Conflict Over Conflicts of Interest

According to an article in the Boston Globe, the American Society of Hypertension has canceled a panel of experts on conflicts of interest at its upcoming meeting (May 19-22, 2007 in Chicago).

"[former New England Journal of Medicine editor Dr. Marcia Angell] Angell, [Dr.Jerry Avorn, a Brigham and Women’s Hospital physician and Harvard Medical School professor] Avorn, and [Dr. Jerome Kassirer, a former editor of the New England Journal of Medicine] Kassirer were invited to take part in the panel about conflicts of interest by Jean E. Sealey, a researcher and former president-elect of the American Society of Hypertension. Sealey has said the drug industry wields too much influence over the society’s activities through its financial contributions to the group and by paying for honoraria, speakers fees, grants, and research contracts with individual doctors . . .

"The group said in a statement that it sent Sealey’s panel proposal to its continuing medical education review committee, which determined Sealey’s plan to limit the panel to three prominent drug industry critics lacked balance. It suggested adding a Food and Drug Administration official to the roster, but Sealey refused."

The Capsules blog, published by Medical Meetings magazine, called this article to my attention. In addition, Capsules has blogged about COI problems at the American Society of Hypertension two other times, here and here.

Given ASH's continuing COI problems, perhaps it's the entire meeting--and not just that panel--that lacks balance. In my view, the panel of drug industry critics was providing needed balance.

Update: Roy M. Poses, MD, has some additional things to say about this on his Health Renewal Blog.

The Numbers Don't Add Up. Number 1 of a continuing series of pet peeves.

You'd think that people with M.D.s and Ph.Ds and faculty positions in major universities would be able to do simple arithmetic. You'd be wrong.

So I'm writing an article based on a poster presentation of a retrospective study. The topic isn't important. I have the full text of the poster on a piece of paper in front of me. The methods section says that the study involved 29 children hospitalized for serious burns and 73 children hospitalized for other serious injuries. One of the study's dependent variables was whether the children has been breast fed as infants or not. Of those children 47 had been breast fed and 56 had not.

Observant readers will have noticed that 29 + 73 = 102 but 47 + 56 = 103.

The total is 102 for all the other dependent variables, so I'm reasonably certain that there were 102 and not 103 children in the study. Either the number of children who had been breast fed is actually 46 or the number who had not is actually 55.

I pore through all the other numbers on that poster, hoping that there would be a way for me to back-calculate the source of the error. No such luck. By this time it's about 10 minutes before my deadline and after business hours on the Friday before a holiday weekend. There's no realistic possibility of reaching one of the researchers on the phone to resolve the discrepancy.

It clearly wouldn't be right for me to guess which number was correct. That would give me at least a 50% chance of being wrong, and a much greater chance if Murphy's Law is taken into account.

I ended up fudging, writing that "just under half" the children had been breast fed.

I'm telling this story not because it's unusual, but because it's not. It's amazing how often I find numerical errors in studies described in medical conferences. I'd guess it's at least 10%-20% of the time (or about 3 times out of 5, as Dave Barry might say). Occasionally I even find simple arithmetic errors in published papers, errors that apparently went unnoticed during peer review.

Calculated percentages are especially subject to error, for some reason. I've learned to recheck every percentage I plan to quote in my stories.

But I've also found major statistical errors. Once, I was all set to write about a study reporting a statistically significant difference between two groups until I took a close look at the data. There was a bar chart, and one of the groups did appear slightly larger on the relevant variable than the other. But when I took a close look at where the error bars would have been (had the authors put error bars on the bar chart), it was clear that the difference between the two groups was clearly within the margin of error, and there was no way in hell that the difference between them was statistically significant at the p=0.05 level.

I guess the moral of this story is that science and medical writers need to take close and critical looks at the actual numbers in the studies they write about, and not assume that scientists with advanced degrees are capable of calculating a percentage.

