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Rapid Responses: Rapid Responses published:
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![[Read Rapid Response]](/web/20081005050729im_/http://www.bmj.com/icons/misc/sectionDOWN.gif)
Virtual Congress of family medicine and general practice
- Dr.N.P. VISWANATHAN (27 June 2008)
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Yes and No - a compromise
- David JR Hutchon (28 June 2008)
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'Heartened by your article'
- Suzanne Adams (28 June 2008)
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Confessions of an Oncotourist
- Michael Baum (28 June 2008)
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Just a question of time
- Andrew Renaut (29 June 2008)
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Is there a relationship between climate change and CO2 emissions? What is the evidence ?
- Fiona Nicol (29 June 2008)
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luxury conferences and transparency
- Clint L. Jean Louis (29 June 2008)
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A Second Life for the Planet? Virtual Conferences - here to stay
- Julian J Leong, James Kinross, David Taylor, Sanjay Purkayastha (29 June 2008)
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Follow the FOGSI way
- Dr Jayaraman Nambiar (29 June 2008)
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Flying: a moral or statistical matter?
- Antony Dowd (30 June 2008)
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International Conferences or International Friendships?
- Sahoo Saddichha (30 June 2008)
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Re: Virtual Congress of family medicine and general practice
- N.P. Viswanathan (3 July 2008)
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Video conference , teleconference are complimentary to traditional international medical conference
- Sukumar Barik (4 July 2008)
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International conferences: An ethical view point
- Abid Jameel, Khyber Medical University, Peshawar (Pakistan) (9 July 2008)
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true problems
- Dr Gloria Rieppi (18 July 2008)
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Reduced patient access to specialist care may be associated with attendance at medical conferences
- Joseph Ting (18 July 2008)
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The wider benefits of a green outlook
- Patrick Harnett (19 July 2008)
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I agree
- Nape Mampane (10 September 2008)
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Dr.N.P. VISWANATHAN, Family physician S.V.clinic GMpalaya Bangalore-560017 India
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I had the occasion to participate in the Virtual world congress of family practice and General practice at Portugal. It started in april 2008 and will conclude on june 30 th. More than 1600 family physicians from 65 countries are participating.There were lot of symposiums,E-oral communications,e- posters,E- learning,Discussion forum, interactive sessions.Every week on mondays and thurs days new topics were posted. I am staying in India thousands of miles away from Portugal.I have very actively participated in the congress for the past three months.It was a very unique way of learning without leaving my country or house.I have asked more than 100 questions. So advances in tele communication and technology have opened new avenues for learning and updating medical knowlege.The Cost paid to the speakers and travellingcost and other expenses for the participants is almost nil.It is a paperless conference.All the communication were done by e-mail to arrange the conference.There is overwhelming response to the conference.Next 2 virtual congress of family medicine and general practice will be conducted from September 2009. The registeration for the 2 virtual congress will start from september 2009. congress website; congressovirtual mgf.com No competing interest Dr.N.P.VISWANATHAN Competing interests: None declared |
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David JR Hutchon, Consultant Obstetrician MemorialHospital, Darlington
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Like most things the right answer is a compromise. Less travelling abroad and more networking with virtual conferences. A local (country- wide) meeting with a few speakers travelling from abroad at each centre gives some of the advantages and atmosphere of an international conference. We need more focus on information and less on empire building. Having said this there is nothing like meeting face to face but subsequent "meeting" can be very effective as a virtual meeting. The meetings can be longer if all the travel is taken out. Time of meetings is important for international meetings with evening in the UK and morning in Sydney. I would not like to lose the oportunity to travel completely as this gives a local flavour but a great deal of information can be obtained nowadays even about very remote locations via the internet. David Hutchon Competing interests: None declared |
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Suzanne Adams, Heart Failure Specialist Nurse Leicestershire and Rutland County PCT
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I recently declined a sponsered trip to Milan to attend the ESC Heart failure congress on the grounds that this would be an unwanted increase in my carbon footprint. I have spoken to two industry representatives as to whether it would be possible to use the lecture theatre of our local cardiology tertiary centre to reach a wider audience whilst reducing carbon emissions. There seems a surprising reluctance within a community ready to embrace technology to benefit the individual, to show the same enthusiasm when considering a benefit to society as a whole. I can be reassured by your article that though in the words of my manager I am 'One of those', at least I'm not the only one. Competing interests: None declared |
