to the healthcare professional and ultimately to the patient while maximizing value for the Companies’ shareholders. STS may choose to seek support from Companies for its independent and varied programs and services that benefit STS members and their patients, consistent with these Standards.

Healthcare professionals and patients count on STS to be an authoritative, independent voice in the world of science and medicine. We believe that public confidence in our objectivity is important to carrying out our mission, and are committed to acting with integrity and transparency across all of our initiatives and collaborations, including our in our interactions with Companies. 

These Standards embody the core principles of our profession, and are intended to benefit both our members and their patients, and to improve cardiothoracic surgical care. 

Definitions

The following terms are defined for purposes of these Standards. STS recognizes that some of these terms may be used or defined differently by others. Some of these terms refer to types of interactions in which STS may engage with non-profit organizations and individuals as well as with Companies. 

 

Advertising: Advertising is a Business Transaction in which a Company or its agents pays a fee to STS in exchange for STS’s publication of a promotional announcement that highlights the Company or the Company’s activities, products, or services. For purposes of these Standards, Advertiser refers to a Company that purchases Advertising. 

Business Transaction: A Business Transaction is an interaction between STS and a Company in which a Company pays a fee to STS in exchange for STS’s item, service, or product. Examples of Business Transactions include Company payment of fees associated with subscriptions to STS publications, Advertising in STS publications, registrations for STS meetings, and exhibit space rental. 

Charitable Contribution: A Charitable Contribution is a gift, including an in-kind gift, given by a Company to a qualified tax-exempt organization (e.g., STS or an affiliated organization) for use in furthering the organization’s charitable purposes and in accordance with applicable tax rules and legal standards. 

Clinical Practice Guideline: A Clinical Practice Guideline (or “Guideline”) is a statement that includes recommendations intended to optimize patient care and is informed by a systematic review of evidence and an assessment of the benefits and harms of alternative care options.1 Section 8 of these Standards addressed Clinical Practice Guidelines, as well as updates to existing guidelines (“Guideline Updates”), medical technology assessments, clinical opinions, and other evidence-based clinical practice tools.

Company: A Company is a entity whose primary business is developing, producing, marketing, selling, re-selling, or distributing products, devices, services, or therapies used to diagnose, treat, monitor, manage, or alleviate health conditions. This definition is intended to focus primarily on entities operating within or interacting with the health care sector and does not include entities through which physicians provide clinical services directly to patients.

Company-Directed Program: A Company-Directed Program is a program offered by a Company or third party that may inform healthcare providers about specific Company initiatives, products or brands through content directly controlled by a Company. Company-Directed Programs are not eligible for CME credit. 

Continuing Medical Education (CME): Continuing Medical Education (CME) consists of educational activities for which the attendee may receive CME credit (American Medical Association (AMA) Physician’s Recognition Award Credit, American Academy of Family Physicians (AAFP) Prescribed or Elective Credit, American Osteopathic Association (AOA) Credit – various categories) based on accreditation awarded to the provider by a recognized accrediting body (e.g., Accreditation Council for Continuing Medical Education (ACCME), AOA, AAFP). CME activities “serve to maintain, develop, or increase the knowledge, skills, and professional performance and relationships that a physician uses to provide services for patients, the public, or the profession.2 For purposes of these Standards, educational activities for physicians that are not CME-accredited are considered Non-CME Educational/Informational Programs. 

Corporate Sponsorship: A Corporate Sponsorship is an arrangement with an identified company in which financial or in-kind support for an STS program, product, or service, is made in exchange for certain forms of acknowledgement of the Corporate Sponsor. Corporate Sponsorships are distinct from Educational Grants and do not constitute Commercial Support of CME. For purposes of these Standards, Corporate Sponsor refers to a Company that provides a Corporate Sponsorship.

Educational Grant: An Educational Grant is financial or in-kind support awarded by a Company, typically through its grants office, for the specific purpose of offsetting part or all of the expenses associated with an educational or scientific activity offered by STS. Typically CME Educational Grants include terms to ensure that activity development remains independent and free from Company influence. Educational Grants typically include terms regarding recognition of the grant-maker in connection with the activity and provision to the grant-maker of post-activity metrics mutually agreed upon. Educational Grants awarded by a Company to support a CME activity are referred to in the ACCME Standards for Commercial Support as “Commercial Support” of CME.2 

Key STS Leaders: The Key STS Leaders include officers in the Presidential line of succession (e.g., the President-Elect, the President, and the Immediate Past President) of STS, the chief executive officer of STS, and the Editor-in-Chief of STS’s journal

Non-CME Educational Program:  Non-CME educational activities include both formal and informal education that is offered by STS, to meet a defined educational need that enables the acquisition or reinforcement of knowledge and/or skills to improve practice or research, but where the decision has been made to not offer CME credit.

