Portal de Periódicos da CAPES

ASCO Annual Meeting

2004; Wolters Kluwer; Volume: 26; Issue: 14 Linguagem: Inglês

10.1097/01.cot.0000292158.47408.1d

1548-4688

Joseph V. Simone,

Advances in Oncology and Radiotherapy

The 2004 annual meeting of ASCO in New Orleans was a huge success by many measures. As in past years, however, some attendees groused about the meeting being too large and unwieldy or too commercial with its huge exhibit area and pervasive presence of industry. We shall address each of these questions after looking at some facts. Attendance by decade since ASCO's first meeting has been: ▪ 50 in 1964. ▪ 1,200 in 1974. ▪ 5,085 in 1984. ▪ 10,500 in 1994. ▪ 28,000 in 2004. The largest two-year increase was from 19,700 in 1999 to 26,500 in 2001. ASCO began managing its own annual meeting in 1998. The 28,000 attendees in 2004 included 21,000 professionals and 5,000 exhibitors, 49% domestic attendees and 51% internationals representing 104 countries. ASCO members made up 32% (8,960) and non-members 68% of attendees. Of the 21,614 ASCO members, 41.5% attended. Of 3,786 abstracts submitted (a new record), 2,113 were presented orally or by poster and 1,431 were published only in the abstract book. There were 69 scientific sessions and 187 educational sessions presented and led by 638 faculty members. Too Big? As a member of ASCO for 30 years, I find the meeting more difficult to negotiate due to the longer distances and overwhelmingly large program. I know many fewer attendees than I did; I may see few if any familiar faces during a stroll through the crowded corridors.Figure: Joseph V. Simone, MD, (shown at this year's ASCO Annual Meeting), is Clinical Director Emeritus of Huntsman Cancer Institute, Professor Emeritus of Pediatrics and Medicine at the University of Utah, President of his own consulting company (www.SimoneConsulting.com), and Chairman of the Institute of Medicine's National Cancer Policy Board. He was previously Physician-in-Chief of Memorial Sloan-Kettering Cancer Center and Director of St. Jude Children's Research Hospital, and has served as Medical Director and Chairman of the National Comprehensive Cancer Network and as a member of the NCI's Board of Scientific Advisors. Dr. Simone welcomes comments about this column, as well as suggestions for future topics. E-mail him at [email protected] (Michael Smith)In the old days, most members were American academics; they are now a minority. Also, I could easily attend virtually any session or get to single talks at several simultaneous sessions, flitting from one to another. Today it is very hard to change venues to catch a single presentation elsewhere due to the distances. But I ask myself how much of this change is bad for our patients and attendees? Despite my curmudgeonly grumbles now and then, I think the growth has been inevitable and fortunate because oncology itself has grown in size, complexity, and diversity at least as rapidly as ASCO. Oncology in Europe and parts of Asia and Latin America has grown robustly, and the presence of those investigators, practitioners, and trainees at the meeting enriches the meeting's ambience and furthers its mission to advance clinical oncology. The annual meeting provides a key, handy venue for unofficial side meetings because attendance is so high. So I conclude that the size can be a mechanical handicap but, all in all, the growth in the program, attendance, and diversity has been a positive trend. Furthermore, ASCO has begun offering smaller meetings around the country throughout the year that focus on a single cancer or issue. Such smaller, focused meetings organized by the American Association for Cancer Research have been very popular and financially successful for many years. With an attendance of 100–300, the meetings encourage more interaction of attendees, many of whom have specific research or clinical interests in the narrower topic. Regional meetings, such as the “Best of ASCO” follow-ups, some under the auspices of state or regional ASCO affiliates, bring presentations closer to home. These smaller meetings often draw those who do not attend the annual meeting. Over the years, I have often found smaller workshop-style meetings more useful scientifically. Too Commercial? Some former presidents of ASCO and others have openly expressed concern that the annual meeting has become too commercial. They point to the “mind-blowing” commercial exhibits sponsored by pharmaceutical companies, some of which cost millions of dollars to stage, as an “obscene sales pitch” that demeans the meeting. Pharmaceutical companies also fund large, and some say extravagant, social events. The critics also say that the substantial revenue that ASCO receives for leasing space to exhibitors is a bargain with the devil. They believe the revenue is seductive and becomes difficult to give up once staffing and programs become dependent on it, and that it risks allowing revenue to drive the growth of programs and staff rather than the reverse. Pharmaceutical companies also fund the travel to the annual meeting of a large proportion of international attendees. In fact, the annual meeting can now be held only in a few cities partly because of the hotel space now required, but also because there are few venues that have sufficient commercial exhibit space to meet the demand. Finally, the critics point to the fact that well over 80% of all of ASCO's revenues comes from firms that sell cancer products. In response, ASCO says it is working hard to reduce its reliance on such revenues, in particular by forming the ASCO