グリーンな医師? 国際医学会議は必要か

 2006年にサンディエゴでの米国胸部学会国際会議に欧州からの3,500人を含め、15,000人の医師が出席し、飛行機利用で10,000トン以上の炭素を消費した。国際学会はそれに値するものだろうか?
 国際会議に行くのを止め、最新の通信手段を利用するならば、時間とエネルギー、炭素放出を節約できるのではないか。
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How Green Is Your Doctor?
Docs Debate Merits of International Meetings
By JOSEPH BROWNSTEIN
ABC News Medical Unit June 27, 2008
http://abcnews.go.com/Health/story?id=5256364&page=1

As environmentalists debate the effects of emissions standards and oil consumption on our carbon footprint, the newest edition of the British Medical Journal tackles another source ― medical meetings.

画像airplane
New research suggests international medical conferences may take a toll on the environment.
(Getty/ABC News)

In 2006, 15,000 doctors, roughly 3,500 of them from Europe, attended the American Thoracic Society meeting in San Diego, adding more than 10,000 tons to their collective carbon footprints through air travel, according to a recent study.

And that meeting is considered to be one of the smaller ones ― a fact that has some doctors asking: Given the pollution from traveling to them, are international medical meetings worth it?

"Low energy light bulbs, improving the insulation of our homes and driving less will contribute. But if we stop going to international conferences we can make a significant difference and be seen to be giving a lead," wrote Dr. Malcolm Green, a professor emeritus in respiratory medicine at the Imperial College in London, in an British Medical Journal editorial. "By finding new ways of communicating with our colleagues in other countries, we can save time, energy and carbon emissions."

Also, Green feels it could start a trend.

"Doctors are big users of conferences, so this would have an effect on its own. And they should show leadership," he told ABC News.

Could Teleconferences Work?

Green, who noted that he has attended conferences for more than 30 years, said that technology enables people to achieve the goals of a conference without moving people so many pollutant-filled miles.

"Organizations such as oil companies, financial institutions and inter-governmental bodies have regular and highly successful conference calls and videoconferences," he wrote. "Some are so vivid that in the heat of discussion members forget they are separated by oceans. At a recent transatlantic conference a participant in New York asked his colleagues if they would like coffee and several hands were raised in London."

But other doctors disagree, saying that the face-to-face contact of conferences is necessary, and videoconferencing is not a convincing substitute.

"At my first videoconference the distant audience wisely stayed out of camera range," wrote Dr. James Owen Drife, a professor of obstetrics and gynecology at Leeds General Infirmary in the U.K., in an opposing British Medical Journal editorial. "My last one was punctuated by unexplained, far-off laughter. For relating to people, videoconferences are less effective than mobile phones."

While he recognizes the importance of watching our carbon footprint, Drife feels that the face-to-face contact of meetings is irreplaceable, and can even be inspiring.

"The most inspiring lecture I've heard on the needs of women in the Third World was at a conference in Rio: An audience of several hundred delegates stood and applauded," Drife told ABC News.

"It's hard to say whether that is the main reason that I now spend part of my time with the World Health Organization in developing countries but I think it's a factor. Without being physically there in Rio, I wouldn't have seen the shacks and favellas that abut against the fashionable beaches."

Drife also believes that the contact can be inspiring to people in those areas.

"What is needed is sustainability, and I increasingly think that this is best achieved by local 'champions' who are talented and willing to remain local rather than seeking to emigrate," he said. "Such people need to be discovered, inspired and empowered and to do that you have to meet them."

Meeting of the Minds

But even less idealistic meetings can be beneficial, said one conference organizer.

"We also look at the meeting as a place where young investigators can represent their research and get feedback," said Dr. Monica Kraft, an asthma researcher who chairs the American Thoracic Society's International Conference Committee.

"I just think it would be challenging to try and do that via videoconferencing and have everyone engaged."

Kraft said she also benefits from informal interaction at conferences, and notes that doctors who attend would miss out on the impromptu discussions they have outside of the formal meetings.

"There are many meetings that take place outside of the presented symposia," she said.

Green disputed that contention.

"Chance social meetings play little part in networking for scientific communication," he said.

While she called the videoconferencing replacement "an interesting premise," Kraft wasn't prepared to say the carbon footprint was too great to justify the face-to-face meeting.

"There's so many other entities around the world that can use improving via the environment," Kraft said, continuing that she wondered why medical meetings would be a target to stop.

Kraft noted that the American Thoracic Society puts videos from the conference online to allow doctors who couldn't attend to benefit.

That may help, as some doctors don't necessarily need to fly to the conference and could view it online, said Dr. Aldo Iacono, the medical director of lung transplantation at the University of Maryland Medical Center, who presented at the 2006 American Thoracic Society meeting.

But Iacono said the conferences are still a boon to researchers and clinicians who benefit from collaboration with their peers and need feedback on research and want others to adopt the new treatments they have developed.

"It enhances your ability to show your work like an artist at an exhibition, and it can make your work more believable if you're able to answer questions and defend it against the arguments that are brought up," he said.

