The rise of the ESC: is the ESC anti-American or pro-industry?

A prominent US cardiologist remarked to me in Stockholm that he was disturbed by the “anti-American” tone of some remarks made at the opening session of the ESC. I’m not entirely sure to what he was referring because I make a point of skipping official ceremonies, but I’m certain that at least part of his concern was grounded in the repeated assertions made during the meeting that the ESC was now the largest cardiology meeting in the world, having surpassed the AHA and the ACC some years ago. Of course, being cardiologists, the ESC officers weren’t going to taunt “nyah nyah nyah we’re bigger than you now” to every American they could find, but I did detect at least a faint odor of childish triumph. And, to be fair, it would be hard to blame the Europeans entirely, since for many years the European meeting– and European cardiology as a whole, for that matter– was routinely disregarded or condescended to by many Americans.

But what is behind the remarkable rise of the European meeting? There were many theories discussed in Stockholm. Most agreed that one common explanation– the economic impact of the great recession– failed to explain the phenomenon, as the effects of the recession appear to be at least as great in Europe as in the US.

It may be impossible to gauge the impact of another factor. Since 9/11 it’s been much more difficult for non-US citizens to get visas to visit the US, and it seems likely that many people may simply have decided to avoid the whole disagreeable process and choose to attend the ESC meeting as a less problematic alternative.

The ESC may also be tipping the scales. It’s widely believed that the ESC leadership imposes a quota system on speakers at ESC symposia and satellite sessions. Simply put: you’ll never find more than 1 or 2 US speakers in these sessions.  (My own belief is that as long as European cardiology was indeed an underdog such affirmative action made sense. But now that the ESC is on an equal footing with the ACC and the AHA it’s less easy to justify this policy.)

And then there’s the role of industry. While many observers of the AHA and the ACC (including myself) have been critical of the close relationship of these organizations to industry, it is clear that the ESC has a much cozier relationship with industry than its US counterparts. Here’s one way this could impact attendance: a substantial percentage of ESC attendees have their travel and registrations costs paid by industry. To the best of my knowledge this type of wholesale support no longer occurs at US meetings, though I believe that foreign doctors often have their trips to ACC and AHA organized and paid for by industry. The ESC estimates that about half of all “delegates” receive financial support for attendance, but doesn’t know what percentage of that comes from industry as opposed to support from universities or other nonprofits. But it seems likely that this support may well play an important role in the rise of the ESC.

Clearly industry has many reasons to look kindly on the ESC. When you start looking the industry ties appear ubiquitous. As Susan Cheng observed on CardioExchange, industry-sponsored satellite symposia aren’t relegated to the margins of the meeting as in the US but instead are given much more convenient “prime time” slots during the convention. In addition, as I wrote about earlier this week, ESC guidelines are far more receptive to new products and devices than US guidelines.

The reception of SHIFT struck me as a perfect example of ESC friendliness toward industry. Every expert I spoke with was highly critical of SHIFT. No one believed that with its current data ivabradine would even stand a chance of approval in the US. Yet throughout the meeting SHIFT was hailed in the ESC daily newsletter as a major breakthrough, and the message was carried through to many major European newspapers.

And then there are the ESC press releases. The AHA and the ACC have large, professional public relations organizations. One of their main functions is to prepare press releases about important news at the meeting. (They typically spend months before each meeting preparing press material for the meeting.) Now I have nothing but good things to say about the ESC press department. They’ve always been extremely courteous and helpful whenever I’ve needed anything. But they don’t write their own press releases. I assume this is not their fault. I’m sure if they had the budget and the resources they would be happy to perform this function. But in the current system they simply make available press releases that have been given to them by the study investigators. In many cases, these press releases may have been prepared by industry. In any case, neither industry nor study investigators should write these press releases. That job should be performed by professionals who would work closely with the program committee to help ensure that the press releases accurately reflect the more objective assessment of the program organizers.

Let me be clear: there are still plenty of great things at the ESC. I always look forward to the meeting (although not the inevitable jet lag). Whenever people complain about small hotel rooms or the absence of Diet Coke from the press room I hold my mouth. My room in Stockholm was only slightly larger than the bathroom in a typical hotel in Orlando but I think the trade-off was worth it. At the very least the waiters weren’t dressed in theme-park costumes. But if the ESC truly wants to take its place as the preeminent cardiology meeting it will need to establish an entirely new relationship with industry. Only then will it truly be a meeting of the very first rank.


  1. Larry, I disagree with only one sentence in the above:

    “In any case, neither industry nor study investigators should write these press releases.”

    Obviously it would be better if industry did not write the press releases, but it would be best if study investigators did. You are one of the best medical journalists I have come across but it is widely known in the scientific community that the media distorts, simplifies, dumbs down and just simply doesn’t understand scientific findings. This has been shown time and again. Then the public takes off on this and blames doctors for findings that just aren’t true; or worse, they stop their medication without consulting them.

    Of course the best of all possible worlds would be if the scientists wrote their press releases in conjunction with media professionals – that way, you would get good clear writing but also scientific accuracy. Leaving it to PR people to write press releases is not the best way to go.

  2. Hi Dan,

    You raise a great point– and thanks for the nice compliment!

    I’m certainly not going to defend the worldwide media depiction of health and science. It’s often quite abysmal. But I would say that the role of press releases is very complicated.

    One of the biggest problems– overhyping new research– is often fueled by the over-eager researchers themselves. The reason we have peer review is because everyone agrees that it is impossible for people to have an objective perspective of their own work. (I won’t get into the larger problem of “objectivity” here.)

    So the basic point I was making is that credible organizations like the AHA, the ACC, and (we hope) the ESC, along with journals like JAMA and the Lancet, should be better able to place new research in a larger perspective. A good portion of the media may then still mess it up, alas. But at least the problem at the source will have been somewhat alleviated.



  3. Quite right…scientists overstate their findings all the time, and one job of peer review is to catch that. However, are PR people and people who are in the media divisions of AHA/ACC/ESC really the right people to vet this? They have no scientific or medical background. Perhaps when submitting abstracts to scientific symposia we should also be submitting a press release to — the vetting people would be the people who judge the abstracts. The former is already standard practice, perhaps the latter could be too.

    You are in the trenches and reading the press releases at AHA, ACC, and ESC and have obviously noted major quality differences – so I don’t dispute your experience or opinion on this. I’ve never found press releases or even abstracts to tell the full story however. I guess that’s why we have peer review and published manuscripts. One could argue in this electronic age of online journals for getting rid of conferences, embargos, and delayed publication altogether — publish as soon as the thing is acceptable from revision standpoint by the referees and editors. Why are we slowing down science by years? That doesn’t pass muster in other worlds – for instance, inventions and patents. But that’s a whole other story.


  4. Hey Dan,

    A few thoughts:

    A good PR person, like a good journalist, is not a trained scientist but a trained communicator. Now I know that many scientists in the trenches don’t have a lot of respect for journalists or PR flacks, but I would argue that it is essential for the most significant scientific results to be explained to the general public. Unfortunately, very few scientists either want to do this or, if they do, are very good at it. The great exceptions (Stephen Hawking, Atul Gawande) prove the rule.

    It’s important to understand that the PR people and science writers at the AHA et al aren’t the ones to choose the abstracts, and in general their work undergoes careful review from the editors or program committee members.

    I like your idea about early, automatic, and presumably online publication. Many fields are already moving in the direction of early preprint publication, and some are even experimenting with online, open-source peer review. I’m all in favor of these experiments. But they won’t replace the role of people who can communicate science to non-scientists.



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