Thursday, 19 December 2013

Cascais near Lisbon

A couple of weeks or so back I found myself in Cascais, 20 miles west of Lisbon, for a conference. I say 'I found myself' probably conveys the wrong impression. Rather like saying, after a stag night, that 'I found myself' naked in a roadside skip near Arbroath, handcuffed to a Puerto Rican stripagram girl and with the word Dolores tattooed across my chest. We've all been there.

No, this time I actually chose to be there. In Cascais not Arbroath. You knew that.

So why Cascais, a well-known and wealthy seaside resort, the Monte Carlo of Portugal indeed, adjacent to Estoril where the yachted aristocracy of Europe would meet for the Portuguese Grand Prix? Not, you might think, a particularly representational venue for an academic conference. And in that you would be right. Since the legislation on pharma-funded conferences tightened, these have been dour, grey affairs so unattractive that there would be no chance of mistaking them for any pharmaceutical jolly. No indeed. These conferences are calls of duty rather than freebies. Food is grey and uninteresting, served by staff of the same ilk. And should you ask for a second helping of anything, you are greeted like a latterday Oliver Twist. Believe me, short of conducting proceedings in a Turkish prison, it's hard to see how they could be less incentivised.

Dissatisfied even with these austerity measures, at least one drug company is rumoured to be terminating all paid relationships with physicians. That includes sponsorship for doctors to attend conferences and honoraria for work on advisory boards. Now call me an old cynic (and many do) but I don't see this working. Okay, there may be those amongst the company who feel that this amounts to a strong occupation of the moral high ground. They may even be right. In a utopian society, doctors might well work for free and give up their annual leave for the greater good, even spend the money set aside for the family holiday in order to attend a conference.

No, really.

Meanwhile, back in reality, I suspect the truth is rather more predictable. Given the choice between unpaid work for a drug company and a round of golf with friends, I think we know who is holding all the clubs. To believe in altruism on this scale you would need to have a strong faith in porcine aviation. The simple reality is that doctors will seek sponsorship from other sources. That means other drug companies. Rival drug companies. The moral high ground can be a pretty lonely place sometimes.

It reminds me of the old Soviet Cold War joke:

Q: what's the definition of a string quartet in Russia?

A: a symphony orchestra after a tour of the West.

Don't get me wrong -- I'm not advocating a return to the gravy train days of old where influential physicians were (allegedly) kept sweet with all sorts of nonsensical and inappropriate inducements. Stories of paid 'fact-finding' trips to the Bahamas, although probably apocryphal, helped create the perception of widespread abuses by an industry grown cynical. Austerity was seen as the only reasonable antidote. And predictably, as so often with regulatory measures, the pendulum swung dramatically. Conference venues, instead of being upmarket hotels were suddenly gulags.

But of course if the pharmaceutical industry is not covering the bar bill, none of the above restrictions apply. And without lavishing speakers with carriage clocks, laptops, iPads and other sundry electronics, it is still possible to make the conference experience more enjoyable. Cascais, where you can walk along the beach at dawn before the scientific sessions, is just such an experience. A place you want to return to and people you want to work with again.

Do I feel sullied by such comparative opulence? Do I feel corrupted by such generous hospitality? Do I believe that my opinions have been in some way bought? No, not in the least. It's just nice to have a conference in an environment that is conducive to productive work and not an attempt to faithfully recreate the film set of Midnight Express.

Obrigado Cascais. Obrigado.

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