Morgenröthe or business as usual: a personal account of the 2nd Annual EULAR Congress, Prague

Abstract

The 2nd Annual European League Against Rheumatism (EULAR) Congress, held in Prague, 13–16 June 2001, was an impressive event with a record turnout of 8300 delegates. It offered a large variety of first-class state of the art lectures by some 180 invited worldwide speakers. Several new and ongoing therapeutic developments were discussed. The aim to attract the young scientific community was only partly achieved, and the dependence on industry posed some problems. The organization, however, was a big improvement compared with the previous congress in this series. The number of submitted abstracts was relatively low (1200) compared with the number of delegates. Accommodation of satellite symposia and organization of poster sessions remain problem areas of this meeting. The Annual EULAR Congress emerges as one of the two most important annual congresses of rheumatology, the other being the American College of Rheumatology meeting.

Introduction

This is not a meeting report. Any attempt to summarize a 4-day meeting with a multitude of parallel sessions, posters and other activities is doomed to be either biased or superficial, or both. Rather, the aim is to give a personal account of some reflections in the mind of an old European after attending what turned out to be the largest congress in the history of our specialty. It should be known that I made no secret of my disappointment with some arrangements in last year's 1st Annual EULAR Congress in Nice. The editors' invitation to write about Prague gives me the opportunity to air some views and hopes.

Biggest in the world

The 8300 registered delegates made this the largest EULAR, and probably rheumatology, congress ever. The turnout does not become less impressive considering that registration was not cheap: 800 Euro on site. The income for the EULAR should make the outgoing treasurer, Josef Smolen (Vienna), and the incoming Ferdinand Breedveld (Leiden) happy. Even the 10% of the surplus that goes to the hosting Czech society will be good news to Karel Pavelka, the president of the meeting, and his countrymen. In addition to all the money from registration fees, the organization received revenue from no less than 17 satellite industrial symposia, industrial exhibitors, and so on. This commercial success makes the EULAR economically sound, which is certainly not a negative thing. The concern is, however, related to the fact that at least 80% of the delegates were sponsored by industry. Some companies were flying in over 1000 delegates from all continents. The individual who pays his own way is an endangered species at the EULAR congresses. Availability of grant money to attend congresses is limited, and in some countries is extremely limited. The generous travel sponsorship of industry eliminates motivation for the organizers to reduce registration fees. It should be added, however, that the fee includes an annual subscription to Annals of the Rheumatic Diseases, the EULAR journal, thereby increasing the circulation of this journal.

Who was in attendance and who was not

It was delightful to meet so many faces of friends at the opening reception, blessed by perfect weather and held in the generous foyer of the Prague Congress Centre. The faces were those of the invited speakers, of colleagues flown in by industry from European and non-European countries, and those of industry. The decision-makers and the speakers in the satellites were numerous, as were the regular practicing rheumatologists from both east and west. The stage was set for a mega postgraduate meeting. You had to look harder for investigators, both younger and older, and many of these (who are regulars at the American College of Rheumatology [ACR] meetings) did not find it attractive or affordable to come to Prague. When the EULAR decided to move to annual congresses, one aim was to capture this core group of active basic and clinical investigators. Some of these indeed made it to Nice, but were utterly disappointed and abstained from Prague. It will be a hard challenge for the EULAR to attract them back. One indicator of failure in this sense was the low number of abstracts submitted to Prague, approximately 1200, in contrast to 3600 for this year's ACR meeting in San Francisco. And it can be no secret that the quality of the 750 accepted posters was mixed.

The opening ceremony

At the opening ceremony in the splendid congress center, the main congress hall with its 2300 seats was nearly full. It was a relaxed event lead by a professional Master of Ceremonies; the speeches were kept to a minimum and included one by the Minister of Health, a university professor. A film showed the history of the city and the country from medieval times to the present, only omitting the Nazi and Communist interludes. Prizes were awarded to a number of young investigators, to one senior team and to the nestor of European rheumatology, Eric GL Bywaters, who at the age of 91 is in good mental and physical health. Meeting Professor Bywaters, who has fostered so many generations of rheumatologists and set the standards for excellence in clinical research, was one of the highlights of this congress. As a young pathologist performing cartilage research in the Courtauld institute, he was visited by Walter Bauer from the Massachusetts General Hospital in Boston. Following an invitation from Dr Bauer, he spent 2 years in Boston and built an early bridge between Europe and the United States. Serving in London's Hammersmith hospital during the Blitz, he described the 'crush syndrome' with its then fatal renal tubular necrosis. Among his classical contributions are the necrotic vasculitis lesions of the fingers, called Bywaters' lesions.