Conflicts of Interest--Part 1 of a continuing series

Interesting post on the Health Care Renewal blog about conflict of interest (COI) in continuing medical education (CME) meetings. Quoting a Wall Street Journal article, Roy M. Poses, MD, president of the Foundation for Integrity and Responsibility in Medicine, discusses a case where GlaxoSmithKline, the huge pharmaceutical company, paid a doc $1,000 to $2,500 per talk to appear at CME meetings. At those meetings the doc would advocate certain off-label uses for one of GSK's drugs, while neglecting to disclose that GSK was paying for him to speak.

I'll be discussing COI frequently in this blog. Today I'll make a few points about disclosure, which is often touted as a COI antidote.

• More docs seem to be following the disclosure rules these days than in years past, but many still neglect to mention their potential conflicts. Often meeting programs will include a page of speakers' disclosures, which is very helpful. But on that page, after a short list of speakers who have disclosed their various advisory boards, equity interests, and sources of research funding, is a much longer list of "Speakers Disclosing No Conflicts of Interest." This heading is quite misleading, of course. Some folks in this list may have affirmed that they have no conflicts of interest, but others may simply have failed to return the COI form the meeting organizers sent them, and they may have COIs up the wazoo.
• Sometimes a speaker's disclosures appear on his first or second PowerPoint slide, which he leaves up for about a microsecond.
• Sometimes a speaker will simply say that he sits on every advisory board or speakers' bureau for every pharmaceutical company with drugs in his specialty, implying that he has no motive for touting one company's drug over another.
• Sometimes a speaker will state regretfully that he has no disclosures to report, but then jokes that he'd be delighted to talk to anyone in the audience who is willing to help him change that sad state of affairs.
• Always the implication of these disclosures is that the speaker is far too principled a scientist and clinician to let any of these financial conflicts cloud his Solomon-like wisdom.

As far as I can tell, the majority of audience members give virtually no weight to what disclosures there are, unless the conflict is so extreme that it can't be ignored. For example, they may give a talk a few mental demerits if the speaker discloses that he holds a patent on the drug or device he's talking about. Otherwise, I believe, they have faith that the speaker would never, no never, let these conflicts affect his judgement. I believe that that faith is often misplaced.

Why I Love Poster Sessions

When I was a graduate student, back in the Pleistocene, there was always a lot of excitement around our specialty's annual convention. The graduate students, postdocs, and faculty in the department all prepared abstracts months in advance of the meeting. (Those abstracts were often works of fiction, reporting data that we hadn't finished analyzing. The coming months were often a desperate scramble to finish the analysis before the meeting. But that's another story.)

We sent these carefully chiseled stone tablets to the meeting's program committee, and then we eagerly awaited their responses. Just about every abstract submitted was awarded a place in the meeting, but it was a special honor to be selected to deliver the paper as an oral presentation, and we were always disappointed when we learned that we'd been relegated to the poster session instead.

I carried that prejudice against poster sessions well into my science writing career. When covering a conference I attended oral sessions exclusively, never even glancing at the list of poster presentations. That all changed when I started a new job and had to return with a dozen or more articles from each meeting, not just the one or two top stories.

In desperation I began trolling the poster sessions, and I quickly discovered that they were well stocked with tasty fish. Here (in no particular order) are some of the reasons I love poster sessions in medical meetings.

1. Walking through poster sessions is a far more efficient use of my time than sitting in oral presentations. Since scientists present information in the exact opposite way as journalists (conclusions at the end instead of in the lede), I usually have to sit through the entire presentation to figure out whether it's as newsworthy as I guessed, based on the title. Most oral presentations in research meetings are 10-15 minutes long, and in that time I can walk past and scan the conclusions of at least a dozen posters.
2. Posters are often put up first thing in the morning and taken down either at lunchtime or at the end of the day. That gives me hours to take a look at it, and I can shoehorn it into any part of my daily schedule. But if I miss a 10 minute talk that I need to hear, I'm screwed.
3. I like to walk through the poster room after the posters have been put up, but before the official start of the poster session. The room is quiet then and not too crowded. I can look at a poster and decide whether it's newsworthy without the author eagerly asking if I'd like an explanation of the experiment. If I need an explanation, further information, or a quote, I can always come back later, when the author is standing by the poster.
4. With posters I can easily pull out my digital camera, and in one or two or three photos, I can capture every word and every number. In oral presentations, I need voice recordings plus photos of practically every PowerPoint slide to get the same coverage. And then I have to listen to the recording and look at 30 individual slides.
5. Most program committees from most medical societies don't scrutinize the abstracts as closely as I believed they did when I was a graduate student. It's simply not true, in most meetings, that the most important studies are presented at oral sessions, and the second-rate studies are consigned to the poster sessions. In fact, I think it's often just the opposite. Many oral presentations are general overviews of a topic (in some meetings this is true of most oral presentations), which is relatively useless when you're looking for actual news. Poster presentations, on the other hand, are more likely to be highly focused reports on a single study.

