24 Apr, 12 | by BMJ
“Doctors are not interested in health” is one of my many wild generalisations. My evidence is my experience, a 40 year collection of anecdotes, and the observation that a thousand page medical textbook usually comprises five desultory pages on health and 995 pages detailing disease. Now I have further evidence.
I’ve just attended the World Cardiology Congress in Dubai, an event with more than 10 000 attendees and an A4 programme that is 370 pages long. Not used to such extravagant events, I imagined every session packed with enthusiasts.
In fact when I arrive at a session on “Prevention of cardiovascular disease in emerging economies: the role of pharmacological intervention” I discover that I’m the third person apart from the two chairs and the three speakers. Nobody else arrives, but the session begins.
The first speaker is from China and tells us that stent insertion has been increasing by 30% a year since 2000 but that very little has been done on prevention. He observes as well that 50% of doctors and 70% of cardiologists smoke. It’s perhaps some sort of justice that the doctors’ lack of interest in health and prevention extends to themselves as well as their patients and potential patients. During this first talk, the man sitting in the front row realises that he’s in the wrong session and leaves. This reminds me of my brother’s first performance at the Edinburgh Fringe, when there were seven people on the stage and four in the audience; and because of audience participation it was later eleven on the stage and none in the audience.
We then have two excellent presentations on prevention in Brazil and the role of the polypill, and the audience has grown by three. (One, I suspect, might be the wife or mistress of one of the speakers. Global conferences can be a good time to arrange an assignation with your mistress. I hasten to add that I write this from imagination not experience and have no evidence whatsoever that the woman in the audience with the short skirt is anybody’s mistress.) Although we now have five in the audience, I note that two of them are looking at their Blackberries.
I must admit that the title of the session made me suspicious that the organisers might be pandering to some “higher agenda.” Why “emerging economies” rather than “low and middle income countries?” Perhaps because business, the sponsors of the meeting, are more interested in these countries with huge populations and rapidly growing economies than they are in countries like Rwanda or Sri Lanka. The same considerations might explain the emphasis on drugs rather than lifestyle or public health interventions.
After this session I go and chair another session on prevention (which is why I am here), and now we have an audience of about ten, only five of whom are from the same place as the speakers. During the session, however, one gets a phone call and leaves and three others, who have sat at the back, leave. Perhaps they got a better offer.
I didn’t go to any other sessions, and perhaps they were all equally empty. It might have been that those at the conference followed the advice of a colleague: “Once I’ve learnt three things at a conference I head for the beach or a bar. With luck that happens in the first 20 minutes.” I was told, however, that a session on stents was full to overflowing. Stents mean money, drama, and even beautiful women and a slot on the television.. Prevention, in contrast, is boring, all about what doesn’t happen rather than what does. Plus, were it to be successful it would put cardiologists out of business. Then there would be no more conferences in exotic venues.
Competing interest: RS was the editor of the BMJ until 2004 and is director of the United Health Group’s chronic disease initiative. He chaired a session at the conference, which is why he was there. His employer, UnitedHealth, paid his expenses, and he taught unpaid a class at a local university on “How to get published.”