ECR's drive for perfection has potential downside

Everything functions like clockwork. You enter Vienna's Austria Center, collect your badge, receive a radio (radio?), pick up your conference bag complete with program and book of abstracts, drop off your coat in the basement (free of charge), and off you go to lectures, courses, and meetings.

Participants at the European Congress of Radiology are pampered. They get free water in small bottles and apples to crunch. There are hardly any queues. The congress infrastructure runs smoothly. The professional organizers and radiologists responsible for staging the show display enthusiasm and initiative.

Everybody appears to like the annual ECR in Vienna. The number of attendees reached 16,000 this year, and more than 200 commercial exhibitors showed their products. Meanwhile, the ECR organization itself has become a major player in the medical congress market, arranging a host of different meetings and teaching courses for different radiological societies throughout Europe every year.

So why are some participants upset? Previously, most feedback about ECR and its organizers had been positive. Suddenly, there is criticism, and when you talk to people, you hear complaints. In medical terms, the pains are more moderate and diffuse than acute and terrifying. Something is wrong, but nobody can pinpoint exactly what that is.

Three days into the conference in March, I suddenly realized the cause of the discontent. ECR 2006 marked the end of an epoch. A congress has turned into an event. Professional event management has taken over and is organizing a flawless show. We have creative meeting solutions and new formats to liven up the scientific backbone of the meeting.

Why do people attend ECR? To mingle with foreign colleagues is one answer, though I doubt this is the main reason. The principal reasons are to keep up with cutting-edge science, refresh one's knowledge, get an overview of technical developments and the medical marketplace, and then yes, to meet people. Despite late-winter blizzards that have coincided with the past two conferences, Vienna itself is an attractive city for enjoying leisure time during out-of-congress hours.

Has the composition of the target group changed during the past decade? Are participants less interested in continuing education and scientific progress, and keener to be entertained and fed superficial information? Do they want to attend a trade fair and pay for it?

The line separating science (or in this case medical radiology), commerce, and entertainment, between seriousness and show, has become blurred. Walking into the Austria Center, you hardly recognize that ECR is a medical imaging congress. It looks like infotainment for people somehow connected to medical imaging. Not only this, individuality has been lost. Intermediaries arrange the congress on behalf of radiologists attracted by a circus sideshow. Watering down ECR to an infotainment show will, perhaps, appeal to the majority that follows the trend toward presentation over objective contents.

You are standing there, admiring the success, and watching the train depart in the wrong direction. Or are you on the wrong train? Is ECR catering to a younger generation of radiologists who tackle science, medicine, patient care, learning, teaching, and continuing education with a different approach from the generation before? Does the younger generation of radiologists want infotainment? I am curious to get some reactions or feedback. Are the organizers trying to tune in to the under-35 MP3 generation? Or are there other reasons?

ECR appears to be moving off focus, albeit slowly. Of course, a major conference of this size, with a target audience that ranges from private-practice radiologists to scientists, is not meant to be a purely scientific or educational endeavor. Rather, it is a combination of these two components, with social elements and a sales fair as well.

I do not intend to criticize without providing possible solutions. I am just describing the situation. Turning back the wheel never works. The question is not whether something is right or wrong, but what the consequences will be. Perhaps this does not matter. Yet I predict that genuine scientific presentations and discussions will move to smaller "elite" conferences in the future.

INFRASTRUCTURE INNOVATIONS

The organizers of ECR say that it is the world's most innovative congress. It is the first congress to offer a digital preview system that enables speakers to prepare their presentations, upload them in advance into a centralized computer system, and test their functionality. It offers the possibility of copying them onto CD-ROM and having them included in eECR, the electronic congress. So all presentations are available on a central server, which also means that everything is copied, want it or not.

Every year trots out a new feature like this one. Last year, registration badges contained a chip that, for the first time, made it possible to tag and trail participants. Big Brother is watching where you are and when. Not all attendees appreciated this kind of surveillance. Some even stopped using the internal messaging system, believing it could be bugged.

