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.