The scientific podium presentations

The invited speakers numbered 180 and included a good mix of leaders in clinical and basic research. There were between three and eight concurrent review sessions or themed sessions to choose from throughout. One could enjoy first-class state of the art information spiced with some new information. There were also podium presentations of some good selected abstracts. One session deserves special mention; the 'Scientific forum for young rheumatologists', which included speakers who had participated in the ACR/EULAR exchange program. I unfortunately could not attend this session because I was speaking in a concurrent session. Several sessions were composed exclusively of invited speakers, and these were of the highest quality. In some sessions, the ambition was to mix invited presentations with selected abstract presentations. These sessions often started with a full house; however, much of the audience left when the selected abstract presenters took the floor. The organizers are well aware of this problem, and are looking for ways to overcome it. I could not help thinking of other recent meetings, like the British Society for Rheumatology Annual General Meeting in Edinburgh, where delegates in general sat through until the end of the sessions. Such problems are of particular importance if one seeks to attract presenters of original, not yet published work. I also noted that afternoon sessions in general had a thinner attendance, and I know that some drug companies had arranged social activities starting while the scientific program was still in progress. This behavior should be formally barred through agreement between the EULAR and industry.

The logistics of poster sessions

The poster sessions were a great improvement compared with the first annual congress in Nice. The time allotted every morning did not overlap with any official sessions, only with committee meetings and similar activities. Yet the attendance was thin and, even worse, many posters were unmanned or even not mounted. And, as already mentioned, the quality was mixed. The panels were too narrow and close together, which made it hard to view some of the popular posters. There are plans to move the poster sessions to the lunch break at the next EULAR congress in Stockholm, 2002. This would then be combined with provision of light food and drink, and hopefully improve attendance. I am attracted by this idea, provided industry and conveners of committee meetings abstain from clashing with the poster hours.

The satellite symposia

The drug industry has delivered a number of powerful new remedies in recent years and more are in the pipeline. This is a good thing, and it has helped rheumatologists to help patients. The enormous expansion of the EULAR Congress and other congresses are made possible by industry support. It was said that 80% of the delegates' registration was carried by industry, in addition to direct fees paid to the congress organizers. It is understandable that industry expects a return for such services. The satellites in their present form are sales events dressed up into scientific sessions. The speakers are paid by industry for their services and their selection must be sanctioned by the sponsor. Having said this, I must also add that, in general, the speakers are highly reputable investigators who present original work. Much of the presented material meets high standards of postgraduate teaching. Nevertheless, one must keep in mind that the hosting event is ultimately intended to boost the sale of products. In my view, satellites should be held before and/or after scientific congresses, and not while they are in progress. There is a limit to what most brains can digest in one day and attending satellites by necessity competes for brain input capacity. Furthermore, delegates whose congress presence is sponsored by an industry feel a natural guilt if they do not attend their sponsor's satellite. And, after all, we not only attend congresses to listen to talks or discussions; we also want to meet old and new friends and colleagues. This latter need is of course met in splendid ways by numerous social events sponsored by industry. The purist may experience ethical difficulties attending such events, and industry could argue that the satellites provide as good science as the congress itself and that one will not happen without the other. This obviously is a tricky issue.

The pre-congress organization

Abstract submission was exclusively electronic this time. I know several people, including myself, who had difficulties delivering their abstract. I found to my surprise that the abstract book said 'No abstract received' in my and several other slots. The EULAR needs to improve on this detail, which works so well at the ACR meetings. Another wish is that the program abstract book becomes available in time before the meeting so that one can make choices among the up to 10 concurrent sessions. Being an invited speaker, I had no problem with hotel reservation, but I know that individuals not invited by the congress or by industry were less fortunate if they were not making reservations extremely early. Again, the ACR has arrived at a fair way to handle this problem by fixing a date before which no reservations are accepted, and requiring registration to the congress before allowing housing reservations.

The future of European rheumatology meetings

In recent years, some EULAR officials expressed the view that the new annual congress should substitute for the national or regional meetings held in most if not in all European countries. This has clearly not happened and is not likely to happen in the near future. Recent British, French and German congresses have had undiminished and good attendance. Although one commonly complains about too many meetings, one rarely stays home. Congress life is attractive to most health workers, not only doctors and not only rheumatologists. There is no question that the national as well as the EULAR congresses offer first-class state of the art information and help in postgraduate teaching. But do they fulfil the need for scientific exchange? The European Workshop for Rheumatologic Research, an annual event, started more than two decades ago by Professor Gabriel Panayi of London, is a good example of what one can do with a limited budget and focused organization. The rule for this meeting is to admit only delegates coauthoring an abstract and to not accept more than 150 abstracts. Should one try to let the European Workshop for Rheumatologic Research expand into a European Rheumatology Research Society, perhaps meeting shoulder to shoulder with the EULAR? This form is, for example, adopted by American orthopedics. Time seems not ready for such a change, so the effort for the EULAR must be to become a more attractive platform to present the best science. This will not happen overnight. I know that the EULAR leadership is well aware of the problem and will continue to encourage the young researcher's participation. The EULAR is now in a position to use some of its wealth for the purpose. This would be more appealing than steering towards a split. I hope the efforts will be successful.

Concluding remarks

The largest ever (?) rheumatology congress in Prague was a sounding success in several ways. The scientific committee had organized excellent scientific state of the art sessions in a large number of areas, appeasing most interests and tastes. The local organization was very good and the venue excellent. The EULAR Annual Congress emerges as one of the two most influential congresses in the field of rheumatology. It should be possible to attract more abstracts to future meetings and make the poster sessions livelier.