Back in the Dark Ages when I covered big medical conferences (like the European Society of Cardiology meeting now getting underway in London) it was necessary to attend the sessions, roam the halls, and talk to doctors. There were no late-breaking or hot line sessions and there were certainly no simultaneous publications in journals. (If memory serves the original GUSTO trial may have been the first to pull of this feat.) Just getting all the details and numbers correct required a major effort. Studying the program and the abstract book to figure out what was new and important was a necessary, time-consuming task.
Today it’s all different. It takes a determined effort to escape the press room bubble. Most of the “important” trials are published simultaneously in the major journals– the New England Journal of Medicine seems especially eager to suck up just about anything it can– and the authors generally appear in the press conferences and are readily available for interviews. The major cardiology organizations– the AHA, the ACC, and the ESC– offer big name experts who are happy to comment on all of these trials. (And, of course, industry offers its own KOLs for interviews about their own trials and trials in which they have a substantial interest.)
Generally today the press focuses on the same trials and quotes the same experts. Although the time constraints have increased– everything has to happen instantaneously these days– it’s really all very easy because the reporters are spoon fed the major trials. This is by no means a completely bad development. With all the resources available some reporters are able to explore the big major trials in great depth.
But I want to focus here on some of the unintended consequences of these changes, and some of these consequences are troublesome.
When you’re hot you’re hot…
First, it should be pointed out that Hot Line/Late-Breaking sessions have multiplied. Much in the same way the major medical societies increase the number of cardiology journals they publish, the Hot Line/Late-Breaking sessions during meetings also proliferate wildly. At the ESC in London this year there are 6 regular Hot Line Sessions, 3 Clinical Trial Update Hot Lines, 2 Registry Hot Lines, and 2 Basic and Translational Hot Lines. That’s a lot of hot.
When you’re not you’re not .
But let’s get out a thermometer for a reality check. How many trials are really hot? How many truly deserve the attention and publicity? Generally, at most meetings there are only a few trials that have a big impact. (Last year at the ESC, for example, there was the PARADIGM HF trial that introduced Entresto– LCZ 696– to the world. Now THAT was a trial that deserved to be called hot.) Many Hot Line trials are more tepid than hot and more likely to provoke a yawn than excitement. And yet, because of the label, many journalists, especially those writing for a professional medical audience, feel obliged to cover most of these trials.
Simultaneous publication is another recent and related development that brings a lot of benefits, including more rigorous peer review and superior and more widespread availability of trial results. Reducing the time between initial presentation and publication helps shorten the gap between the acquisition of new knowledge and its application to clinical practice.
But it has become clear that this development also has its unintended consequences. For one, it’s hard not to wonder about the quality of some of the hot line/late-breaking trials published by some of the major journals, including, perhaps especially, the august New England Journal of Medicine. Notoriously difficult to break into, the publication barrier seems to be far lower when a trial is published simultaneously at a major medical meeting. I’m not sure why journals seem to have lower standards for publication of these trials, but many others have made this observation. One possible explanation is that in an era in which print appears to be in a fatal death spiral there is a new premium on really fresh news. Medical meeting are a natural source of this news. (There may be additional commercial factors at play of which I’m not aware.)
There is another related danger as well. I’ve been told by very experienced clinical trial investigators that they really love simultaneous publication because it means that, compared to non-meeting related publications, the peer review process will be both less rigorous and less prolonged.
I don’t think it’s possible or even desirable to go back to the old way of doing things. But in our rush to embrace the future we should probably expend more effort to recognize and confront the unintended consequences of our actions.