The American Society for Surgery of the Hand (“ASSH”) is dedicated to advancing the study and practice of surgery of the hand. To accomplish that mission, it provides support, directly or indirectly, for a variety of activities in the areas of research, education, promotion, and advocacy. The integrity of ASSH, and the activities it undertakes, depends on the avoidance of conflicts of interest, or even the appearance of such conflicts, by the individuals involved in those activities.
At the same time, ASSH recognizes that the elected and appointed leaders of ASSH, as well as other individuals acting on its behalf, also have significant professional, business and personal interests and relationships. Therefore, ASSH has determined that the most appropriate manner in which to address actual, potential or apparent conflicts of interest is initially through liberal disclosure of any relationship or interest which might be construed as resulting in such a conflict. Disclosure under this Policy should not be construed as creating a presumption of impropriety or as automatically precluding someone from participating in an ASSH activity or decision-making process. Rather, it reflects ASSH’s recognition of the many factors that can influence one’s judgment and a desire to make as much information as possible available to other participants in ASSH-related matters.
ASSH acknowledges that some conflicts cannot be “managed.” There are some unresolvable conflicts. As such, under certain circumstances mere disclosure is not sufficient; a person with a disclosed conflict must be precluded from participating in a particular activity. For example, the ACCME’s Standards for Commercial Support, which ASSH supports and follows, sets forth certain situations where persons who have the potential to affect the content of a CME entity may not be allowed to participate in CME related activities because their conflicts are unresolvable. ACCME’s separate conflict of interest disclosure requirements and policies are incorporated as part of ASSH’s more general conflict of interest policy.
General Disclosure Requirements
Any individual involved in an ASSH activity or decision-making process shall disclose any conflicting or potentially conflicting personal, professional or business interest he or she may have, directly or indirectly, with the affected activity or decision. Potentially conflicting interests may relate to ASSH’s programs and services (e.g., educational courses, research grants, journal matters) or its operations (e.g., contracts with third parties). “Directly or indirectly” relates not only to the individual’s potential conflicts but also those of others (e.g. family members, business partners, etc.) that could affect the individual’s decision-making.
In particular, participants in ASSH-related activities are obligated to disclose the positions they hold or relationships they have within ASSH and with other organizations or entities that may conflict, directly or indirectly, with their ASSH activities. They also have an obligation to disclose any significant financial interest in, or other relationship with, an entity having a “commercial interest” in the activity. A commercial interest may exist not only where the entity’s products or services are under consideration by ASSH, but also where the entity’s products or services are in competition or potential competition with those under consideration. By the disclosure of such interests, Council or its designee(s) will be in a better position to determine whether the participant may have an interest in conflict with the interests of ASSH.
ASSH primarily is concerned with potential conflicts of interest involving those individuals participating directly in ASSH-related activities. Potential conflicts of interest also may arise, however, if an individual with whom the participant directly shares income (e.g., a spouse, minor child, or business partner) or a third party whose interest may affect the participant’s decision-making (e.g., a sibling or adult child) has an interest in, or relationship with, an entity having a commercial interest in the activity or matter under consideration. As a result, participants should disclose not only their own interests or relationships but also those of their spouse, minor children, or business partners. In addition, participants should disclose interests or relationships held by others that may affect their decision-making, but only to the extent they are aware of such information. Participants are under no obligation to determine the nature of every interest held by a sibling, business partner, etc. if they have no independent knowledge of such interests.
Comparable principles apply to participants’ obligations to disclose research grants received by the institution(s) with which they are affiliated. In addition to grants received for their own research, participants are presumed to know what grants have been received by other members of their department engaged in upper extremity-related research. Therefore, those grants also should be disclosed. In contrast, participants have no affirmative obligation to ascertain the nature of grants received by others in their institution. If they are aware of such grants, however, those also should be disclosed.
In general, participants should err on the side of disclosure if in doubt as to whether it is required under the Policy. Examples of relationships or interests related to ASSH or hand surgery which should be disclosed include:
Positions in ASSH - All positions currently held or sought in ASSH (e.g., Council or committee member, editor, course or publication contributor), as well as any other current or proposed relationship with ASSH (e.g., service provider, paid consultant) must be disclosed.
Relationships with Other Organizations/Entities - Any leadership role in, or other relationship with, another organization or entity (e.g., board member, committee member, advisor, journal contributor) directly or indirectly related to ASSH or hand surgery must be disclosed.
Employment - Any current or proposed full- or part-time employment, as well as any employment within the previous three (3) years, must be disclosed.
Consultancies - Any current or proposed consulting arrangements, as well as any consulting performed or paid for within the previous three (3) years, must be disclosed.
Royalties - Any individual or entity that is currently paid or has paid (in the past three (3) years) or is about to pay, royalties or similar payment, must be disclosed.
Ownership Interests - Any ownership interests (including stock options but excluding indirect investments through mutual funds and the like) in a company, the stock of which is not publicly traded, must be disclosed. Ownership interests in excess of $10,000.00 in companies that are publicly traded also must be disclosed. In addition, any other ownership interests in an entity having a commercial interest in an activity or matter under consideration by ASSH must be disclosed.
Honoraria - Honoraria or other reasonable payments for seminar presentations, speeches, or appearances must be disclosed in the event the amount paid within the previous three (3) years, or about to be paid, is equal to or greater than $2,500.00 per year or $5,000.00 over a three-year period.
Research Funding - Receipt of funds for conducting research must be disclosed.
General Disclosure Form
Integral to the implementation of the Conflict of Interest Policy is the ASSH Conflict of Interest Disclosure Form, a copy of which is attached as Attachment A, which shall be considered a part of the Conflict of Interest Policy and must be submitted by any individual participating in an ASSH activity. Initially, a participant’s obligation to report actual, potential or apparent conflicts is discharged by completing the Disclosure Form. Participants remain under a continuing obligation, however, to report such conflicts as they arise, including those that were not reported on the Disclosure Form, but which later become relevant to the ASSH activity in which they are involved.
