The opening session of the XVIII Congress of the European Cardiology Society (ECS), held August 25 to 29 at the National Exhibition Centre (NEC) in Birmingham, England, kicks off with a blast of bagpipes from Scotland's Caledonian Highlanders, possibly to remind the crowd of international delegates that they're in Great Britain.

But the international nature of the gathering reasserts itself as Philip P.A. Poole-Wilson, MD, president of the ECS, presents a series of portraits of the presidents of the 40 national cardiology societies that comprise the ECS. Names and faces of representatives from Finland to Morocco, Portugal to Georgia, Ireland to Croatia flash on the screen. Each of the 40 societies will have its own meeting while in Birmingham.

The ECS draws almost 15,000 professional attendees, including cardiac nurses and technicians as well as physicians. Roger Balcon, president of the British Cardiology Society, local host of this year's meeting, points out that the last time the ECS met in England was 1952, a three-day meeting at which 91 papers were presented. This year, there are literally thousands of papers being presented at 24 simultaneous sessions over five days. There are 11 plenary sessions, 31 scientific symposia, five debates, and 55 specialized symposia. The accompanying trade show has 206 exhibitors-among them 46 U.S.-based firms (not from European offices) and 15 cardiology-related medical societies, including the American College of Cardiology (ACC) and the American Heart Association (AHA). The exhibition will use 180,000 square feet, filling Halls Six through Twelve at the NEC. (An exhibition using all 16 halls would have 1,580,000 square feet of space available to it.)

Easy Show Logistics What brought this gigantic session to Birmingham? Show logistics may have been part of the attraction. The NEC abuts the Birmingham Airport, making transfers as painless as possible. Some American show crews get off the direct flight from Newark, NJ and start setting up their booths before bothering to check in at their hotels. If they are staying at the 800-room Metropole Hotel, they never even have to step outdoors-it is directly accessible from the NEC. (On the other hand, if they are staying in Birmingham's city center, they have a 20-minute drive to contend with, or a 12-minute ride on British Rail. Some attendees are staying in Stratford-Upon-Avon, where the beauty of the countryside may take the sting out of a 20-mile commute.

On the Show Floor Unlike at many American meetings, exhibit halls stay open during the scientific sessions. Out on the show floor, Jeffrey Apton is a happy man. The president of Synchor Communications Associates, a company that markets for Pfizer, Inc., is watching a steady stream of physicians pass through his booth. They pick up a short quiz on a Pfizer product, watch a large-screen video that provides them with answers, then exchange the completed forms for a portable desk lamp. Watching a cardiologist carefully print his Moscow address, an observer notes that the booth is nothing more or less than a giant data collection machine.

Across the aisle, three Japanese cardiologists pose for pictures in front of an old limousine, the major prop in a Bonnie-and-Clyde themed booth run by Schneider, a Swiss manufacturer of cardiovascular surgical devices. After the picture session, the doctors visit the Japan desk, where they meet with Schneider's Japanese representatives. A few feet farther along the booth there are similar conversations going on in French, Spanish, and English.

To American eyes, the trade show at the Eighteenth Congress of the European Cardiology Society (ECS) may seem a bit over the top. "You would never see something like the Schneider booth at our meeting," says Marcia Jackson, associate executive vice president of education for the American College of Cardiology (ACC), which has a booth of its own at the convention. Yet, for the most part, the gangster-theme is an exception. "There is food, and beer and wine on the show floor, none of which we allow," says Jackson. "But beyond that, I think the differences are subtle."

"The ECS meeting is very similar to ours," says Julie Miller, ACC's assistant director for exhibits. "There are some obvious differences-hard walls instead of pipe and drape-and some of the booth tie-ins appear unusual to us, but I can't think of anything I've seen here that we would prohibit. They're as concerned as we are about not crossing the line into excessive promotion."

An Idea for Symposia The biggest difference between the ECS meeting and any American medical meeting is that there is little regulation of the relationship between pharmaceutical firm and physician. Companies can-and do-cover the costs of attending for physicians. And the nonaccredited satellite meetings are actually incorporated into the conference.

"We have 59 satellite conferences," says Wil Neijmann, managing director of the European Congress Organization (ECOR), which runs the ECS meeting. "These are different from those in the U.S., because here industry may invite-pay-doctors to attend. Even so, we maintain control by integrating these meetings into the scientific program."

"The idea of setting aside time during the regular meeting for surrounding symposia is something American groups are starting to look at," says Miller. "There is so much demand for function space for activities held while our meetings are not in session. Maybe we should do what ECS does, and set aside an afternoon for these kinds of meetings in the convention center."

"We used to handle housing through travel agents," says Wil Neijmann, managing director of the European Congress Organization (ECOR), managers of the European Cardiology Society's meetings. "As we grew, our industry partners requested that we handle it instead.

"So I decided, reluctantly, to have a hotel department. It is not profit-making, but it makes our industry people happy. And we made the change with their involvement.

"The hotel market in Europe is difficult. You're lucky to block 60 percent of a hotel's rooms. If you're unlucky you might get 40 percent."

Neijmann says there are only five European cities that have the necessary infrastructure to handle very large medical conventions. Not surprisingly, he will be using four of these five for his next four meetings:

1. Amsterdam 2.Stockholm 3. Barcelona 4. Vienna 5. Berlin

The AMA Steps in Regulation is on the way, however. Earlier this year, the American Medical Association (AMA) sent out a directive to conference organizers that says, in effect, that American physicians may receive CME credit only at international meetings that comply with the Essentials and Standards-rules for the way a meeting is developed and for the prevention of commercial influence-of the Accreditation Council for CME (ACCME).

Neijmann is sanguine about this new directive. "The AMA has allowed our American attendees to earn CME credit through the ACC for years," he says. "I don't think they will suddenly refuse us now. We will meet the requirements and do the paperwork. We do not see this as an obstacle."

His friends at the ACC are not so sure. "European organizers are not accustomed to using faculty disclosure forms," says Jackson. "The AMA is asking them to follow the ACCME guidelines, but the ECS has none of the underlying apparatus in place to motivate them to do it-at least not for the hundred or so American physicians who want to go to that meeting. As this article went to press, a meeting with Neijmann and Dennis Wentz, MD, director of the AMA's division of CME, was to take place at the American Heart Association's meeting in New Orleans.