Medical progress and the advancement of science depend on a number of factors. Some discoveries take years and years to prove, others are serendipitous (but much rarer these days). Almost all breakthroughs require tremendous amounts of money and research, highly qualified experts, and institutional and academic support. One important factor, which may not always be emphasized, is scientific exchange.
The exchange of ideas, theories, new information, among researchers and scientists can often lead to new discoveries. Where does this scientific exchange take place? At medical schools, professional medical organization or society meetings; continuing medical education; government meetings, and so on.
Conferences organized by medical societies and related organizations are particularly crucial for encouraging scientific exchange. These events come in all sizes, from relatively small, local gatherings, workshops, and symposia to large international mega-congresses that mobilize tens of thousands of clinicians, researchers, exhibitors, and staff to build small-sized towns for a few days. A recent article, however, questioned the purpose of these conferences.
While the author recognized that the goals of these meetings are to “disseminate and advance research, train, educate, and set evidence-based policy,” “there is virtually no evidence supporting the utility of most conferences.”
The author claims that such conferences “may be harmful to medicine and health care.” For example, the article claims that having numerous conferences causes the “bulk product of abstracts” and that peer-review is insufficient to detect this poor quality. The author attempts to call into question these trends by noting that comparable meetings in engineering or computer science are able to complete “full” reviews. What the author fails to recognize are the tremendous disparities between information about sprockets and hard drives and medicine. While both change rapidly, medicine actually affects whether people live each day, while the former, well, we could live without.
The article also takes issue with the fact that “many abstracts reported at the medical meetings are never published as full-text articles.” Under this line of reasoning, the author would rather researchers and scientists not present anything and let the silence of the room speak to doctors. Essentially, the author would silence this scientific exchange out of fear that the audience members are not sophisticated enough to understand the abstracts being presented for them. Of course every researcher, physician or scientist in the audience knows they are hearing about an abstract! They know the process for submission, review and so forth. There is no guarantee of publication, perhaps millions of manuscripts have been submitted only to be turned down by the review committee for a variety of reasons. To state that publication is the highest form of learning is ludicrous.
Doctors know that these “abstracts” will likely change. No physician is attending these conferences and going back to their patients or departments and making monumental changes. Instead, what physicians do with this information is think; they interact with their colleagues, exchange ideas, and begin to push the next line of reasoning and theories to come up with the latest treatments. Fearing that doctors will use this information incorrectly is not only misguided but contrary to one of the core liberties America believes in: freedom of speech and expression. The academic community, whether in medical conferences or elsewhere, is truly one of the most sacred places for this fundamental liberty.
Another issue the author raises is why physicians must attend these conferences in person, around the world. The author would prefer that researchers save gas and the environment, by having such scientific exchanges via email or online. Once again, the author fails to recognize the true nature of interacting with ones peers and colleagues. In isolation, the announcement of an abstract or research results may go unnoticed and unread by many. Collectively, however, and in an interactive format, medical conferences discussing abstracts and recent research can shape the future of our lives and improve the health of millions of patients.
Additionally, the author believes that these conferences “build the reputations of scientists working in the field and promote herding after elevated prestigious opinion leaders.” This argument fails for several reasons. First, no medical society would ever pick a leader or speaker who was not qualified. Moreover, those attending such conferences, voluntarily, could easily respond by leaving or not showing up in the first place. Second, medical societies all have stringent conflict of interest and disclosure policies to ensure against bias. To suggest that young scientists would be discouraged when seeing true experts is counterintuitive. In fact the opposite holds true: if there were less medical conferences, how would young scientists learn from experts and some day replace their superiors?
What criticism of medical conferences wouldn’t be complete without bringing up industry? The author notes how companies provide exhibits at conferences and satellite meetings. While the article asserts that speakers at these conferences have “numerous conflicts,” it fails to recognize that no evidence to date has shown any kind of patient harm resulting from attending a meeting where a speaker had disclosed his collaboration with industry. Moreover, physicians and conference attendees know what to do with disclosure information, and more importantly, almost all of them work with industry in one way or another. Most importantly: these conferences are voluntary. Doctors are taking their own free time to go, and if they were not worthwhile, we would see fewer conferences.
One suggestion from the author, however, seems reasonable: the need for societies to spend more money on developing education modes. As the author recognizes, “smaller, focused groups of researchers, in-person meetings may be indeed helpful and indispensable.” He maintained that, “Some of the substantial resources for mega-conferences may be better directed toward more scientifically productive research workshops.”
However, the authors suggestion that these conferences be repurposed toward academic detailing is farfetched. Doctors do not need to learn about dealing with sales representatives or prescribing information. While it is important to learn about new medicines and treatments, over 75% of drugs are generics, and almost every state requires generics when they exist. In addition, focusing on “fewer tests and interventions” sounds exactly like the government controlling out healthcare – and how is that any different than the author suggesting that industry controls these conferences? It isn’t.
In the end, medical meetings and conferences lead to better patient care and outcomes. The exchange of scientific information and the interaction healthcare professionals are able to experience at these meetings generate the newest breakthroughs, theories and ideas to transform patient care and lead to more effective and efficient care. While abuses have occurred in the past, the industry as a whole, as well as all stakeholders has significantly responded through increased firewalls and transparency, and a greater focus on patients and education. While we agree that “mega-conferences” might not be the best format, money for education and meetings is already sparse.
Moving forward, medical societies should look to CME as a potential option, or at the very least, co-sponsorship or collaboration with CME providers who can provide the expertise and experience necessary to achieve truly innovational medical meetings.