The Best Unheralded Medical Meeting

As I’ve said before, journalists are pack animals. A small group of medical meetings each attracts hundreds of reporters, because they’re reliable sources of news year after year.

But there’s one meeting I think is better than the American Society for Clinical Oncology (ASCO), the American Heart Association (AHA), and the Radiological Society of North America (RSNA) put together. For some reason, however, hardly any reporters attend.

It’s the annual meeting of the Pediatric Academic Societies (PAS), a conference jointly sponsored by the American Pediatric Society, the Society for Pediatric Research, the Ambulatory Pediatric Association, and the American Academy of Pediatrics.

PAS is a big meeting, attracting thousands of researchers and clinicians. It even has a press room, of a sort, but only a handful of reporters register. Those reporters are both happy and busy; happy because there’s not much competition for terrific stories, and busy because there are so many worthwhile stories that it’s hard to choose.

It’s a four-day meeting, but the time I covered it I only attended three days’ worth. In that time I picked up no fewer than 40 solid news stories. If I had been three people, I could easily have picked up 120. This is no exaggeration.

It’s clearly the major pediatric research meeting of the year, but it’s my impression that more reporters attend the much less interesting annual meeting of the American Academy of Pediatrics. When I covered the AAP meeting I learned, to my surprise, that it’s mostly a CME meeting, with a relatively small proportion of original research presentations.

The PAS meeting, in contrast, is all original research. Just about every talk, and just about every poster presents the results of a clinical trial, and is thus a potential news story.

So why doesn’t the PAS meeting get the respect and the attention from journalists that it deserves? In part, it’s the name, I think. The biggest offender is the word “academic.” If I didn’t know better, I’d think that the meeting involved mostly basic research, with little of interest to physicians or to the general public. In fact, the overwhelming majority of the talks have direct clinical relevance.

The word “pediatric” is the next offender. If I didn’t know better, I’d think that the meeting was solely of interest to pediatricians. In fact, there are papers at this meeting of interest to virtually every medical specialty, from neonatal medicine, to neurology, to infectious diseases, to psychiatry, to child development, to name a few.

The third problem is with the word “societies.” Although I have little evidence to back this up, I’m guessing that the AAP, by far the biggest of the four sponsoring societies, invests more resources in promoting its own annual meeting to the press than the PAS meeting. The other three societies don't have the resources (or perhaps the knowhow) to promote the meeting on their own.

By the way, if you’re a medical journalist, please forget everything you’ve just read. You just keep running with the pack, and I’ll keep all those sweet PAS stories for myself.

The next PAS meeting will be held May 5-8, 2007 in Toronto.

"You are not even legitimate, credentialed press."

Conference organizers are usually happy—or at least tolerant—when reporters seek to cover a meeting. Sometimes they even treat us like royalty. But sometimes someone behind the registration desk with a Napoleon complex chooses to make things difficult.

Here’s an awful story told by a friend of mine who works for a medical trade paper, which happens to be a small part of a much larger parent company. I’ve changed all identifying details:


"Now's the time to tell you guys about a horrible experience I had a few weeks ago. I was sent to a meeting in [big city]. I arrived very enthusiastic about it because I had in fact asked to go to it. It was about a . . . disorder which my daughter has. My husband and daughter trailed along, also enthusiastically, since this was one of those meetings which has an entirely separate program geared towards patients and families.

