WHAT IS CIOMS?

The Council for International Organizations of Medical Sciences (CIOMS)

is an international, non-governmental, non-profit organization established
jointly by WHO and UNESCO in 1949.
Through its membership, CIOMS is representative of a substantial
proportion of the biomedical scientific community. The membership of
CIOMS in 2003 includes 48 international member organizations,
representing many of the biomedical disciplines, and 18 national members
mainly representing national academies of sciences and medical research
councils.
The main objectives of CIOMS are:
To facilitate and promote international activities in the field of biomedical
sciences, especially when the participation of several international
associations and national institutions is deemed necessary;
To maintain collaborative relations with the United Nations and its
specialized agencies, in particular with WHO and UNESCO;
To serve the scientific interests of the international biomedical community
in general.
To achieve its objectives, CIOMS has initiated and coordinates the
following main long-term programmes:
Bioethics
Health Policy, Ethics and Human Values - An International Dialogue
Drug Development and Use
International Nomenclature of Diseases
BIOETHICS
The remarkable progress of biomedical sciences and biotechnology, and its
applications in medical practice, are confronting our societies with new
ethical dilemmas, extending from traditional medical ethics to the many
emerging areas of bioethics.
The particular contribution of CIOMS in this field has been the issuance of
international guidelines for the application of ethical principles in various

key areas. Specific reference should be made to the International Ethical

Guidelines for Biomedical Research Involving Human Subjects (developed
in conjunction with WHO), which superseded Proposed Ethical Guidelines
(1982) and were published in 1993. They have been very widely utilized,
particularly in low-resource countries. In 1999-2002 the Guidelines were
revised and updated. CIOMS published in 2002 the new text of the
International Ethical Guidelines for Biomedical Research Involving
Human Subject which are available on the CIOMS websites. Moreover,
translations of the Guidelines have been made in French, Spanish,
Portuguese, Chinese, Japanese, Korean and Vietnamese.
A chapter by Professor Juhana E. Idnpn-Heikkil and Mr Sev Fluss,
CIOMS, describing the 2002 Guidelines has been included in The Oxford
Textbook of Clinical Research Ethics.
In 1991 CIOMS issued International Guidelines for Ethical Review of
Epidemiological Studies. In 2003 CIOMS initiated the revision of theses
Guidelines by establishing a multidisciplinary Working Group which has
collected comments on the draft revision of the guidelines from various
institutions, organizations and individual experts involved in ethics and
epidemiological research. Provisional Guidelines were posted on the
CIOMS website in February, 2008.
Specific reference should also be made to the "Principles of Medical Ethics
Relevant to the Protection of Prisoners Against Torture", prepared by
CIOMS at the invitation of WHO and adopted by the United Nations
General Assembly in March 1983.
HEALTH POLICY, ETHICS AND HUMAN VALUES - AN
INTERNATIONAL DIALOGUE
This major programme originated at an international conference organized
by CIOMS in cooperation with WHO, held in Athens in 1984. This
programme has brought together health policy-makers, ethicists and
philosophers from many of the world's major cultural and religious groups,
as well as "securalists". The topics covered have included equity, social
justice, community participation, and the dignity of individuals in sickness
and health in the context of health policy-making.
DRUG DEVELOPMENT AND USE
Safety requirements for the use of drugs
This programme was initiated in the early 1980s in the light of the benefits
that society as a whole derives from modern drugs and vaccines. At the
same time, society must be prepared to accept the possibility of remote risks

to the individual as the corollary of modern medical care and further

therapeutic progress; without this realization, the basis of contemporary
drug development will ultimately founder. Moreover, society must be
assured that a responsible and committed effort is undertaken to minimize
drug-induced injury, and that the risks of such injury compare favourably to
those accepted in other aspects of daily life.
Assessment and monitoring of adverse drug reactions and
pharmacogenetics
The following CIOMS working groups are currently preparing their reports
or have published their recommendations:
CIOMS I. (1990) International Reporting of Adverse Drug Reactions
The most valuable outcome of the working group of CIOMS I was the
introduction of the "CIOMS I reporting form" for standardized
international reporting of individual cases of serious, unexpected adverse
drug reactions.
CIOMS II. (1992) International Reporting of Periodic Drug-Safety
Update Summaries
This working group proposed a standard for periodic safety update reports,
which has been adopted extensively since the publication of the report in
1992. It also served as a basis for the development of the official ICH
guideline for such reports.
CIOMS III. (1999) Guidelines for Preparing Core Clinical-Safety
Information on Drugs - Including New Proposals for Investigator's
Brochures (second edition).
This Working Group Report developed proposals for international
harmonization of the practical aspects of defining, creating and modifying
the sections of data sheets or package inserts that contain safety
information. It elaborated the concept introduced under CIOMS II of a
manufacturer's Core Data Sheet for a product and the Core Safety
Information (CSI) it contains.
CIOMS IV. (1998) Benefit-Risk Balance for Marketed Drugs:
Evaluating Safety Signals
CIOMS IV is to some extent an extension of CIOMS II and III. It examines
the theoretical and practical aspects of how to determine whether a
potentially major, new safety signal signifies a shift, calling for significant
action, in the established relationship between benefits and risks; it also
provides guidance for deciding what options for action should be
considered and on the process of decision-making should such action be

required.
CIOMS V.(2001) Current Challenges in Pharmacovigilance: Pragmatic
Approaches
CIOMS Working Group V commenced work in 1997 to revise and put
together the most important elements that need to be taken into
consideration in dealing with drug safety of post-marketed drugs. The final
report was published in 2001; for further information, see the Publications
section of this website.

