Former ESC president judged guilty of severe misconduct over drug ties

A British cardiologist and former president of the European Society of Cardiology (ESC) has been judged by the ESC to have committed severe misconduct after a Danish TV documentary reported that he had been involved in drawing up guidelines for the use of the heart drug ivabradine (Corlanor, Procoralan) while profiting from lucrative contracts with the drug's maker. 

An investigation published by The BMJ today describes how between 2006 and 2015, Kim Fox, emeritus professor of clinical cardiology at the National Heart and Lung Institute, Imperial College London, who reportedly served as cardiologist to the late Queen Elizabeth II, and his wife Karen Summers, a former drug industry executive, received more than £50m as co-directors of the UK based contract research organisation Heart Research. 

This company was involved in running at least three clinical trials of ivabradine, made by French drug company Servier, that were published in the same period, reports freelance journalist, Laura Spinney. 

In 2006, when Fox became president of the ESC, he chaired an ESC taskforce that published a guideline recommending ivabradine as an alternative treatment for angina in patients who couldn't tolerate beta blockers. Authors were asked to disclose conflicts of interests, but the guideline did not publicly identify what Fox had disclosed. 

As outgoing ESC president in 2008, Fox championed the drug publicly though it had failed to meet the primary endpoint in the first of the three trials Heart Research was involved in. 

Ivabradine remains approved for angina and heart failure in Europe, and for heart failure in the US, but persistent doubts have been expressed over its efficacy. 

It's rare for alleged conflicts of interest to involve such large sums of money. The case remains unreported in most of Europe and beyond, even though the ESC's guidelines are influential worldwide. 

The Danish documentary, which aired in September 2024, triggered an internal review by the ESC which found that the 2006 guideline recommendations were "appropriate" and reported "no evidence to suggest a bias towards ivabradine."

But in March 2025, the ESC ethics committee found that Fox "had failed to meet his ethical obligations and considered his behavior as a severe misconduct." 

Pulmonologist Irène Frachon, described the sums involved in the case as "monstrous" while Rita Redberg, a cardiologist and former editor in chief of JAMA Internal Medicine, said: "It totally goes against the grain of the profession."

Fox rejected the ethics committee's findings and resigned his ESC membership, claiming that he had always declared any conflicts of interest and that "he was not prepared to be judged on the basis of rules and regulations described in 2024 retrospectively for activities in 2006 to 2008." 

The ESC admitted to The BMJ that its declarations process was relatively lax in the early 2000s and said that it had been substantially strengthened since. Meanwhile, Servier said that it "strictly complies" with transparency guidelines established by the European Federation of Pharmaceutical Industries and Associations, a trade body. 

The Fox story has emerged at a time when some in Europe are pushing for reforms that would end voluntary declaration of conflicts of interest and enshrine greater transparency in law. 

For former ESC vice president John Martin, the ESC has not done enough to restore public trust, and the recent revelations risk damaging the doctor-patient relationship while also leaving the volunteers who run the society feeling betrayed. He urged further action. "The ESC board might be seen as tacitly complicit unless there is a thorough public investigation," he said. "Many questions remain."