Research Grant: A Research Grant is an award that is given by STS to an individual, institution or practice to fund the conduct of scientific research. Companies may provide STS with programmatic support (e.g., an Educational Grant or Charitable Contribution) designated for the specific purpose of funding Research Grants. 

STS Journal: STS publishes The Annals of Thoracic Surgery and Annals Short Reports (collectively, “STS Journal”), which are peer-reviewed scientific publications produced by STS to disseminate scientific research, clinical findings, and professional insights in relation to cardiothoracic surgery. STS Journal is published by a publishing company on STS’s behalf.

Standards for Interaction

1. Independence 

1.1 STS develops all educational activities, scientific programs, products, services and advocacy positions independent of Company influence, and develops and adopts policies and procedures that foster independence. When STS collaborates in an arms-length business relationship with a Company on a project or utilizes the Company’s product or service, STS will apply its independent judgment and will remain the ultimate decision-maker with respect to content or project decisions.

1.2 STS’ programmatic decisions are made independently of its efforts to seek Educational Grants, Corporate Sponsorships, Charitable Contributions, and support for Research Grants.

1.3 STS has identified a high-level group responsible for ensuring that STS interactions with Companies are consistent with these Standards. 

1.4 STS uses written agreements with Companies for Educational Grants, Corporate Sponsorships, Charitable Contributions, Business Transactions, and support of Research Grants. The elements of each agreement vary according to the agreement’s purpose; at a minimum; the agreement specifies what the funds are for, the amount given, and the separate roles of STS and the Company, as well as other participating organization(s) if applicable. 

2. Transparency 

2.1 STS’ conflict of interest policies are available to its members and the public. 

2.2 STS discloses Company support (at a minimum Educational Grants, Corporate Sponsorships, Charitable Contributions, and support of Research Grants), making this information available to its members and the public. 

2.3 STS has written disclosure policies for the identification and management of Financial Relationships held by Key STS Leaders, Board members, committee members and others who serve on its behalf. STS requires these individuals to update disclosure information at least annually and when material changes occur. 

2.4 STS has policies for the review of each individual’s disclosures submitted as part of the formal process to identify and manage Financial Relationships and address any identified Financial Relationships in accordance with its policies.

2.5 STS discloses all financial and uncompensated relationships that Key STS Leaders and members of the Board of Directors of STS’s membership organization have with Companies, making this information available to its members and the public in accordance with its conflict-of-interests policy.

3. Accepting Charitable Contributions 

3.1 STS (and its affiliated foundation) controls the use of Charitable Contributions in a manner that is aligned with STS’s strategic plan and mission. 

3.2 STS (and its affiliated foundation) accepts reasonable requirements for reporting on the uses of the donated funds and reasonable restrictions on the purposes for which Charitable Contributions will be used, but declines Charitable Contributions if donor restrictions would influence STS programs or advocacy positions in a manner that is inconsistent with the STS’s mission. 

4. Accepting Corporate Sponsorships 

4.1 STS only accepts Corporate Sponsorships that are consistent with STS’ strategic plan and mission. This includes support for a specific item or program or broader, multi-program partnerships that reflect long-term alignment and are managed with appropriate safeguards to maintain independence. 

4.2 STS does not place the names or logos of Companies or products on STS-distributed “reminder” items (e.g., tote bags, lanyards, highlighters, notebooks, and luggage tags).3

4.3 STS does not accept Corporate Sponsorships of the STS National Database or other registries in which STS participates.  Corporations are not allowed to participate in the management of such registries in any way. 

5. STS Continuing Medical Education Activities

5.1 STS complies with ACCME Standards for Integrity and Independence in Accredited Continuing Education or standards adopted by other accrediting bodies4, including: by ensuring that content is valid and independent of Company influence; by adopting policies and procedures designed to identify, mitigate and disclose relevant Financial Relationships; and by adopting policies to ensure the appropriate management of commercial support and other ancillary Company activities.