CIOMS Working Group on Pharmacogenetics (2005)

In 2001, senior scientists from ten drug regulatory authorities, with senior
scientists from ten pharmaceutical companies, plus experts from WHO and
academia, formed a CIOMS Working Group to consider drug development
and regulatory, ethical, educational and economic issues related to
pharmacogenetics. Issues related to genetic testing, genetic data, genetic
information,human genome projects and data bases for clinical trials using
pharmacogenetics were also considered.
The final report entitled Pharmacogenetics Towards Improving
Treatment with Medicines, was published in 2005.

CIOMS Working Group on Standardised MedDRA Queries (SMQs)

Since 2003, the CIOMS Working Group has developed search queries for
some 95 selected adverse reactions based on MedDRA in order to use the
terminology in a rational way and to allow comparisons of drug safety
findings between databases. The Working Group has as members senior
scientists from drug regulatory authorities and pharmaceutical companies,
MedDRA Maintenance and Support Service Organisation (MSSO) and
WHO. The Workin Group operates in close collaboration with the ICH
MedDRA Management Board and the ICH Secretariat. By December, 2007
it had published 63 SMQs and will finalise 12-15 additional SMGs in 2008.
The Working Group published in 2004 a report entitled SMQs
Development and Rational Use of Standardised MedDRA Queries
(SMQs)

CIOMS VI.(2005) Management of Safety Information from Clinical

Trials
The Working Group was established in 2001 to consider issues related to
the surveillance, assessment and reporting of drug dafety data from clinical
trials. It was composed of 12 senior scientists from drug regulatory
authorities (including representation from South America, Africa and Asia)
and the final report Management of Safety Infromation from Clinical
Trialswas published in 2005.

CIOMS VII.(2006) Development Safety Update Report (DSUR)

The Working Group considered the rational, format and content of a
periodic development safety update report to inform drug regulatory
authorities on safety findings of new medicines during their developmental
research. The report, The Development Safety Update Report (DSUR):
Harmonizing the Format and Content for Periodic Safety Reporting
During Clinical Trials was published in 2006.

Joint CIOMS-WHO Working Group on Drug Development Research

and Pharmacovigilance in Resource-Poor Countries.(2006)
Many endemic diseases appear only in developing countries and the
development of safe and effective treatments require clinical trials to be
conducted in these countries. Many obstacles and barriers to clinical trials
and creation of an efficient collection and assessment of drug safety data
from clinical trials need special consideration and appropriate solutions in
resource-poor countries.
The recommendations of the Working Group have been posted in 2006 on
the CIOMS website for comments.

CIOMS/WHO Working Group on Vaccine Pharmacovigilance

The Working Group was created in 2005 at the request of WHO to
-develop general definitions strictly focused on vaccine pharmacovigilance;

-contribute to the development, review, evaluation and approval of

definitions on adverse events following immunization as developed by the
Brighton Collaboration process and to their dissemination; and
-collaborate with other CIOMS Working Groups
The Working Group is composed of 23 members from the pharmaceutical
industry, regulatory authorities, governmental institutions and academia,
from both industrialized and developing countries.
The definition on Vaccine Pharmacovigilance was adopted by the
Working Group in 2007 and has been published on the CIOMS website.

CIOMS VIII. CIOMS Working Group on Signal Detection (Point so

consider in application of signal detection in pharmacovigilance)
(2006).
This CIOMS Working Group was established in 2006 based on requests
from drug regulatory authorities and pharmaceutical companies. The
Working Group is currently developing a consensus report on Points to
consider in the development and application of quantitative methods for
signal detection using pharmacovigilance databases The report will be
published in 2009.
The progress made in various CIOMS Working Groups can be seen in the
section "Current Programme and Planned Activities."
Reporting and Terminology of Adverse Drug Reactions
The use and interpretation of certain ADR terms differ considerably in
different countries. This can lead to misinterpretation of data or delay their
proper evaluation by drug regulatory authorities. The need to establish
minimum requirements for the proper diagnosis of a suspected ADR, and
thus to describe it with the correct term in reports, represents the most
important type of information for raising suspicions about drug safety,
generating signals and, frequently, even taking action. Single case reports
are transmitted by a reporting physician to a collecting centre at either a
drug regulatory agency or a pharmaceutical company, and quite often
between these organizations as well.
The magnitude of the project is reflected in the fact that over 180 terms
were defined, more than 120 experts were involved, and 16 working
meetings were held. The end product of the project was the publication in
1999 of a cumulative volume entitled Definitions and Basic Requirements

for the Use of Terms for Reporting Adverse Drug Reactions and a
corresponding CD-ROM.