The 3rd Annual EULAR Congress, held in Stockholm on 12–15 June 2002, had a turnout of 8300 delegates, almost identical to last year's record attendance level in Prague. The venue was close to ideal, allowing ample space for poster sessions in the exhibition hall. The manned poster sessions were well attended, even on the last day of the Congress. The numerous invited speakers represented the world's elite, allowing the staging of excellent state-of-the-art podium sessions. The aim of attracting the young scientific community was partly achieved, but individual delegates' dependence on industry sponsorship poses potential problems. The organization was a big improvement compared to that of the two previous congresses. Approximately 1800 abstracts were submitted, an increase of 50%, resulting in a higher quality of accepted abstracts. The satellite symposia held every morning and late afternoon were well attended; thus, industry exposure of new products, both in podium sessions and at the exhibitions, was well accommodated. The Annual EULAR Congress consolidates its position as one of the two most important annual congresses of rheumatology, but EULAR economy and commercial aspects are still too dominant in relation to science.
Keywords:ACR; EULAR; poster sessions; rheumatology congress; satellite symposia
A year ago I wrote a personal critique of the 2nd Annual EULAR Congress in Prague for this journal . This year, I was asked for a similar article on the 3rd EULAR Congress in Stockholm, and although playing a small part in the local organizing committee I felt unbiased enough to accept the challenge. This will not be a normal meeting report; I will not even attempt to summarize the sessions and activities I was obliged or allowed to attend. Realizing that this is the most important rheumatologic meeting outside the USA, I will attempt to convey positive and negative experiences, fully aware of the constraints under which EULAR strives to achieve a number of goals, political, economic, educational, scientific and social. All are important but difficult to achieve simultaneously.
A gigantic meeting
The number of delegates registered (8,300 – almost the same number that attended the Congress in Prague in 2001) was no match for the EULAR congress organizer CMI in Geneva and its local partner in Stockholm. Hotel rooms were found for all the delegates, although those arriving without previous reservations had to accept less than classy accommodation. Volvo provided limousine transport for some VIPs, the invited speakers had a shuttle bus service from hotel to congress center, and the ordinary delegates were provided with a pass for public transport, which took them to the central station in 11 minutes. The venue was excellent, not least the big central exhibition hall which housed nonprofit exhibitors, industry exhibitions and scientific posters. It was easy to get oriented by reading the program book, which compensated for the almost complete absence of signs. One would have wished for signs at the meeting room entrances, at least, indicating which session was in progress.
It was nice to encounter a large number of non-European attendees, although some voices said that this made ACR observers nervous. My belief is that attendance of most non-European delegates not invited by the Congress organizers was paid for by industry, either directly (as industry employees) or by individual invitations of sponsorship.
The Congress fee was again impressively high, but included a one-year subscription to the Annals of Rheumatic Diseases, the official EULAR journal. This now has an impact factor of over 3 and is next only to the ACR journal Arthritis and Rheumatism in its field. The submission rate to the Annals is increasing substantially these days. Editors of other journals may be envious, but perhaps this is the start towards one European competitor for the ACR journal. The cost for registration was even higher for Swedish delegates, who were forced to pay VAT (value-added tax). This resulted in a major effort to subsidize juniors' participation by providing bursaries to those with the best abstracts, and also in enrollment of a large number of volunteer workers, working 50% of the congress time. These arrangements resulted in a nice turnout from Sweden, but reduced the Swedish Society's net income from the Congress.
The opening ceremony
The opening ceremony was attended by 4000 delegates, and featured modernized folk tunes and modern Swedish music of various kinds, mostly too loud for my taste. I missed a Queen named Silvia, who has a keen interest in handicapped children, and whose presence would have been all the more fitting, considering that the EULAR Congress this year also included the 9th European Paediatric Rheumatology Congress. Instead we were briefly addressed by the vice chancellor of Karolinska Institutet, Hans Wigzell, who invited us to find the cause of rheumatoid arthritis and its cure. When this had been achieved he would be pleased to invite another Nobel laureate from amongst us. He indicated that the task should not be impossible, now that vaccination had advanced to the point where even cucumbers could be vaccinated! At the subsequent reception both wine and food were plentiful, and I even spotted traces of cucumbers, vaccinated or not.
The scientific podium presentations
The invited presenters numbered over 300 and there was a global spread of speakers, rather than a European spread. I think this is exactly the right policy, although probably to some extent controversial. The chairman of the scientific committee, Steffen Gay, had again brought together an impressive selection of frontline investigators. It was also nice to spot a couple of younger presenters, mostly selected from those who submitted abstracts.
The "Scientific forum for young rheumatologists" was given two sessions rather than one, and included not only young speakers who had participated in the ACR/EULAR exchange program but also some from Korea and China. The significance of this session was underlined by the choice of chairmen, Joachim Kalden and Peter Lipsky. Unfortunately, this interesting program coincided with a session on genetics, cell signaling and cytokines with invited speakers Tim Vyse, Jerry Saklatvala and Ian McInnes, and with a session on molecular aspects of tissue repair, which I co-chaired. Every conscientious delegate must have experienced daily frustrations with regard to which session to attend, and I heard some friends saying that a dominating feeling after the Congress was regret at all the sessions one had been unable to take in.