For example, an individual appointed to serve as editor of an ASSH publication is not expected to anticipate all the conflict situations that may arise during the course of that appointment. If, however, the editor is asked to review an article submitted for publication that could affect, directly or indirectly, an entity in which the editor has a financial or other interest, the editor has an obligation to disclose the potential conflict to Council, or its designee(s), before becoming involved in a review of the article.
Disclosure Forms shall be kept on file at the ASSH Central Office for a period of two (2) years, or one (1) year after the conclusion of the relevant activity or decision-making process, whichever is longer, unless otherwise determined by Council.
General Implementation Procedures
All participants in ASSH-related activities, including CME-related activity, must comply with the ASSH Conflict of Interest Policy. It is the responsibility of the disinterested members of Council or designated committee chairs, editors, etc. to apply and abide by this Policy. Inasmuch as the Policy is stated in general terms, they should use their best judgment in doing so.
In order to facilitate implementation of the Conflict of Interest Policy, Council or its designee(s) shall determine, based on the disclosure form and other relevant information, when an individual engaged in, or about to engage in, an ASSH-related activity or other matter under consideration has an actual, potential, or apparent conflict of interest requiring some response by ASSH. Specifically, subject to the procedures set forth herein, Council or its designee(s) may require any action they deem appropriate, including, but not limited to, the following:
- Disclosure of the interest to the other participants in the decision- or policy- making body (e.g., committee, editorial board).
- Written and, in some cases, oral disclosure of the interest (e.g., to an audience receiving the results of clinical research or at scientific or educational sessions).
- Recusal from voting on a matter and limitation of the individual’s participation only to the provision of factual information of benefit to the group discussion.
- Complete recusal from a portion of a meeting or from other consideration of the subject matter.
- A decision not to invite someone to participate in an ASSH activity.
- Replacement of the individual in the affected position or activity.
In most instances, disclosure of the conflicting or potentially conflicting interest will itself suffice to protect ASSH’s interests. In other words, once such a conflict is fully disclosed to the relevant parties, they generally will be able to evaluate the possible influence of the disclosed interest. However, in other situations, disclosure alone is not deemed to be sufficient. In situations where disclosure does not adequately deal with actual or potential problems, additional action, including denial of participation in the affected activity or consideration of the matter, may be appropriate or necessary. ASSH’s adherence to ACCME’s standards for Commercial Support provides examples where such denial is required.
It should be noted that Council has determined that certain relationships – dualities of interest, for example, where a member has potentially competing duties of loyalty – are so pervasive that such conflicts and dualities of interest should be avoided from the outset. In other words, denial of participation often is best implemented by not allowing the participation in the first instance. For example, many members serve on the Boards of organizations that have a commonality of interest with ASSH. That can be a very good thing. However, when a member serves on the Board of another organization and, simultaneously, serves in a position of leadership and influence in ASSH, the potential conflicts and dualities of interest often can be too fundamental to be managed by either disclosure or recusal, and too awkward and difficult to implement by after the fact denial of participation.
As such, Council is providing guidance that certain conflict situations should be avoided at the outset. Examples of such situations include persons serving on the boards of organizations such as AAHS, AAOS, ASPS, OREF, etc. who seek to serve in key leadership roles at ASSH (in the Presidential Line, for example, or as an officer or member of Council, or as a trustee of AFSH). These types of conflict scenarios should be avoided, upfront, to the degree possible or practical. Similarly, serving as an Editor of JHS and seeking to simultaneously serve in another ASSH leadership position also may be problematic and should be avoided. A table summarizing ASSH’s general guidance on organizational relationships is attached as Attachment B
In all such situations, Council or their designee(s) will weigh all of the facts and circumstances and determine what is in the best interests of ASSH. For example, in weighing the facts and circumstances, Council or their designee(s) may determine that serving as, say, an ASPS director would not preclude someone from serving in the ASSH Presidential Line, but serving as an ASPS officer would. Similarly, Council or their designee(s) may weigh the facts and circumstances and determine that no one serving as an AAHS director should serve as a member of Council.
In all circumstances, members who seek to serve in leadership roles in ASSH are cautioned to avoid conflict and duality of interest situations which could result in an upfront denial of participation in an ASSH leadership role. Or, in the alternative, and in order to serve in a leadership role in ASSH, they should be prepared to sever the duality of interest position.
Council has charged the Executive Committee with having primary responsibility for interpreting and applying this Conflict of Interest Policy. As such, the Executive Committee will regularly review all conflict of interest disclosure forms and will be available to provide advice to ASSH committees, task forces, members, or staff on managing conflicts of interest including, without limitation, policies, practices, and procedures on disclosure, recusal, and/or denial of participation. In the special circumstance of the Nominating Committee, the Executive Committee shall not influence the recommendations coming from the Nominating Committee, but may review specific candidate recommendations and advise Council on potential conflict and duality of interest issues with respect to nominees.
CME Disclosure Requirements
ASSH is committed to fully complying with ACCME’s Standards for Commercial Support. As such, for CME related activities, in addition to complying with ASSH’s Conflict of Interest Policy, individuals also must comply with additional, special rules for identifying relevant financial relationships and resolving conflicts of interest. Those additional, special rules are set forth in ASSH’s CME Conflict of Interest Policy and Disclosure Form, which is attached and incorporated by reference.
AMERICAN SOCIETY FOR SURGERY OF THE HAND Conflict of Interest Disclosure Form
ASSH Council Conflict of Interest Form