"First Mistake: I didn't call ahead of time to confirm that I was welcome. When I showed up at the media registration the secretary's face turned to stone. "OH, you are [Large Parent Company]," she announced grimly. Well, I never introduce myself in such a way, but sure enough, it's written in boldface on my business card and on the letter from [trade paper]. How could I deny it? There was some muttering and heated discussion between the organizers in the back of the room, a couple of hurried cell phone calls, and then she handed over the badge, albeit very reluctantly. I scurried off, anxious to get lost in the crowd before she changed her mind.

"Second Mistake: I relaxed. It was a very stressful meeting to cover because of all the patients who swarmed the docs and made it impossible for me to get close. I flagged one of the meeting room organizers at one point and asked her if she could help me corner a couple of docs. She, at least, was enthusiastic about my presence, even saying "Well, for a reporter, we'll do everything we can to help." NOT!!! Although she successfully re-routed traffic and helped me snatch a few quick words with a couple of docs, I quickly realized I'd have to play catch-up once I got home, so I decided to just concentrate on gathering business cards at every opportunity. Bad Move. I approached my next target, introduced myself, and went on to explain what I was doing. Then, "The Request" for his e-mail address. The secretary who didn't like me reared up from behind him somewhere (they are on the podium and I am several feet below), steam blowing out of her ears. She was furious. "It is absolutely inappropriate for you to be soliciting the speakers. Who are you?" I reminded her who I was and she practically blew her top. "You are not even legitimate, credentialed press."

"I spent several frantic minutes trying to explain to this woman that [my paper’s] stuff is FREE for docs, FREE!!! But no, that part was not heard. I can't tell you how frustrated I was, particularly because, as I said, we have had such familiarity with this disorder in our family, and I KNOW how much lack of awareness there is about it among doctors. This was the main theme of the meeting, and yet they were trying to banish the one reporter who could have addressed that issue!

"I won't bore you with the whole long and confusing story. I stalked her down later and tried, unsuccessfully to get an explanation. I received the cold shoulder from both organizing physicians who wouldn't speak to me on the phone or return my e-mails. I know it's not personal, but it's hard not to be hurt by such rude, unprofessional and hostile behavior. Now I am struggling to write these stories and I am feeling so fed up and discouraged. All I want is an explanation (I believe there is some kind of ongoing dispute between [Big University], which organized the meeting, and [Large Parent Company] )and a sincere apology. Dream on!!

"I found a week or so later [that my editor had talked with the organizers before the meeting]. Weirdly, they had been totally fine with it, so I still do not know what the problem was. It was definitely my connection to [Large Parent Company] that totally spooked the woman, but what scared me was how she managed to poison all her colleagues against me too, and this EVEN before I had managed to contact any of them. Such a horrible feeling of being gagged, silenced, without even the chance to explain yourself. I felt so frustrated that I had been judged so harshly and had no recourse, but I guess that's me taking things WAY too personally. . ."

If any other medical journalists wish to relate funny, horrifying, or instructive stories about conference coverage, I'd be happy to put them here, and I'll keep you anonymous if you wish. Just email them to me at medmeeting(at)gmail(dot)com.

Picking Some Nits with Emma Hitt

Science writer Emma Hitt has written an excellent piece for journalists on meeting coverage called "How to survive--or even enjoy--a medical conference." Her piece originally appeared in ScienceWriters, the newsletter of the National Association of Science Writers (NASW), and now it's available in expanded form on her web site.

(By the way, if you're a science or medical journalist, and you're not a member of NASW, you should join immediately. Here's a link to the benefits of membership and here's one to the PDF membership application.)

Emma's article includes a number of fine suggestions. My favorite is,

With regard to covering the presentation itself, the most important piece of advice I have is not to sit through a 3-hour symposium in order to attend a 15-minute presentation. Try to get into the conference hall about 10 minutes before the scheduled presentation. Presentations generally lag behind their scheduled start time anyway, so 10+ minutes of sitting there listening to some presentation in which you have no interest will be more than enough time. On rare occasions, speakers go out of turn and will give their presentation before you show up. This practice should be made illegal. Basically, there's nothing you can do in this situation except try to get all the information you need when you find the speaker later on-if you find the speaker later on-or tell your editor that you've found a much more interesting presentation to cover (importantly, one that has yet to take place).

