ACC14: The Quickening Pace of Change

I just returned from the American College of Cardiology and wanted to write down a few of my 50,000-foot impressions from the meeting for, as the song goes, the times, they are a-changin'.

First, while I don't know the overall attendance at the meeting, there really appeared to be fewer attendees.  Interestingly, the outside-the-US contingent seemed strong, but by comparison, the US presence at the meeting seemed much lighter (no facts to support this, just my impression).

The pharmaceutical and medical device displays seemed awkwardly overdone.  Gigantic displays, lots of sales people standing around, with really not much to do.  The amount of money these companies spend to attract doctors in an era when doctors really aren't the purchasers of this stuff anymore, seems crazy - like they haven't gotten the memo.  And for goodness sakes, pharma needs to understand how bad it looks when they're charging $6 a pill to our patients on novel oral anticoagulants and they've got these bulls**t displays.  Either tone it down, or cut your price… er, never mind: do both.

Surprisingly, I never saw a single model walking on a regular treadmill - a standard at every cardiology meeting I have ever attended.   What this means, I'm not sure.  Perhaps the ACC has matured to realize that women cardiologists are a growing force, or (more likely) the advertisers understand that no one cared about regular treadmills (they don't make any revenue) and are sick and tired of standing in from of them at work.

RFID tracking seemed larger than ever.  Little scanner doomajiggies were all over the place to track us wherever we went, that is, of course if we agreed to have one in our badge.  (I was happy to see that the ACC respected by wishes not to have the RFID in my badge, and none was there).  One thing that several doctors noticed (and I confirmed): they really didn't care if you had your badge on UNTIL you went to the expo floor, showing what really matters, I guess.

I had the great pleasure of meeting and chatting with a few fellows from across the country and around the world: New York, Massachusetts, North Carolina, California, China, China, and China.  These younger folks were cool, but clearly lamenting that it might not be one they participate in much longer.  For the most part, most of them were there on much of their own nickel.  I quickly polled them to inquire about the annual stipend they receive from their institutions for these things, and the numbers I heard were quite low: from $1500 to $2500.  Between cuts to doctors' income and low expense stipends, it is no wonder more and more physicians are staying away - kind of sad for doctors, sure, but really sad for these bright, eager residents and fellows.  One is starting to wonder how many more years such expensive sessions will continue.

The other big thing that I noticed at this meeting: not much was scientifically new.  It was striking. Think about it: the big trials were a trial on TAVR, a few talks on Mitra-clip, renal denervation, cardiac resynchronization, and pericarditis.  Maybe the PCSK9 inhibitors that drop LDL substantially in folks with familial hypercholesterolemia were novel, but that one's not really my bag…  It just seems that the  of innovation in US medicine has taken a pause.  Even in the posters: meta-analyses of old big trials seemed to outnumber and new big trials.  It's different now.  The cuts are real.

Finally, there was an important first at the meeting.  I was impressed that the topic of social media in medicine was given it's own real, live session with it's own central room at #ACC14.  I was even more amazed they invited me.  After all, I haven't exactly ingratiated myself with the College lately.  To their credit, however, they are giving folks like you and me a place to learn about and a platform to promote what I believe to be an important tool for physicians in the years ahead.  For that, I am truly grateful.   We are, after all, are all professionals all doing this crazy work of medicine together.  We may not agree at times, but I think we all want to improve the system for our patients' sake, and social media is a very powerful way to affect change, act collectively, vet ideas, and improve our health care system for the better.  Industry, too, is learning from doctors and patients as they use social media to critique, explain, and promote ideas and tools for better patient care.  Sure there will be bumps.  Sure there will be disagreements.   And change may not come right away.  But more more often than not, with enough collective voices reaching some compromise, there will be effective change for the better.  Seriously, where else can we get value like that?

So to the ACC leadership and all the great people I had the chance to meet, discuss, learn from, share ideas with, thank you.  It was a blast.

-Wes