BMJ  2008;336:1467 (28 June), doi:10.1136/bmj.a351

Head to Head

Are international medical conferences an outdated luxury the planet can’t afford? No

¹ Leeds General Infirmary, Leeds LS1 3EX

Every year thousands of doctors and scientists fly to meetings at distant locations. Malcolm Green (doi: 10.1136/bmj.a358) argues that this is no longer justifiable or necessary, but James Drife believes face to face contact is hard to replace

Last week I resolved to give up international conferences. It was at 5 am in a hot Asian airport, after waiting an hour for someone to stamp our papers. In the plane I cooled down and reflected that it could have been worse. At least I didn’t have food poisoning this time. On balance the trip seemed worthwhile. Women in that resource poor country needed better health care. Our conference may not have done much to help them, but I would do even less by staying home and sulking.

But I suppose this debate is about big conferences in posh places. It is easy to be cynical about them. Medical journals keep expressing doubts, from an urbane Lancet editorial in 1957¹ to a BMJ cover in 2003 depicting doctors as pigs fed by pharma reptiles.² In 2008 our guilt is expressed as concern about carbon footprints,³ so I should start by putting this into perspective.

The United Kingdom is ranked eighth among the world’s carbon dioxide emitters, with 160 million tons/year (one tenth of the United States’ total and one eighth of China’s).⁴ Air travel accounts for 6.3% of our emissions.⁵ In 2007, UK airports handled 230 million passengers, 12% of whom were on domestic flights.⁶ Sixty per cent of UK international travellers are holidaymakers.⁷

Forgoing medical conferences will have a minuscule effect on global warming, but it is argued that doctors should lead by example,⁸ as we did on smoking.⁹ This seems fanciful. Although people respect our opinion on medical matters, we should not kid ourselves that we have the same influence on all issues. We could campaign collectively for fuel surcharges but simply staying in our surgeries will not persuade patients to stop attending away matches or tropical weddings.

Importance of real contact

Nevertheless everyone should do their bit, so we must weigh the benefits of conferences. An excellent 1995 paper gave these as "education, inspiration, evaluation, presentation and recreation."¹⁰ Education means more than dishing out knowledge. It also involves skills and attitudes. We will not influence attitudes by haranguing people on a video link, like Orwell’s presciently named Big Brother.

For me, inspiration is the most important. A conference can motivate those attending, and I still feel inspired by hearing Mahmoud Fathalla, founder of the Safer Motherhood initiative, in Rio in 1988.¹¹ Conferences can also stimulate global action. The 1964 Declaration of Helsinki would have had less effect on research ethics if it had been the 1964 group email. Conferences in the 1990s focused world attention on overpopulation and tobacco and boycotted the apartheid regime in South Africa.^{12 13 14} Uniform journal references were agreed only because medical editors met in Vancouver in 1978.

Of course, there are alternatives. Journals are still the best way to disseminate research findings. In the 1980s the internet was expected to replace meetings¹⁵; in the 1990s electronic conferences were promoted¹⁶; and last year a "Facebook for science" appeared.¹⁷ None of these can replace genuine communication. The Lancet commented: "There is no substitute for meeting in the flesh . . . One savant said that he attended only to learn whether X and Y were as big liars as he judged them to be from their published papers."¹

And now there is videoconferencing. Some speakers believe that being seen is more compelling than being heard or read and that fielding questions is real interaction. This is not my experience. At my first videoconference the distant audience wisely stayed out of camera range. My last one was punctuated by unexplained far-off laughter. For relating to people, videoconferences are less effective than mobile phones.

Changing attitudes is a two way process. As a travelling speaker, you learn more than you teach. You begin to understand local problems by observing fellow delegates, who are usually more interested in new technology than public health.¹⁸

Compromise

I believe doctors should continue to meet, but where? Should we insist on going only to resource poor countries¹⁹ despite their airports? Conferences have to be economically viable, and most delegates want comfort. Should we ban sponsorship?² If we do, only the richest doctors will attend. Rather than taking extreme positions, I think compromise is essential.

For too long we have had articles from well known speakers complaining about too many invitations and preaching self denial.^{20 21} They evoke little sympathy. If they are tired of travelling they should say so, not dress it up as a moral crusade. We need less posturing and more practical proposals. Editors, happy to publish advertisements for conferences,²² should offer a networking facility so that congresses on the same topic are not organised back to back in different continents. Medical organisations could get tough with the professional conference organisers who now run these events. We could insist that doctors’ meetings are run differently from those of hairdressers or sales people.

When Professor Fathalla was asked, "What is the most exciting travel you have undertaken?" he replied: "In rural areas in several continents, trying to communicate with, and learn from, poor, rural women."²³ Organisers could be pressed to organise similar experiences to complement plenary sessions. This would be hard work and increase costs, but it would be more constructive than hiding behind our computer screens and pretending that this is helping the planet.

---

Competing interests:JOD travels about three times a year as a consultant to the World Health Organization’s "Making Pregnancy Safer" programme.

References

1. Editorial. International meetings. Lancet 1957;270:929-30.
2. Abbasi K, Smith R. No more free lunches. BMJ 2003;326:1155-6.[Free Full Text]
3. Roberts I. Confessions of a climate criminal. BMJ 2005;331:643.[Free Full Text]
4. Union of Concerned Scientists. Global warming. www.ucsusa.org/global_warming/science/each-countrys-share-of-co2-emissions.html.
5. Shaik T. Britons named world’s biggest emitters of CO2 from air travel. Guardian 2007 Oct 10. www.guardian.co.uk/environment/2007/oct/10/carbonemissions.travelnews.
6. Civil Aviation Authority. Recent trends in growth of UK air passenger demand. 2008. www.caa.co.uk/recenttrends.
7. Civil Aviation Authority. Demand for outbound leisure air travel and its key drivers. London: CAA, 2005.
8. Roberts I, Godlee F. Reducing the carbon footprint of medical conferences. BMJ 2007;334:324-5.[Free Full Text]
9. Gulland A. Doctors encouraged to take the lead in tackling climate change. BMJ 2008;336:794.[Free Full Text]
10. Cutting WAM. How to do it: participate in an international conference. BMJ 1995;310:249-51.[Free Full Text]
11. Drife JO. A Calvinist on the Copacabana. BMJ 1989;289:762.
12. Gulens M. Population conference finalises action plan. BMJ 1994;309:687.[Free Full Text]
13. Beaglehole R. The challenge for Beijing: the 10th world conference on tobacco or health. BMJ 1997;315:440-1.[Free Full Text]
14. Crawshaw R. Out in the cold: academic boycotts and the isolation of South Africa. BMJ 1995;311:136.[Free Full Text]
15. Parsons D. Telecommunication discussion groups for health services and medical research. Lancet 1989;334:1087-9.[CrossRef]
16. Purves I, Bainbridge M, Trimble I. Ongoing electronic conference is available for general practitioners. BMJ 1995;311:512-3.[Free Full Text]
17. Cohen D. Facebook for scientists? BMJ 2007;335:401.[Free Full Text]
18. Drife JO. We know why they die. BMJ 1996;312:1044.[Free Full Text]
19. Potter AR. Conferences should be held where the problems are. BMJ 1999;318:613.[Free Full Text]
20. Llewellyn-Jones D. It’s conference time again. BMJ 1995;311:817.[Free Full Text]
21. Greenhalgh T. The new jetsetting. BMJ 2007;334:210.[Free Full Text]
22. Call for papers: international conference on doctors’ health. BMJ 2008;336:446.[Free Full Text]
23. Fathalla MA. Lifeline. Lancet 2004;363:92.[Medline]

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