Naturally, though, I do have a couple of nits to pick with her.

1. In a section on deciding what to cover she writes:

Look through the titles of the big oral sessions (oral presentations are generally more important and contain more mature data than poster presentations) and scour them for words such as "randomized" and "phase III." Any trial that contains hundreds of patients is often newsworthy, especially if it has the word "final results" in the abstract. By contrast, animal studies and phase I trials are generally not newsworthy.

I agree with those final two sentences completely. But I can't let her diss poster presentations at the expense of oral sessions. In fact, I often find poster sessions far more productive than oral sessions, especially the oral "plenary" sessions.

Plenary sessions are usually held in the largest auditorium available, are jam packed with conference attendees, and have at least two huge screens for the PowerPoints and another where a video image of the speaker is projected at ten times life size. All of this is theater, intended to make it appear as if something important is going to happen, when the speaker is actually going to spend three-quarters of his hour going over the history of the field (starting, in many instances, with Hippocrates or Aristotle). During the final 15 minutes the speaker may start talking about his or her own work, but make no mistake, almost none of this will be newsworthy, since it's all old work. It's only during the very last minute that the speaker will talk about the newest stuff, and if it's interesting and newsworthy he or she is likely to say something like, "And if you want to hear the details of this study, come to my poster presentation on Thursday afternoon."

I'm aware of course, that other types of oral presentations can be quite productive for the reporter, particularly the 10-minute brief presentations. It's only the plenaries that I avoid. But it's been my experience that poster sessions are often the most productive part of the meeting. I love poster sessions, and I'll have much more to say about them in future postings.

2. This next one leaves me speechless (well, actually, not really). After explaining that she uses her digital camera to capture each individual PowerPoint slide (a practice I endorse wholeheartedly) Emma writes:

I typically don't take notes except to make a note to myself when something important was said that wasn't included in the abstract or the slides. I also don't record the presentation-the audio tends to sound like an announcement you'd hear in a train station.

No notes and no recording? I'm dumbstruck. Now between paying attention to the presentation and photographing the slides I don't have time to take extensive notes (it would be easier if I had 3 hands and 2 brains), but I do take the time to write down the speaker's name (and his or her title and degree), the general subject of the talk, the size of the study, and the most newsworthy conclusions. After a meeting in which I could easily attend 30 talks or more, how else would I even remember whether any given talk was worth writing about?

And I record everything. While some speakers merely read their PowerPoint slides, most do not. Often they'll explain something beyond what's in the slide, and frequently they'll say something quotable. That's particularly important if it proves difficult, as it often does, to snag them for one-on-one interviews.

I know some reporters who record but take few notes, and I know others who take lots of notes but don't record. But until I read Emma Hitt's article, I thought I didn't know any reporters who neither took notes nor used a recorder.

Excellent but Little Known Medical Conferences

Journalists are pack animals. Where you find one, you tend to find many. This is as true in the world of medical conferences as it is in celebrity coverage.

Hundreds of journalists will register for the big annual meetings such as the American Society for Clinical Oncology, the American Heart Association, and the Radiological Society of North America. Journalists come to these meetings year after year because they’re dependable sources of news on the latest in clinical science.

I cover those big meetings too, but I cover a lot of unheralded meetings as well. I’m the only reporter at the majority of meetings I attend. Many of these meetings are interesting only to physicians within a narrow subspecialty. But many of them have much more general interest, and are productive sources for news of solid clinical advances.

Here’s a list of the meetings I’ve attended within the last five years that were especially productive and at which I was the only reporter, or one of a small handful of reporters. I’ve added a bit of commentary on some of them.

