Medical Examiner

Conventional Wisdom?

The excesses of the medical conference craze.

A medical convention. Click image to expand.
A National Medical Association convention

Doctors attend lots of conventions. For example, as an infectious-disease specialist, I could go each year to the meetings of the Infectious Disease Society of America in September; the Interscience Conference on Antimicrobial Agents and Chemotherapy in October; the Conference on Retroviruses and Opportunistic Infections in February; the Society for Healthcare Epidemiology of America in April; the American Society for Microbiology in May; and, every other year, a summer international conference on AIDS. If I want to focus on AIDS in particular, I could add on an annual conference on viral resistance, one on vaccine development, and one on drug adherence. In other words, I could spend much of my life in faceless airports, airless limos with free bottles of spring water, and cavernous conference halls hurrying to and fro with a few thousand of my closest friends. And this without even slumming at meetings of questionable pedigree—the “update your medicine” kind held in ski resorts and beach cabanas.

Is the pace of medical discovery really so blistering that only a circuit of nonstop meetings can accommodate the headlong rush of critical new information? Or is the constant conference part of the drug companies’ scheme to hypnotize the doctor class and create a fleet of medical Manchurian Candidates? More salient, probably, is the oddly powerful urge to convene; the surest evidence of professional probity in America is attendance at an annual meeting. Profession by profession, we’ve become a Meetings ‘R Us collective in which no one can speak without the authority of the group and no group can speak without the authority of a members’ vote.

So, doctors are suckers like everyone else. Other than wasting some time, does it much matter? Well, yes. The medical convention is bad for doctors, bad for patients, and bad for everyone in between. The state of constant meetings has introduced to medical work the same false urgency that 24-hour news has imposed on the production and presentation of news. With the rare exception of a true calamity (anthrax, AIDS, West Nile, mad cow), we don’t have enough to talk about.  So we sex up the facts to create the next urgent crisis. It’s all vigilance, all panic, all the time.

This is easy enough. There is pandemic flu and avian flu and resistant bacteria and always AIDS, the mumps, measles, and tuberculosis in its old and new strains. In the end, we don’t even have to exaggerate much. These are scary and awful diseases.

But other than AIDS, they are not grand-scale public health crises, at least not right now. Diagnosing and managing these infections is what infectious-disease doctors do. And we should do it methodically, carefully, quietly, in a way that respects the natural pace of science—its fits and starts, in which a step forward is followed by two steps back when the “breakthrough” is reconsidered. The 24/7 conference treadmill has warped the necessary deliberative (though often boring) medical discourse. At the meeting, hyperventilation takes over. Never mind all the past letdowns. Like the Democrats and Republicans every four years, we are certain—certain—that this meeting will prove to be the one we can’t afford to miss. 

The “Dark Winter” smallpox scenario is my favorite example of how we seduced ourselves with theatrical nightmares. Dark Winter was a simulation that examined the consequences of a smallpox attack by terrorists—a standard aerobic workout for the military, but dazzling and new for the medical world. The medical and military experts concluded: “The infection rate would continue to increase tenfold every two to three weeks … Continuing this grim calculation, that would mean 30 million cases, with 10 million deaths in the fifth wave. And then, two to three weeks later, a final wave sweeping the nation and killing off nearly one out of every three Americans.” This type of fantasy, which always seems weirdly sadomasochistic to me, may suit Wes Craven quite well, but has little utility in a medical context. Yet Dark Winter quickly became the starting point for all discussions about smallpox preparation, its questionable pedigree quickly forgotten. Fear piled upon fear—who wouldn’t be bothered by 100 million dead Americans?—and like O.J. addicts, we had to hurry to that next meeting to get our fix on the latest reconsideration of the fictional simulation carried out in a conference hall by experts and their computers (complete with coffee breaks).

To be sure, there is a role for humans congregating with other humans, even in the day of conference calls and e-mail and all the rest. The wizened get to see old friends. Newbies can stand timidly at the edges and envy the vets’ camaraderie. And in 20 years, I have been at a few genuinely hair-raising meetings. The early AIDS conferences were a source of drama and genuine awe. And the urgent need for information, spit out as fast and to as many people as possible, made perpetual meetingdom necessary. This harks back to the 19th century, when medical meetings were critical. Robert Koch announced his findings on the bacterial basis for tuberculosis at one. Louis Pasteur and Joseph Lister presented theirs, redefining the worlds of bacteriology and infection. Their results, and those of other era brand names, were sometimes met with derision, at other times with acceptance. Either way, meetings were where medical progress happened.

Now, however, the ersatz excitement of the endless convention obscures the real slow march of science and medicine, and erodes their discourse. Here in fact is what doctors have been up to in the last 25 years: Cancer deaths have decreased because we realized hormone therapy was dangerous for women. We’ve come up with a few new approaches for cancer detection and treatment. AIDS deaths are down if you can afford the pills and remember to take them. Heart disease and stroke are less likely if you exercise and watch your diet. Smoking and drinking and drugs and obesity, on the other hand, are bad for you. Many medications are more convenient and have fewer side effects than they once did. Vaccines are very effective.

That’s about it, people. That’s your update after hundreds and hundreds of breathless meetings attended by hundreds of thousands of us. So, I have a modest proposal. Let’s agree to a one-year moratorium on medical conferences. Just close it out.

Then, a year from now, we’ll have a meeting to discuss what happened.