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Michael Baum, Professor emeritus of surgery The Portland Hospital W1N 6AH
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Confessions of an Oncotourist By way of economy I am able to conflate my rapid responses to two BMJ debates in sequential issues of the journal, commenting on my double life as a key opinion leader and as someone who enjoys the luxury of international medical conferences. Many, many years ago, in the golden age of the popular journal, “World Medicine”, I coined the term “oncotourism”. This described an activity in which I was actively involved, thoroughly enjoyed, secretly ashamed of, and like the subject itself demonstrated uncontrolled growth at the primary sites with a propensity to metastasize. I look back over a long career in breast cancer research and wonder whether my journeys were really necessary. On many occasions my club class flights and accommodation at glamorous conference resorts were paid for by industry and other occasions from “slush funds” in my academic department’s account. I could never have afforded to lay out for myself but I tried to reassure my conscience that all this was a reward for my years of self denial in eschewing private practice. Thus I have seen the world at other’s expense and enjoyed the sightseeing and camaraderie enormously. In addition my knowledge has grown and my wits sharpened in the cut and thrust of academic debate. I’ve taken the odd modest honorarium at industry sponsored events, when 7-11 hours of jet lag has been rewarded by, the now going rate of $3,000. So who loses and have I sold out? Of course I leave others to judge, but I honestly believe that my advocacy of adjuvant endocrine therapy for early breast cancer has spared many women the toxicity of chemotherapy and added to the thousands of lives saved over the last 20 years. Furthermore there have been many occasions when I refused to toe the party line and have never avoided controversy. So I’ve had fun, industry’s sold drugs, lives have been saved then who’s lost out? Now at last I have found a genuine reason for guilt – my carbon foot print is all over the face of our beautiful globe. Perhaps as penance I can suggest a partial remedy - Stop the proliferation of unnecessary meetings with the usual suspects repeating the same data every other month all around the planet. In any one year we have the San Antonio, ASCO, EBCC, St. Gallen, Milan, ESSO and ASBO conferences. This year alone I can add the Düsseldorf meeting, St Petersburg White nights and the Mexican society of Senology, to my list of invitations. We must inhibit this proliferation; someone needs to invent an oncotourist inhibitor. (OI) I would like to suggest that we only need one big International meeting a year to hear new data after which all we might need is for the big wigs to report back to local or regional meeting for the young and the lame that haven’t yet started to collect air miles. (Oops another tax free perk) Their time will come. Until that time comes I will have to live with my guilt that is best expressed in the immortal words of the great poet Anon. "Michael had a little scam, its feet were black as soot, And everywhere that Michael went His sooty foot he put." Yours Sincerely, Mike Baum Professor Michael Baum ChM, FRCS, MD, FRCR hon. Professor emeritus of surgery & visiting professor of medical humanities. University College London The Portland Hospital Great Portland Street London W1N 6AH Tel. +44(0)20 7034 8890 Fax. +44(0)20 7034 8883 Michael@mbaum.freeserve.co.uk Competing interests: Often receive conference expenses and honoraria from industry. |
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Andrew Renaut, Associate Professor of Surgery Brisbane Private Hospital
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I emphatically agree. One just has to look at the dramatic changes that have taken place in the last year with regard to the perceived causes of climate change, increase in oil price, the practicalities of simply getting on a plane (security, sheer passenger numbers etc). Couple this with the clamping down of freebies from drug companies (quite right too - sorry Mike but there's no such thing as a free lunch!!), and that the taxman will wise up fairly rapidly that you don't actually need to be there in person - the result is the end of the conference as we know it. As for the alternatives - the technology of course already exists. The secret is to offer an exceptionally high quality, interactive, on-line experience. My media company already webcasts a large number of conferences as an add-on. It's merely a question of time before it becomes routine and then of course it will be the gold standard. You heard it here first. Andrew Renaut MS(Lond) FRCS(Gen) FRACS FDSRCS, Associate Professor of Surgery. Director, Videosurgery. www.videosurgery.com Competing interests: My media company, Videosurgery (www.videosurgery.com), produces high-quality conference webcasts |
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Fiona Nicol, GP Principal Green Practice, Stockbridge Health Centre, 1 India Place, Edinburgh . EH13 0ED