5.2 STS accepts in-kind support for CME programs from Companies when the purpose of the CME activity is to demonstrate or train attendees in the safe and effective use of a particular drug, device, service, or therapy. STS may accept in-kind support from a single Company when other equal but competing products or services are not available for inclusion.

5.3 STS makes reasonable efforts to seek multiple sources of support for CME activities, including support from Companies, support from organizations outside the for-profit healthcare sector, and registration fees from attendees.

5.4 STS requires that any organizations with which it partners, or to which it offers opportunities to provide accredited CME activities adjunct to or as part of STS’s educational portfolio, agree to comply with the requirements set forth in Section 5.1 of these Standards.

6. Company Opportunities

6.1 Company-Directed Programs at STS Events

6.1.1 STS requires Company-Directed Programs to be clearly distinguished from CME programs, separated by physical space and time. STS will utilize disclaimers and limitations on use of STS trademarks to show that the Company-Directed Program is not endorsed or sponsored by STS. When Company-Directed Programs are held at an event that includes CME activities, STS ensures compliance with ACCME Standard 5.

6.1.2 STS will direct Companies to disclose to attendees the fact that individuals employed or paid by the Company were involved in developing and presenting the Company-Directed Program.

6.2 Company-Sponsored Educational Program Endorsement

6.2.1 STS has adopted a published policy and standard forms governing applications for STS endorsement of Company-sponsored educational programs, the consideration of such applications, and contracts governing STS endorsement of such programs under appropriate circumstances.

6.3 Exhibits 

6.3.1 STS has written policies that govern the nature of exhibits and the conduct of exhibitors, including requiring exhibitors to comply with applicable laws, regulations, and guidance. When Exhibits are shown at an event that includes CME activities, STS ensures compliance with ACCME Standard 5.6.3.2 STS will permit Companies to exhibit and promote goods and services only within their defined exhibiting footprints and during established times (e.g., exhibit hall hours, Company-Directed Programs)

6.4 Advertising

6.4.1 STS has written policies that set standards for Company Advertising and for overseeing compliance with these standards to ensure that Advertisers do not influence Society editorial or programmatic decisions. 

6.4.2 STS ensures that Company Advertising in STS Journal and other STS publications is easily distinguishable in design and placement from editorial content. 

6.4.3 STS will ensure that Company Advertising for activities through which attendees may earn CME credits comply with ACCME requirements for marketing and advertising in the Standards for Integrity and Independence in Accredited Continuing Education.

6.5 Licensing

6.5.1 STS has adopted practices and standard forms for licensing contracts that are intended to prevent misuse, unintended use, and modification of licensed STS content in a way that would change its meaning. 

6.5.2 STS will adopt standards governing the use of STS trademarks in relation to Company activities that minimize any implication of Society collaboration in the creation of Company products or provision of Company services.

7. Awarding of Research Grants

7.1 STS does not permit Companies to select (or influence the selection of) recipients of Research Grants. 

7.2 STS appoints its own committees to select recipients of Research Grants based on peer review of grant applications. 

7.3 STS will not require recipients of Research Grants to communicate with Company supporters about their work, outside of the parameters clearly defined in the grant agreement between STS and the Research Grant recipient.

7.4 STS does not permit Companies that support Research Grants to control or influence manuscripts that arise from the grant-funded research. 

7.5 STS discloses Company programmatic support (e.g., an Educational Grant or Charitable Contribution) for STS’s own research. STS acts independently in selecting research topics and conducting the research itself. 

8. Clinical Practice Guidelines 

8.1 STS follows a transparent Clinical Practice Guideline development process and will not accept sponsorship, grants, contributions, or other direct support from Companies for the development of Clinical Practice Guidelines or Guideline Updates. 

8.2 STS ensures that Clinical Practice Guideline recommendations are informed by a review of the best available evidence and, where possible, based on an extensive, reproducible, and robust body of evidence.

8.3 STS may, after completion of Guideline development, accept Company support or engage in licensing arrangements with Companies for the distribution, publication, translation, repurposing, or archiving of the Guideline or Guideline Update. In any Company-supported context, STS shall ensure that a written statement accompanies the Guideline or Guideline Update, acknowledging the Company’s role and affirming the independent nature of STS’s Guideline development process.