• American Academy of Psychiatry and the Law (At this meeting I was the only reporter in the room to hear Dr. Park Dietz, the famous forensic psychiatrist, discuss his involvement in the Andrea Yates case, after her first trial but before Dr. Dietz admitted that he had given false testimony on the stand, which earned her a second trial.)
• American College of Clinical Pharmacology
  
• American College of Forensic Psychiatry (Excellent for opinion pieces, not so much for news.)
  
• American Headache Society (All the top headache docs in the country, always at a very nice resort.)
  
• American Neuropsychiatric Association
  
• American Psychosomatic Society
  
• Association for the Advancement of Behavior Therapy
  
• International Gynecologic Cancer Society
  
• NIMH New Clinical Drug Evaluation Unit (Everyone who’s interested in new drug development for mental disorders should attend this conference every year.)
  
• Pediatric Academic Societies (An absolute gold mine, with nuggets for many specialties beyond pediatrics. Far better than the American Academy of Pediatrics meeting, which is mostly CME.)
  
• Sleep Disorders in Infancy and Childhood
  
• Society of Behavioral Medicine (From its title this sounds like a psychiatry or psychology conference, but it really should be seen as an excellent primary care meeting.)
  
• World Congress of Cardiothoracic Surgeons
  
• World Congress on the Insulin Resistance Syndrome
  
  
  
  

Beware the Ingelfinger of Doom

So I'm sitting in the front row of a packed seminar room as four speakers describe different parts of an important, but not earthshaking, clinical trial. This seminar, they said, constituted the first public release of data from the trial. A news story for sure, I'm thinking, and since I'm apparently the only reporter in the room, an actual scoop.

The first three speakers describe the trial’s background, details of the experimental treatment, and details of the control treatment. The final speaker, the trial's principal investigator, stands up to reveal the trial's results, and the first thing she says is, "We’ve just submitted a paper on this trial to JAMA [the Journal of the American Medical Association, one of the top three or four medical journals in the world], and if there are any reporters in the audience we request that they not print anything about this trial, because that might jeopardize our publication."

My first thought: “Puh-leese.” My second: “If you wanted this seminar to be off the record, you should have said something at the beginning, before I invested an hour in this room.” My third: “Dream on, sister. You’re describing the results of this trial at an open meeting to which reporters were invited, and there are a hundred other people in the room. If the results were secret before, they sure ain’t secret now. I’m not the only one in the room with a recorder, and I’m not the only one taking digital photos of every PowerPoint slide.” And my fourth thought: “I bet they shake that damn Ingelfinger at me.”

Franz J. Ingelfinger, M.D., (1910-1980) was editor of the prestigious New England Journal of Medicine (NEJM) from 1967-1977. During his tenure he decreed that for an article to be published in his journal it must not previously have appeared elsewhere. The rule prohibited authors from releasing their results to the news media before the date they were published in the journal. A small number of other journals (such as JAMA) developed similar policies, and the net result is that scientists are often afraid to talk to reporters for fear that they’ll lose the opportunity to publish in JAMA or NEJM (or Nature or Cell or Science).

Their fears are misplaced, I explain to one of the clinical trial’s investigators, who worriedly accosts me at the end of the seminar. I promise to send him an e-mail, quoting chapter and verse, and this is what I wrote (with identifying details altered):

Subject: JAMA publication policies

Dr. Smith,

I'm happy to set your mind at ease regarding the effect my article in [my newspaper] will have on your intended publication in JAMA.

It should not hurt your chances of publication if we report on the study as you and your colleagues presented it at the meeting. In general, medical journals follow rules approved by the International Committee of Medical Journal Editors regarding prepublication publicity. (See NEJM 328(17):1283, 1993, and NEJM 324:424-8, 1991). Specifically:

"Policies designed to limit prepublication publicity should not apply to accounts in the media of presentations at scientific meetings or to the abstracts from these meetings (see the section 'Prior Duplicate Publication' in the Uniform Requirements for Manuscripts Submitted to Biomedical Journals). Researchers who present their
work at a scientific meeting should feel free to discuss their presentations with reporters, but they should be discouraged from offering more detail about their study than was presented in their talk."