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It is astounding that the BMJ is publishing this article and an editor's comment calling for doctors to take a lead in reducing CO2 emission when the evidence for a link between C02 and global warming is lacking. Surely you should be calling for a careful analysis of the evidence rather than signing up uncritically to the UK’s self imposed CO2 reduction. There is no dispute about levels of CO2 which have risen consistently throughout the 20th Century. What should be contended is whether global warming is caused by CO2. There is no doubt that climate change happens but should not be muddled with global warming. The average global temperature (with all the problems inherent in measuring this) showed an upward trend from 1920 – 1940, little change from 1940 – 1975 and a further upward trend between 1975 and 2000. Since then there has been no further recorded temperature increase. All these changes have occurred at a time when CO2 emissions haven risen faster than ever and computer models have failed to predict the recent lull in warming. Rather than accepting the dubious science you should be asking Is the world getting warmer ? If so – why and by how much? What will the consequences be? Do they matter? What can we do? What should we do? Even accepting the worst case scenarios being discussed, a 3 degree C rise in 100 years equates to .003 degrees C annually. Adaptation will occur as it always has; there will be benefits as well as problems. India and China and other developing countries are not going to stop their development and cut back their CO2 emission ( nor should they be expected to since that would result in many more deaths from persistent poverty) so the UK’s reduction targets are meaningless ( and in any case have been already met to some extent by outsourcing manufacturing to the countries mentioned). The current generation is being asked to pay the cost and inconvenience of reducing CO2 emissions in order to benefit future generations at least a hundred years hence. Given the projected increase in standard of living they will be enjoying, it has been calculated that in 100 years people in the developed world will be only 2.6 times better off compared with 2.7 and people in the developing world will be 8.5 times better off rather than 9.5 times if we cut back as we are currently being asked to do. I am not in favour of waste and profligacy however I would welcome a rational debate properly informed by the facts and free from the prevailing uncritical acceptance of spurious science. If you want to know more I recommend An Appeal to Reason – a cool look at Global warming by Nigel Lawson. 2008. Duckworth Overlook. THE BMJ prides itself on promoting evidence based practice, please ensure that you promote this in all articles that you publish and give editorial support to . Competing interests: None declared |
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Clint L. Jean Louis, MD Pamplona, Navarra,31010 SPAIN
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I believe that conference organisers should publish costs and payments incurred and be more transparent. Having attended a number of international congresses there is a sensation of classes: an elite group (speakers,organisers, presidents of societies,so called experts,etc) and a second group of participants. Who pays for the fancy dinners and the hotels of guests and speakers? Are they lodged in 4-5 star hotels? The last one I went to in Belgium many of this "elite" were lavished with boat dinners, which requiered special invitations. How many participants have been sponsored by pharmaceutical companies? How many have beared the cost themselves? (hotel,transport,inscription,etc) Is there an audit of the quality of scientific communications?... Most conferences cost the participants over 400 euros. Privileges are not free, and someone pays for them.Tell us who? In times of the nobel prize winner Dr. Santiago Ramon y Cajal, a conference meant that scientists would meet one weekend in a local bar in some convenient city and discuss their findings. There was no time to waste and no time for much tourism and it was pretty much get down to business.Though more modest, they had the "luxury" of greater scientific enrichment. With the internet it is much easier to be updated and most conferences repeat what is already available. It is good to get together once in a while and see each other, but as physicians and scientists we should be more responsible about how we do it, and see the world as a whole. Competing interests: None declared |
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Julian J Leong, Honorary Clinical Research Fellow Imperial College London, W2 1NY, James Kinross, David Taylor, Sanjay Purkayastha
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We agree with Professor Green that the current format of international meetings is inefficient1, and would like to provide evidence to suggest that robust alternatives to international conferences are currently readily attainable2. On the 22nd April 2008, the first International Virtual Association of Surgeons (iVAS) meeting was held in the virtual world of Second Life®. Forty seven delegates from 5 different countries attended, ranging from professors to students of medicine and engineering. Within this ‘metaverse’ each person is represented by an avatar (a digital representation of the self), and is able to communicate with other users by voice over internet protocol (VOIP), instant messaging, body language and multimedia slide presentations. The conference lasted for 2 hours, and ideas were exchanged about surgical robotics and technology. A questionnaire survey was completed by the delegates, of the people responded, 96% “agreed” or “strongly agreed” that the overall experience was highly rated, and all delegates “agreed” or “strongly agreed” to attend another meeting in the same medium. The cost of attending the conference was a computer with an internet connection, a headset for voice communication and clearly there was no travelling time or impersonal hotels. The use