8.4 STS requires all Guideline development panel members to disclose all Financial Relationships prior to panel deliberations, and to update their disclosures throughout the Guideline development process. 

8.5 STS requires that a majority of Guideline development panel members are free of Financial Relationships relevant to the subject matter of the Guideline.

8.6 STS requires the panel chair (or at least one chair if there are co-chairs) to be free of Financial Relationships relevant to the subject matter of the Guideline, and to remain free of Financial Relationships for at least one year after Guideline publication.

8.7 STS has procedures for determining whether Financial Relationships between Guideline development panel members and Companies constitute conflicts of interest relevant to the subject matter of the Guideline, as well as management strategies that minimize the risk of actual and perceived bias if panel members do have conflicts.

8.8 STS requires that Clinical Practice Guideline recommendations be subject to multiple levels of review, including rigorous peer-review by a range of experts. 

8.9 STS’ Clinical Practice Guideline recommendations are reviewed and approved before submission for publication by at least one STS body beyond the Guideline development panel. 

8.10 STS publishes Clinical Practice Guideline development panel members’ Financial Relationship disclosure information in connection with each Clinical Practice Guideline and identifies voting abstentions. 

8.11 STS requires all Clinical Practice Guideline contributors, including expert advisors or reviewers who are not officially part of a development panel, to disclose Financial Relationships that may constitute conflicts of interest. 

8.12 STS shall recommend that Clinical Practice Guideline development panel members decline offers from positively or negatively affected Companies to speak about the Guideline on behalf of the Company for one year after publication. 

8.13 Clinical Practice Guideline development panel members and staff must not discuss a Guideline’s development with Company employees or representatives and must not permit Companies to review Clinical Practice Guidelines in draft form. 

9. STS Journal

9.1 STS Journal maintains editorial independence from STS and from Advertisers, consistent with accepted standards for scholarly medical publishing, such as the recommendations provided by the International Committee of Medical Journal Editors (ICMJE) and the World Association of Medical Editors (WAME).5

9.2 STS Journal requires all authors, editors, and reviewers to disclose financial relationships with Companies in any way related to the content of the article. This disclosure should appear on the first page of the article.

9.3 STS Journal’s Editor-in-Chief, in consultation with STS, has the ultimate responsibility for determining when a conflict of interest should disqualify an editor or reviewer from reviewing a manuscript, according to established policies.

9.4 STS Journal’s policy prohibits submission of “ghost-written” manuscripts prepared by or on behalf of Companies. 

9.5 STS Journal may publish Company-sponsored supplements if they are clearly distinguishable from other STS Journal editorial content and disclosed as being Company-sponsored.

 

Adopted by the STS Board of Directors January 30, 2011, amended by the STS Executive Committee on September 9, 2026

 

1.  Institute of Medicine. 2011.Clinical Practice Guidelines We Can Trust. Washington, DC: The National Academies Press. https://doi.org/10.17226/13058 (Accessed June 4, 2025)

2. Accreditation Council for Continuing Medical Education (ACCME): CME content. http://www.accme.org/index.cfm/fa/Policy.policy/Policy_id/16f1c694-d03b-.... (Accessed October 25, 2009); American Medical Association (AMA): The Physician Recognition Award and credit system. http://www.ama-assn.org/ama1/pub/upload/mm/455/pra2006.pdf. (Accessed December 18, 2009).

3. Pharmaceutical Research and Manufacturers of America (PhRMA): Code on Interactions with Healthcare Professionals, https://cdn.aglty.io/phrma/global/resources/import/pdfs/PhRMA%20Code%20-%20Final.pdf (Accessed June 4, 2025); Advanced Medical Technology Association (AdvaMed): Code of Ethics. https://www.advamed.org/wp-content/uploads/2023/06/2023-AdvaMed-Code-of-Ethics.pdf. (Accessed June 4, 2025). 

4. See https://accme.org/rules/standards/ for a list of other accrediting bodies that have adopted the ACCME Standards for Integrity and Independence in Accredited Continuing Education.

5. International Committee of Medical Journal Editors: Recommendations for the Conduct, Reporting, Editing, and Publication of Scholarly Work in Medical Journals. https://www.icmje.org/icmje-recommendations.pdf. (Accessed June 4, 2025); World Association of Medical Editors: The Responsibilities of Medical Editors. https://wame.org/responsibilities-medical-editors. (Accessed June 4, 2025).