And in the JAMA instructions to authors at http://jama.ama-assn.org/misc/ifora.dtl#PreviousPresentationorReleaseofInformation it says, "Previous Presentation or Release of Information. A complete report following presentation at a meeting or publication of preliminary findings elsewhere (e.g., an abstract) is eligible for consideration for publication.
Media coverage of presentations at scientific meetings will not jeopardize consideration, but direct release of information through press releases or news media briefings may preclude consideration by JAMA. Rare instances of papers reporting public health emergencies should be discussed with the editor. Authors submitting manuscripts or letters to the editor regarding adverse drug or
medical device reactions, reportable diseases, etc should also report such to the relevant government agency."

I hope this answers your concerns.

Sincerely,

[Roueche]

This satisfied Dr. Smith and his colleagues, but I would have gone ahead with my article even if it had not.

Whatever motives Dr. Ingelfinger had when he originally promulgated his rule, the current effect is to stifle dissemination of research results to the public that, in most cases, paid for that research, and to increase the influence of a small number of journals at the expense of the public’s right to know.

The Worst CME Meeting Ever

I cover a lot of continuing medical education (CME) meetings, partly because there are just not enough good medical research meetings to go around.

In good CME meetings the speakers are experts in their specialties, and they inform their audience of physicians of the very latest new research and put that research into context. It's not that difficult to find news when the speaker is discussing his or her own recent research. But when the speaker is essentially reading a textbook chapter, the most I can hope for is a "tips and tricks" or "clinical pearls" article.

Not all CME meetings are good. Some are mediocre, and some are downright awful. It can be challenging to find news stories at these meetings.

One year, and again two years later, I covered a CME meeting organized annually by a major San Francisco Bay Area university with a very active CME unit. This university presents dozens of different CME meetings every year, some of them quite good. The three-day meeting I attended is called "Advances in Infectious Disease," and it includes about a dozen of the university's faculty members discussing many different aspects of this important topic.

That first year it was clear that at best this was a mediocre meeting. Although I never attended medical school, it was obvious that the speakers weren't presenting information on the latest advances in infectious diseases. Instead, they were merely reviewing elementary material that all the docs in the audience should have learned in their first or second year of med school, even if they had graduated 20 years ago. I was lucky to eke two articles out of that meeting.

But when I attended the same meeting two years later, it became clear that the meeting had transcended "mediocre" and had ascended to the heights (or descended to the depths) of "breathtakingly awful." And that's because it was quite literally the same meeting I had attended two years earlier.

The faculty consisted of the same dozen speakers, and their talks were word for word and PowerPoint slide for PowerPoint slide the same as the talks from the earlier meeting. Not one of them had taken the trouble to update his or her presentation. I could have played my recordings of the earlier meeting for the audience and saved the faculty the trouble of turning up in person.

This may have been marginally acceptable had there been no important developments in understanding infectious diseases in the interval. But I cover this stuff every day, and I knew that there had been many important developments during the prior two years.

The meeting's organizer, for example, delivered the identical talk on malaria both times. Unfortunately, he forgot to mention (or worse, perhaps he didn't even know), that the results of a major international clinical trial on malaria had been published several months before the second meeting.

I couldn't file a single story from this meeting, and I begged my employers not to send me again.

If I were one of the several hundred docs who paid about $500 (not counting lodging and transportation) for this worthless conference, I would have loudly demanded my money back. Perhaps, however, the content of the meeting wasn't as important to most of them as the tax-deductible vacation in San Francisco.

Five-Star Hotels: A Rant

You can tell you're in a five-star hotel by the beautiful view, the plush bathrobes, and the disquieting sensation of a disembodied hand rooting around in your pockets for every last bit of spare change.

That's the sensation I had recently when I was covering the biennial meeting of the International Gynecologic Cancer Society at the Loews Santa Monica Beach Hotel in Santa Monica, California. (Parenthetically, this was a terrific meeting with lots of good news stories, but I believe I was the only reporter there.)

I wasn't too surprised that the room rate was $279 a night plus tax. After all, this was a hotel a few steps away from the Santa Monica Pier, and it had ocean views and the aforementioned plush bathrobes. But the (required) valet parking was 28 FREAKING DOLLARS A NIGHT, and even that understates the cost, because of course you have to tip the valet a couple of dollars every time he brings up your car.