of the Second Life® platform is free, however Imperial College London purchased the virtual ‘land’ on which the meeting was performed. The conference was setup in a virtual island with an ‘open air’ lecture theatre with minimal rental charges, hence no commercial interests or attendance fees were required. The site can be visited at http://ubimon.doc.ic.ac.uk/iVAS/ and users can join the association within Second Life®. In this respect, professional networking and maintenance of academic links is a far more straightforward process than in the real world. The environmental impact of virtual worlds is not entirely negligible, as international servers must be maintained3. However, if this model is extrapolated to a larger conference, then it is far less than the impact of 100 million person air miles1. Furthermore, this model provides a significantly smaller impact on healthcare provision than a real world conference. Users may only have to give up a few hours of their time to log in and learn and interact in an environment with their colleagues, rather than give up many precious clinical days. The combination of live links can further provide an even more immersive environment for craft specialities such as surgery. Although true “hands on” work shops such as surgical skills training is not currently possible in this virtual world, the core agenda of a medical conference can and has been delivered using the set up described above. The rapid evolution of this medium is likely to generate continued innovations that will facilitate this process. It remains a challenge to hold large scale virtual conferences (e.g. with many thousands of delegates) and to run week long meetings. Furthermore, current platforms such as Second Life® make personal identification difficult when used for serious purposes such as this. However, we struggle to find a more cost-effective and easily accessible way to arrange an international academic meeting. References (1) Green M. Are international medical conferences an outdated luxury the planet can't afford? Yes. BMJ 2008; 336(7659):1466. (2) Drife JO. Are international medical conferences an outdated luxury the planet can't afford? No. BMJ 2008; 336(7659):1467. (3) Carr N. Avatars consume as much electricity as Brazilians. Internet: http://www.roughtype.com/archives/2006/12/avatars_consume.php Competing interests: The authors organised the iVAS meeting |
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Dr Jayaraman Nambiar, Associate Professor KMC Manipal
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FOGSI stands for Federation of Obstetricians and Gynaecologists SOciety of India.They have been now regulraly conducting satellite meetings in India.India being a poor country it is very difficult for most Gynaecologists to attend conferences due to financial probelms But FOGSI has come with a big idea of Satellite conferences They are really good and widely appreciated by all Obstetricians all over India .I wish all developing nations should follow this idea. Also millionsof Dollars are wasted in COnferences,this expenses can be brought down drastically if everyone opts for Satellite conferences. Competing interests: None declared |
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Antony Dowd, GP Somercotes Medical Centre, DE55 4JJ
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James Drife seeks to justify continued flights to medical conferences on the grounds that stopping “will have a minuscule effect on global warming”. He correctly states that although the UK is ranked eight among the world’s carbon dioxide emitters, air travel accounts for only 6.3% of our emissions and doctors taking flights to conferences will be a tiny proportion of this. Using the same argument, one could reason that only a small proportion of murders carried out worldwide are in the UK and, even with the likes of Dr Shipman taken into account, doctors in the UK are responsible for a tiny proportion of murders. Although one more murder wouldn’t make much difference in the big scheme of things, no-one would justify it on such grounds. Murder is a moral matter not one to be judged by statistics. What other people are doing and on what scale doesn't come into the argument. I would therefore suggest that James Drife’s line of argument is irrelevant and all we need to ask ourselves when deciding whether to fly is: is it right or wrong? Competing interests: None declared |
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Sahoo Saddichha, Senior Consultant, WHO-BGI Kolkata, India
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I am really surprised that authors can make such sweeping comments based on so little scientific evidence. As it stands today, carbon footprints are the in-thing to discuss. But to link it with international conferences and eventually global warming, is taking it too far. There are indeed reasons to cut down on large international conferences, but carbon emissions are certainly not the reason. The huge economics of conducting such conferences and consequently the savings that can be accomplished by limiting them are the only reason why we need to cut down on them. One can never argue that virtual conferences are better off, since the pleasure of meeting someone in the real world is different. Would one agree to spend one's married life with a virtual wife? The same argument holds for conducting conferences, where the human interaction is necessary, nay important, for people who otherwise would never get to present their findings, make contacts and develop networks. I can only give a personal example which, I hope, many would agree with. I was at the recent American Psychiatric Association meet in Washington DC and was indeed lucky to hear a talk by Stephen Stahl, a leader in psychopharmacology. The talk would have been exciting even if done through a tele-conference. But the icing on the cake was when I got to meet him, speak to him and shook his hands. That was reason enough for a young researcher to be motivated and enthused enough to continue his research. Competing interests: None declared |