Is there a way out from this dilemma? One strategy I would favor would involve fewer parallel sessions and would streamline the program into one basic/experimental, one clinical research, one clinical problem discussion and one state-of-the-art/update line of sessions. Having fewer invited speakers would certainly incur some disappointment among the rank and file congress speakers, and their absence would attenuate the quality of the discussions. Perhaps the Organizing Committee could invite discussion-panel participants who would not present a lecture themselves. This was a role often (not always) played by competent chairmen at the EULAR congress, and it is used in several smaller scientific workshops.
Lively poster sessions
The three poster sessions, featuring some 350 posters each, were a very positive experience as I see it. The average quality of the posters was distinctly better than last year's, and the selecting committees had more submissions from which to choose. Importantly, the midday, manned, poster sessions were well attended. Even the morning session on the last half day of the Congress was far from empty. I encountered both established and young presenters. Some were from countries like Japan, and, according to the presenters, were supported by the medical institution in which they worked. This is indeed encouraging and will hopefully continue.
Satellite symposia and industry support
Coming back to the problem of conflicting concomitant sessions, one was impressed by the fact that three hours on each of the three full Congress days were reserved for satellite symposia. They did not overlap with the Congress program, but their existence reduced the time available for the EULAR program itself. An obvious way to improve this situation would be to move all satellite meetings to one or two days before or after the scientific meeting. This would allow accommodation of three more hours of proper Congress program every day, but would not be popular with the industry. Industry invests substantially in the EULAR congress, and the shareholders want sales promoting returns. Eric Bywaters and others addressed these problems in the past and criticized commercialism in the EULAR Congresses, as he recently told me, without much success.
We fully appreciate the legitimate need of industry to expose scientific progress. But I believe there should be a mutual interest in separating marketing/advertising, be it open or disguised, from scientific reporting. I am naive enough to believe that the goodwill generated by unrestricted sponsorship for scientific exchange (product unrelated) cannot be overestimated, and I have personal experience to support this belief. The legitimate and mutual interest in hearing about and discussing novel therapeutic developments should be accommodated in the Congress program itself. The results should be openly presented and discussed, just like all other material presented at the Congress. And the satellites could be arranged under the umbrella of the Congress but on separate days.
The risk with organizing the Congress this way is that fewer individuals will attend the Congress, but perhaps it will be those who were seen in the scientific sessions in Stockholm anyway, so the real loss may be insignificant. Let it be no secret: a substantial proportion of the 8,300 delegates enjoyed archipelago cruises and other outside activities, rather than attending the congress sessions. Unfortunately, some of these escape activities were organized by industry. I wonder how many of the 8,300 registered delegates were present during peak hours of the congress.
A more sensitive risk is that the Congress would lose paying delegates and therefore make less profit. I leave it to the wise men in the EULAR leadership to contemplate what might be done. Right now they can negotiate from a position of strength, based not only on the turnout and success in Stockholm, but also on the large number of interesting new products on the market or in development. Industry needs EULAR at least as much as EULAR needs industry.
The pre-Congress organization
Abstracts and conference program
The electronic submission of abstracts seemed to work better than last year, although I heard of some problems from Australian colleagues. The abstract selection system allowed for four possible outcomes: podium presentation, poster presentation, rejection or abstract-book printing only. The last category was said to be necessary to accommodate people who otherwise would not be allowed to travel to the congress. This category is probably very small after the recent political developments in the world, eliminating travel restrictions other than economic. I believe the abstract-book-only category is dispensable for the next EULAR Congress. This year the program and abstracts were indeed available on the web site before the meeting, although for reasons I don't understand could only be accessed using Internet Explorer and not Netscape.
The hotel reservations were probably handled as well as they could be, although I understand that the availability of attractive hotel options for those who were not invited by the Congress organizers or sponsored by large companies was negligible.
The Annual EULAR Congress and other European rheumatology meetings
There does not seem to be any doubt that attendance at the Annual EULAR Congress will be essential for key players from academia, clinical practice and industry in years to come. How will this influence the more local rheumatology meetings in Europe? Originally it was planned to incorporate the 2002 Scandinavian meeting in the EULAR Congress, but the Swedish Society did not want to do this. Another Scandinavian country, Norway, promptly volunteered to arrange the Scandinavian congress for 2002. Although it will be held only two months after the Stockholm meeting, and although the number of delegates will be lower than it was two years ago in Finland, the meeting will be of a reasonable size. The British and continental meetings continue to attract large crowds. My prediction, therefore, is that we will not see any large reduction in national meetings because of EULAR's annual congresses.
The Congress in Stockholm marked a distinct step forward with regard to overall scientific quality and, in particular, many more young rheumatologists and trainees presented their work. The poster sessions were, for me, enjoyable for the first time. Some major problems remain to be addressed, however. The very high Congress fee makes participation dependent on industrial sponsorship of registrants unless they are the lucky recipients of grant money or have been invited by the Congress. The vulnerability of this system is obvious. The chairman of the scientific committee this year, Steffen Gay, has laid a splendid foundation for his successor, Maxime Dougados, but also leaves some challenges: to ensure the young and active investigator's presence; to allow the poster sessions to play a leading role in Lisbon 2003 and Berlin 2004; to streamline the program and reduce the number of parallel sessions; and, most difficult, to incorporate industrial developments in the Congress program and move the sponsored satellite symposia to before or after the congress. We all wish him good luck with the important task of keeping the catch, that is to say, the young generation, involved in the future EULAR congresses.
ACR = American College of Rheumatology; EULAR = European League Against Rheumatism; VIP = very important person.
Arthritis Res 2001, 3:E006. BioMed Central Full Text