But the charge that really gets my knickers in a twist at these five-star hotels is the $10 per day charge for Internet access. At this particular hotel the charge was $10 a day for wired access in the rooms, and another $10 a day if you want to use the wireless in the lobby. These days even cheap motels have free wireless in all the rooms and public areas. Providing free wireless is so inexpensive that most mom-and-pop coffee shops make it available to their patrons for the cost of a small latte. Why can't a hotel charging exorbitant rates absorb this minimal cost?

But since I need Internet access for my job, I have no choice but to pay, or rather my employers have no choice but to pay. And the day I arrived I would gladly have paid, because I had some work to do. But guess what? After wrestling it for 20 minutes or so, it seemed like the wired connection in the room wasn't working. I called out to the front desk, and the person on duty quickly explained, "Oh, that's because we're installing new flat-screen TVs in the rooms."

I didn't quite get the connection, but I let that pass. "How soon can you fix it?" I asked. (It was about dinnertime on Friday night.)

"Well, our technician has gone home for the day, and he won't be back until Monday."

"Can you switch me to another room?"

"We're having the same problem in all the rooms."

"You mean to tell me that you're hosting an international meeting of several hundred gynecologic oncologists, and you're going to go entire weekend without even attempting to get the Internet connections fixed?" If their technician was unable to pull a little overtime, perhaps they could have picked up the phone and called the Geek Squad.

To the hotel's credit, they did offer me free use of the business center, and free use of the wireless in the lobby. And they even sent up a bottle of wine to apologize for the inconvenience. I was somewhat mollified until I went to the business center and found that the Internet connections weren't working there either. The wireless in the lobby worked that evening, but by the next day it was no longer working, and it was apparent that management had no intention of even attempting to get anything fixed before the following Monday.

In contrast, I recently stayed at the Tremont Plaza Hotel in Baltimore's Inner Harbor, probably a 3.5 or 4-star hotel. The rooms, all suites with a kitchenette, cost $139 a night, including free wired Internet access in the rooms and free wireless in the public areas. The view wasn't bad, but there were no bathrobes, plush or otherwise. In comparing the two hotels, I can't help thinking that it cost my employers about $150 a night to rent me a bathrobe.

Oncologists vs. Cardiologists

Attending a wide variety of medical conferences, I've learned that it's true that different medical specialties attract different personalities—or perhaps different medical specialties subtly mold their practitioners. I'll have a lot more to say about this coming posts, but for now I'd like to relate an amusing story about one of the differences between oncologists and cardiologists.

The science writer Beryl Lieff Benderly, a veteran of many medical conferences, began to notice a difference in the kind of food served at cardiology and oncology meetings. The cardiologists snacked on fresh fruit and low-fat yogurt, and at their banquets, they invariably ate a heart-healthy diet: salads with a small amount of dressing on the side, lots of steamed vegetables, and maybe a little lean meat, such as a dry slab of chicken breast. Oncologists, on the other hand, snacked on doughnuts and sweet rolls, and their banquets tended to include a generous slab of the original red meat, beautifully marbled with fat, with side dishes swimming in butter and covered with cheese.

Sitting next to an oncologist at one of these banquets, Beryl asked about this difference. The oncologist replied, "Ah, that's because we oncologists know something the cardiologists don't."

"What's that?" Beryl asked.

"We know that, given a choice, you want to die of heart disease!"

Welcome

I'm medical journalist, and I go to a lot of medical meetings. Some are large, and some are small. Some mostly present new research, and some are primarily devoted to continuing medical education (CME). Some are great, and some suck.

I intend to use this blog to discuss many different aspects of medical meetings, from the quality of research that's presented, to the food that's served during breaks, to the swag that's available in the exhibit hall.

I've chosen Rouche as my nom de plume in honor of Berton Rouche, who for many years wrote the New Yorker's Annals of Medicine column.

I hope you enjoy this, and I welcome your comments.