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N.P. Viswanathan, Family physician, S.V.clinic,Gm Palya,Bangalore-560075,India
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I am very happy to inform you that I was given the Best Congress Participant award by Portuguese Association Of general practitioners. Congress was paper free conference. I achieved this without leaving my home or country. BMJ is my guidance for the past 34 years. I am very happy to share my joy through BMJ. N.P.Viswanathan Competing interests: None declared |
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Sukumar Barik, Consultant Obstetrician and Gynaecologist and Academic Director Westbank Hospital , Howrah , 711109, India
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Process of communication has undergone sea change in recent years. Marked changes also been observed in the process of information gathering. In this context debate about the effectiveness of traditional international conference is timely. In the nineties, we are all anxious about the future of print journal with the widespread availability of internet. But we gradually realised that both are here to stay. There is little doubt that video-conference or tele-conference or satellite- conference has its own benefits and pitfalls; but benefits and implication of traditional conferences are much wider. In a state level conference about three years back I was presenting a lecture on how to get best out of conference. I presented an acronym “UPAHAR” (Bengali word – meaning gift) as main benefits of a conference: [U = Update Knowledge; P = Presentation; A = Action Plan; H = Hear New Ideas; A = Access to new instruments and books; R = Recreation (includes visiting places). We must clearly understand that our primary objective is essentially academic and rest is secondary. Unfortunately sometimes secondary objectives get more priority over the primary one. Clearly, the benefit of tele-conference or satellite-conference is limited mainly to updating of knowledge (may be more focused one). The impact from air-travel to conference leading to more release of carbon -dioxide and global warming is interesting but addresses a small aspect of a significant problem of global warming. Involvements of pharmaceutical Industries, sponsorship to individuals are far more debatable issues in arrangement of a conference. Sadly one of our professor friends told us that anybody can give a lecture but getting the sponsorship is the main aspect of arranging a conference today. Listening to a speaker face to face has its own impact. Listening to a live jazz concert and watching the same in television are never be the same. Interestingly, we had the opportunity to listen to Mahmoud Fathalla (as professor Drife also mentioned in his article listening to him in different conference) at world conference of Obstetrics and Gynaecology at Copenhagen in 1997. Since then, we clearly believe that gynaecologists are not ‘only gynaecologists’; they are the advocate of women’s health. Our own attitude of practice has changed ever since we had the opportunity to listen to the lecture and meeting him. We feel the traditional conference is here to stay and satellite conferences will be complementary to it. Debate should continue about the ways a conference to be arranged now and development of some form of basic guidelines many be appropriate (both for the organiser and for the participants). Competing interests: None declared |
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Abid Jameel, Assistant Professor Medical Oncology Postgraduate Medical Institute, Khyber Medical University, Peshawar (Pakistan)
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I agree with most of the contributors views regarding the huge amount of money spent on these conferences at holiday resorts, most of which are repeats or mere updates. In addition to large sums being spent as well as environmental issues, there is an ethical aspect involved as well. As Dr. Sukumar Barik has elegently put it, "anybody can give a lecture but getting the sponsorship is the main aspect..." Sponsors (mostly pharmaceutical companies) would like the speakers to concentrate on their interests, highlighting products manufactured by that particular company. Payment of heavy amounts in the form of honoraria to these speakers also shift their loyalties towards a specific pharmaceutical company. Having attended many of these conferences myself, I sometimes feel that the speakers are behaving like Medical Representatives of a particular company rather than a distinguished speaker. In fact I have heard the same international speaker advocate one particular drug for a particular cancer in one conference and another one in another - because the first conference was sponsored by Company "A" while the second was sponsored by Company "B". Furthermore, participants sponsored by companies, specially from the developing countries, have to "repay" them by prescribing their products. That is where the whole question of professional ethics comes in. By utilizing video conferences, we can save 90% of the costs and that will take care of unnecessary expenditure of money by pharmaceutical companies and the environment. We at Postgraduate Medical Institute, Khyber Medical University at Peshawar are investing in establishing videoconferencing facility so that we can play our role in providing access to latest knowledge without having to spend a fortune on honorarium and booking hotels at expensive resorts. I am sure others will follow suit to address the issues of money and time spent, environment and ethics. Competing interests: None declared |