EPOS, the electronic poster system, is another example of well-meant but overabundant perfectionism. It has democratized the poster sessions, and presentations are now basically standardized. EPOS has leveled poster presentations.

Watching congress attendees staring at the EPOS screens, you realize that there is hardly any contact between neighboring screens. There is no academic exchange. Participants sitting in front of their monitors have mostly retreated within themselves, creating an air of autism.

Paper posters promoted conversations and exchange. This social and scientific contact is lacking with EPOS. EPOS is useful for animations and novel presentations, but it cannot recreate the environment of ad hoc discussion that could happen when several people met, often incidentally, in front of one poster. The individualism of paper posters might be off-putting to some people. But at least they allowed congress delegates to walk through exhibitions, assess single posters at a glance, and grasp their essence within seconds. EPOS does not allow this.

One does not need EPOS at a conference. Everything could be watched from home over the Web. ECR already offers such presentations. You don't have to attend the conference, just pay a small fee, and your learned paper will show up in the EPOS system.

MULTIMEDIA

ECR introduced radio and television coverage this year. All participants receive a miniature radio. Most people must have thought that it was a nice gift to take back home for their children. I did not see anybody listening to the radio during the meeting. Why should they? They went to Vienna to talk or to listen to people. The same holds for the television program which, to add insult to absolute dispensability, was periodically interrupted by CNBC news. Participants do not attend ECR to watch television. Radio and television coverage does not fit the social dynamics of a conference of this kind.

I personally missed the welcome additional information from ECR Today, the daily newspaper that ECR Radio and TV have replaced. I used to take my copies of the newspaper back to my hotel, and back home, to read about those sessions I had not attended.

The most striking feature of ECR for me this year was the expansion of company-sponsored satellite meetings. While they were usually limited to lunch sessions, they also now run in parallel to proffered papers, competing with scientific sessions. There has never been a clear-cut distinction between the presentation of "clean" scientific results and "sponsored" results. There has been a gentlemen's agreement, though. The buck stops here. Sponsorship of scientific events can be advantageous and ethical, as long as both sides agree to this unwritten law.

Satellite symposia are considered to be sales shows, even if attendees receive CME points. Be careful. These points might not be recognized in all countries. There is no free lunch.

SUCCINCT EXPRESSIONS

The annual review of advertising slogans and mottoes at ECR used to be an entertaining game. But even this has been replaced by marketing fast food. ECR itself claims "We make congresses-and it shows." Shows with a capital "S"?

Some slogans are empty talk, some aggressive or offensive, some are rude, some likeable. They have no influence on sales. At least they do not increase them.

One company promotes itself with the message "Proven Outcome," and adds that it is "Setting the trend again." For trend, see the earlier discussion. In medicine, a proven outcome requires outcomes research, that is, the study and eventual improvement of the end results of healthcare. This would be counterproductive for sales. Most likely, they mean "Proven Income."¹ We also have "Let's make things better." They aren't so bad, are they? "Inspire the next." The next what? "Life from inside." From inside what? "Imagination at work" will be turned into "Imagine it works."

One of the worst mottoes is the oft-quoted "Making medicine work." This implies that medicine does not work without that particular company. Doctors are morons. There are even worse slogans, not to be discussed here. Why this lack of subtlety and lack of cultural and historical understanding?

I prefer the catchphrase, "Sense and simplicity."

I should add that these comments do not imply any endorsement or sanction of certain manufacturers. They are just subjective reflections.

PROF. DR. RINCK is visiting professor at the University of Mons in Belgium. He can be reached at peter.rinck@umh.ac.be

Reference

1. Proven Outcome at South Carolina Heart Center. We see a way to generate an additional $720,000 in annual revenue via increased cath lab capacity. (http://www.medical.siemens.com/webapp/wcs/stores/ servlet/PSGenericDisplay? storeId=10001&langId=-1&catalogId=-1&catTree=100001&pageId=33161).