I fully agree with your comments regarding meetings. My impression, though, is that the attendance to meetings of all kinds has decreased in a progressive manner during the last 3-4 years. I have been organizing a meeting in Spain for 20 consecutive years, the Madrid Arrhythmia Meeting. It initially had a great success with an attendance of up to 1100 people that for a meeting of this kind was a lot. RF ablation was at its inception when we began back in 1988 and the ICD was on its rise. There was a great interest but also at that time it was difficult and expensive to have access to the latest information. We had no internet and the time lag for publication frequently extended over one year since you presented your work as an abstract until it finally reached the printed status in a journal. And last, but not least, you had to go to the library to get a photocopy of the paper to read and study its content. From 2000 onwards the Internet has become universally available. The Internet has brought the library to our offices and homes. We file on our disks the original papers in a few seconds. And the publication process has been speeded up making the papers available to the Internet audience well before their appearance in the printed version of the journals that by the way few people utilize today as a source of study. And when a new important presentation of a trial is presented at a meeting it is possible to obtain detailed information of it, even with comments from various sources, through internet portals such as theheart.org, medscape etc. Travelling has become expensive, inconvenient, and the chances for finding sponsorship are more and more difficult for economic but also for ethical reasons. The economic impact is not only related to the expenses incurred to attend the meeting but also in the money that practicing cardiologist would not earn during their leave period to attend a congress. When you balance what you get against what you lose having other alternatives to keep informed, the final result is what we are seeing: the attendance to meetings is shrinking! An additional factor that I have found at least in my country, Spain, is that the younger generations of cardiologists are much more actively involved in the sharing of familial responsibilities and tasks with their couples and that stimulates to limit the attendance to meetings, again taking into consideration that there are other alternatives to maintain a good information level.

 

In fact I believe that the Internet represents the key issue as the invention of the Gutenberg press did in the 15^th century. I do not know if it realistic to try to see how can we get more people attending to the Abstracts sessions, when we should probably develop Internet-based abstract presentations admitting comments (like you are doing here) that would be selected by the chairpersons and answered by the authors and maintained for at least one year in the web.

 

Jerónimo Farré MD, PhD, FESC

Eric -- You've hit upon a critical problem: one that may affect the future of innovation in medicine. One thing that I've seen radically change in these meetings is the significant presence of the outside non-medical world in the form of the popular press and the investment community. This did not exist 25 years ago when we first met at that very modest live PTCA demonstration course in San Francisco. These days, every late-breaking trial generates major headlines around the globe, often incorrectly stating the results. We saw this two years ago at the ACC when the CHARISMA trial was mis-reported by hundreds of news outlets, warning patients that aspirin and clopidogrel were "a risky combination". How many stent thromboses occurred that week from DES patients prematurely stopping their dual anti-platelet therapy?

Then there is the investment community, stock analysts, fund managers, etc. who are looking for the next big thing, or who are monitoring current trials to get the news before their competitors. If one were to watch some of the closed-circuit broadcasts from the exhibit floor, you might think you were at a football or soccer match, when the sales team cheers positive results for their product.

Can you imagine if Andreas Gruentzig were to present his modest abstract on this odd procedure he called angioplasty in the current meeting environment? Would interventional cardiology have survived the instant amplification of results?

How to present and exchange scientific information and have the freedom to show results of early stage experiments, how to look for professional feedback without the entire process being corrupted by the enlarged eye of the media/financial world is indeed a complex question -- definitely a case of the Heisenberg principle -- where the effect of the observer on the observed is inversely proportional to the mass of the observed object. In other words, small, embryonic concepts presented in abstracts and poster presentations are highly susceptible to alteration by the external forces I've described.

Hi Eric, thought provoking and insightful as usual. I guess it will be harder every year to maintain "megameetings" with the current wealth of info available through the internet and the sub-subspecialization of cardiology. However, in my view one of the major drawbacks of how most meetings are currently organized is the almost total lack of participation by the audience in any meaningful way (... please, ... spare me those phony "select your option"  question and answer sessions .. who are we kidding ...) not only at the abstract sessions but, why not, at plenary sessions also (less time to talk or fewer speakers, more time for the audience, how about that?). Nobody can ask ANY questions, ever. Smaller meetings, informal but paradoxically sometimes more scientifically sound, may also be a lot more fun and educational. Arguments and even heated discussions are good  for science ... could it be that they are not as good for sponsors ... hoops, I am sorry I said that ... allright i'll take it back ... I also feel that the "external forces" have gone a little too far, making more people of the medical community somewhat skeptical about what they hear at megameetings.

Dear Eric This is a matter of increasing concern. I find that a lot of my time at an international meeting is taken up by attending "Hot Line" sessions which always seem so important and attract such large attendances. I would prefer hearing some of these (usually megatrial) results in the context of other research in the area and as part of a session dedicated to the subject. The information that I would miss hearing could always be made up by a quick reference to the conference or other (eg. theheart.org) website. Another factor attracting attendees away from listening to original research presentations is the concomitant presentation of excellent review / overview sessions. Perhaps one could consider allocating such sessions to a different time slot at the beginning or end of the day's sessions or, as I experienced recently, by combining a state of the art lecture with abstracts in the same session. The ACC got it right in New Orleans by dividing their program into easily navigable sections that made the selection of preferred sessions easier for me.

Eric,

Thanks for these comments and for bringing this important observation to the forefront. I fully agree with your concerns about attendance at the abstract sessions and think that it might be a function of total sensory overload. I suggest that consideration be given to reformatting these meetings so that we interdigitate original research sessions with general or disease-focussed sessions, e.g. part of the day be more oriented to original research and the rest of the day to general or disease-specific session ratherthan both all the time? Another model would be to "frontload", "backload" or even "interdigitate" relevant new original reserach into particular theme. I quite like the latter.... I look forward to your thoughts.