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Dr Gloria Rieppi, Intensivist teaching public hospital Uruguay
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This article causes me to reflect. This paper has emphasised if massive conferences determine some ecologic disasters, this is eventually true. I think other more important aspects could be discussed. Massive medical conferences do not always contribute to updating topics or discussion with other colleagues. Most of the participants take these events as "tourism events". Invitations are in general given to doctors who are experts but most frequently by "laboratory marketing". Many investigators around the world have had serious limitations in their opportunities to communicate their results in the congress or in publications. This is the biggest problem for scientific communication. Competing interests: None declared |
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Joseph Ting, Staff Specialist Department of Emergency Medicine, Mater Public Hospitals, South Brisbane 4101 Australia
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The lively debate brought about by two published contrary positions 1, 2 on the merit and drawbacks of attendance at international medical conferences largely focused on their environmental cost on the one hand1 and educational benefits on the other. 2 Even domestic conferences in Australia require some form of medium haul flying, and that is even before considering long haul flights to European and North American destinations where the bulk of international medical conferences are held. As such, the debate is more relevant to internationally isolated Australia and could be extended to domestic conferences in countries which are continental in expanse. The debate has yet to allude to difficulties with referral of patients for specialist care encountered during major conferences, when a large number of that craft group become unavailable for the duration or greater of the conference. This transient shortage of local specialist cover may be critical in resource poor countries. Video and internet-mediated conferencing allow clinicians access to cached presentations in their own (convenient) time, stay within their local practice area and offer a level of health delivery at least better than being in absentia. Some travel with adventures rather than new knowledge acquisition as a priority. Educational benefits, as espoused by Drife, 2 are only possible if the conference registrant attends an “acceptable” number or type of conference sessions. This requires self-discipline and a personal ethic to fulfill. Allow me to extend the “flying doctors” analogy to flightless mechanically powered migratory birds flocking to distant feeding grounds to sate a hunger and thirst for knowledge. Like that other great flightless bird of yesteryear, the dodo, will international conferencing be rendered extinct by powerful information technology resources that yield the same educational benefits, but with our feet firmly planted on terra firma? References: 1. Green M. Are international medical conferences an outdated luxury the planet can’t afford? Yes BMJ 2008; 336: 1466. 2. Drife JO. Are international medical conferences an outdated luxury the planet can’t afford? No BMJ 2008; 336: 1467. Competing interests: None declared |
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Patrick Harnett, Consultant Renal Physician Southend Hospital
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The issue of carbon dioxide is important but only one of the arguments in favor of less travel and more on line conferences. Having attended a few large conferences I am often bewildered by the choice and restricted by the time table. There are often two lectures relevent to practice at the same time, only one of which I can attend. With recorded on line video being something that most eleven year olds now do routinely, if these lectures were stored on line I could see both without having to leave the comforts of Southend on Sea. Not only that but colleagues anywhere, even in Basildon, would be able to hear the wisdom from our accademic leaders almost directly. I have been asked to give feedback on conferences. It is dissapointing how little can be recalled after a short interval. Colleagues would also be able to attend on line rather than having to rely on the inadequate recollections of the individual that attended. It may also go some way to solving the problem of getting a cardiology opinion during cardiology conference week! On line lectures could be a reservoir of knowlege which whould not be depleted no matter how many chose to look. It would take leadership from accademics to get their lectures on line and available. I suspect there would be considerable resistance from those who travel and lecture regularly. The long sited ones would recognise that should they get on line their audience would vote with there mice. Hits and downloads could mean prizes ( such as a trip to a conference) Patrick Harnett Competing interests: None declared |
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Nape Mampane, Medical Advisor Rosslyn, South Africa 0200
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Apart from meeting new faces and personalities, there could not be any other reason for conferences if technological advances are available to achieve the same goal.The whole delivery may be more affordable than travel, time away from home and work. I will miss the opportunity at making new friends, though. Competing interests: None declared |
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