In 2006, Kim Fox became president of the European Society of Cardiology and chaired the taskforce that wrote its new guideline for treating chronic angina. Among the taskforce's recommendations was a drug called ivabradine, offered as an alternative for patients who could not tolerate beta blockers. What the guideline never told the cardiologists who followed it was that, between 2006 and 2015, Fox and his wife, Karen Summers, together earned more than £50 million as co-directors of Heart Research, a UK contract research organization running clinical trials of that same drug for its manufacturer, the French company Servier.
A clinical guideline occupies an unusual place in medicine. No practicing cardiologist has time to re-read every trial behind every recommended drug; they read the guideline instead, and they read it precisely because they trust the panel weighed the evidence without a stake in the outcome. That trust is the entire value of the document. A guideline that quietly restates what a drug's own manufacturer would say is not independent guidance — it is an advertisement with a committee's letterhead on it, and the letterhead is the only thing separating the two.
The arrangement held for nearly two decades before anyone outside it knew to ask. It surfaced only after a Danish documentary aired in September 2024 forced the European Society of Cardiology to open an internal review, which found the 2006 guideline appropriate and reported no evidence of bias. That finding did not survive contact with the society's own ethics committee, which reached the opposite verdict in March 2025: Fox had failed to meet his ethical obligations, and his conduct amounted to severe misconduct. Fox rejected the finding and resigned his ESC membership, arguing he had always declared his interests and that he was being judged, years later, by disclosure standards that did not exist when he served. The society itself, pressed by a BMJ investigation published in August 2026, admitted that its declarations process had been relatively lax in the early 2000s, and had been substantially strengthened since.
The pulmonologist Irène Frachon, who spent two years proving that another Servier drug, the diabetes pill Mediator, was destroying patients' heart valves before French regulators withdrew it in 2009, called the sums involved in the Fox case monstrous. The cardiologist Rita Redberg, a former editor-in-chief of JAMA Internal Medicine, put it more plainly: the arrangement, she said, went against the grain of the profession. Neither reaction was really about the size of the number. It was about what that number was doing inside a document built to contain no numbers at all except the ones describing patients.
A biased trial can eventually be caught by replication — another lab runs the experiment and the result either holds or doesn't. A biased guideline is harder to catch, because the guideline is the very thing doctors consult instead of re-running the trials themselves; it exists to save them that labor. Undermine it quietly enough, for long enough, and the people relying on it never learn there was a question to ask. The cardiologists who followed the 2006 recommendation were not careless. They were doing exactly what the profession asks of its members: trust the guideline. That is precisely why the guideline had to earn it.