Foundation, a separate nonprofit organization charged with raising revenue for ASCO's educational and research programs. The hope is that nonprofit philanthropic organizations might be more approachable by the Foundation. (Full disclosure: I am a member of the Foundation's board of directors.) Of course, the membership must also support the Foundation if it is to succeed; philanthropies often ask how much the membership contributes to gauge its commitment to the mission. ASCO also points out that it has put in place a stringent conflict-of-interest policy to reduce the likelihood of undue influence of commercial interests on the program and conduct of the annual meeting. Pharmaceutical companies provide unrestricted funds for fellowships and grants that are given by ASCO through a peer-review process; this is viewed as an especially important use of such funds by ASCO leaders. So is the meeting too commercial? Many people I talk to are either indifferent or say that commercial ties are inevitable in today's environment. Others, many with levels of integrity, experience, and wisdom that demand respect, say it is an insidious, serious, and growing problem. They believe that the mere fact that so much of ASCO's overall revenue (and travel funds for many oncologists, especially internationals) comes from pharmaceutical companies gives, at the very least, the appearance of a conflict of interest and that the elaborate exhibits serve no useful purpose other than to sell products and create a circus-like atmosphere at the meeting. In my own case, I have gone back and forth on industry largesse in my career, mainly over small potatoes. I gladly accepted free baby formula and antibiotic samples for my kids when I was a house officer with a serious cash-flow problem. I have objected to drug company representatives buying coffee and donuts for tumor boards; I prevailed once and was voted down once. Some of the exhibits at the annual meeting are grotesque imitations of Las Vegas, but I do take an occasional cappuccino there. On a larger scale and qualitatively different from rentals of exhibit space, for 18 years I was an associate editor of the Journal of Clinical Oncology, which cannot be published without revenues from ads placed by pharmaceutical companies; I never felt any influence on my decisions from industry. In fact, the annual meeting (and the Journal of Clinical Oncology) as constituted today cannot be supported by membership dues and registration fees alone. To offer the services ASCO now provides with dues and fees alone would either be impossible or place an unacceptable burden on members and attendees. My position on this matter is a tad idealistic, with a large dose of pragmatism: ▪ I am uneasy, though not opposed, to ASCO's accepting money from industry for worthwhile programs—such a relationship can be mutually beneficial without the loss of integrity by either party. I think virtually all attendees understand that the exhibits and sponsored fellowships are not an endorsement of any product by ASCO. ▪ However, I have a number of concerns. The first is for the very large absolute amount of support because it makes the stakes of the relationship so high. The second concern is that commercial funds make up such a large proportion of ASCO revenues that it suggests an improper or, at least, an unseemly relationship. Finally, dependence on the above may inevitably lead to a compelling need for ASCO to sustain and grow that level of support; like any addiction, will it someday be “at any cost?” ▪ I see no short-term solution. So I offer a famous admonition to ASCO in this situation, “Eternal vigilance is the price of liberty.” ASCO must be firm and very conservative in protecting the independence, scientific integrity, and propriety of the meeting. A formal assessment of the exhibits and of the annual financial transactions with industry by an independent group (non-ASCO members and non-physicians) would be prudent and helpful; sunshine can be an excellent antiseptic. ▪ Expansion of the exhibit space for the sake of increasing revenue would be a dangerous step on a slippery slope. Programs, fellowships, and grants should be evaluated as to their effectiveness, value, and appropriateness to ASCO's specific role; because not everything we do turns out well or remains effective and efficient, pruning should be formal and regular. As with cancer therapy, more is not necessarily better. Generating new programs and initiatives is easy; achieving and sustaining the highest quality is not. ▪ The utter dependence of the annual meeting and other programs on pharmaceutical funds for their very existence is a foolish bet. A formal plan should be established to sustain the organization should a sudden reduction of such revenue reach 25%, 50%, or more. The survival of ASCO without pharmaceutical revenues would be very difficult today; should ASCO bet that the money will always be there? ▪ It is too soon to know whether the ASCO Foundation can raise enough revenue to forgo a substantial portion of revenue from commercial sources; one worries that even if it does, those new revenues may simply add to rather than replace some portion of commercial revenues, leaving the proportion the same. ASCO is healthy and productive. The JCO is doing extremely well both in its influence and finances, and the Web site and patient information services are of high quality. The meteoric growth of programs and staff has created a rich and powerful organization. But amid all the congratulatory back-slapping, ASCO should be careful not to lose its soul.