While Green foresees a time when, "huge international conferences will be as outdated and unsuitable for a modern world as the dodo, the fax machine, carbon paper, and the horse drawn carriage," other doctors don't think that time has come.

If international medical conferences were to halt, the idea would be to see results, and Drife is unconvinced that others would follow physicians' leads.

"I feel modest as a doctor about my abilities to persuade others to change their behavior, unless this is directly related to medical matters," he said. "Politicians and pop stars would have a lot more influence than doctors if they did less flying."

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American Thoracic Society 2006 International Conference
May 19 - 24, 2006, San Diego, California

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BMJ 2008;336:1467 (28 June), doi:10.1136/bmj.a351

Are international medical conferences an outdated luxury the planet can’t afford? No

James Owen Drife, professor of obstetrics and gynaecology

1 Leeds General Infirmary, Leeds LS1 3EX

j.o.drife@leeds.ac.uk

Every year thousands of doctors and scientists fly to meetings at distant locations. Malcolm Green (doi: 10.1136/bmj.a358) argues that this is no longer justifiable or necessary, but James Drife believes face to face contact is hard to replace

Last week I resolved to give up international conferences. It was at 5 am in a hot Asian airport, after waiting an hour for someone to stamp our papers. In the plane I cooled down and reflected that it could have been worse. At least I didn’t have food poisoning this time. On balance the trip seemed worthwhile. Women in that resource poor country needed better health care. Our conference may not have done much to help them, but I would do even less by staying home and sulking.

But I suppose this debate is about big conferences in posh places. It is easy to be cynical about them. Medical journals keep expressing doubts, from an urbane Lancet editorial in 19571 to a BMJ cover in 2003 depicting doctors as pigs fed by pharma reptiles.2 In 2008 our guilt is expressed as concern about carbon footprints,3 so I should start by putting this into perspective.

The United Kingdom is ranked eighth among the world’s carbon dioxide emitters, with 160 million tons/year (one tenth of the United States’ total and one eighth of China’s).4 Air travel accounts for 6.3% of our emissions.5 In 2007, UK airports handled 230 million passengers, 12% of whom were on domestic flights.6 Sixty per cent of UK international travellers are holidaymakers.7

Forgoing medical conferences will have a minuscule effect on global warming, but it is argued that doctors should lead by example,8 as we did on smoking.9 This seems fanciful. Although people respect our opinion on medical matters, we should not kid ourselves that we have the same influence on all issues. We could campaign collectively for fuel surcharges but simply staying in our surgeries will not persuade patients to stop attending away matches or tropical weddings.

Importance of real contact

Nevertheless everyone should do their bit, so we must weigh the benefits of conferences. An excellent 1995 paper gave these as "education, inspiration, evaluation, presentation and recreation."10 Education means more than dishing out knowledge. It also involves skills and attitudes. We will not influence attitudes by haranguing people on a video link, like Orwell’s presciently named Big Brother.

For me, inspiration is the most important. A conference can motivate those attending, and I still feel inspired by hearing Mahmoud Fathalla, founder of the Safer Motherhood initiative, in Rio in 1988.11 Conferences can also stimulate global action. The 1964 Declaration of Helsinki would have had less effect on research ethics if it had been the 1964 group email. Conferences in the 1990s focused world attention on overpopulation and tobacco and boycotted the apartheid regime in South Africa.12 13 14 Uniform journal references were agreed only because medical editors met in Vancouver in 1978.

Of course, there are alternatives. Journals are still the best way to disseminate research findings. In the 1980s the internet was expected to replace meetings15; in the 1990s electronic conferences were promoted16; and last year a "Facebook for science" appeared.17 None of these can replace genuine communication. The Lancet commented: "There is no substitute for meeting in the flesh . . . One savant said that he attended only to learn whether X and Y were as big liars as he judged them to be from their published papers."1

And now there is videoconferencing. Some speakers believe that being seen is more compelling than being heard or read and that fielding questions is real interaction. This is not my experience. At my first videoconference the distant audience wisely stayed out of camera range. My last one was punctuated by unexplained far-off laughter. For relating to people, videoconferences are less effective than mobile phones.

Changing attitudes is a two way process. As a travelling speaker, you learn more than you teach. You begin to understand local problems by observing fellow delegates, who are usually more interested in new technology than public health.18

Compromise

I believe doctors should continue to meet, but where? Should we insist on going only to resource poor countries19 despite their airports? Conferences have to be economically viable, and most delegates want comfort. Should we ban sponsorship?2 If we do, only the richest doctors will attend. Rather than taking extreme positions, I think compromise is essential.

For too long we have had articles from well known speakers complaining about too many invitations and preaching self denial.20 21 They evoke little sympathy. If they are tired of travelling they should say so, not dress it up as a moral crusade. We need less posturing and more practical proposals. Editors, happy to publish advertisements for conferences,22 should offer a networking facility so that congresses on the same topic are not organised back to back in different continents. Medical organisations could get tough with the professional conference organisers who now run these events. We could insist that doctors’ meetings are run differently from those of hairdressers or sales people.

When Professor Fathalla was asked, "What is the most exciting travel you have undertaken?" he replied: "In rural areas in several continents, trying to communicate with, and learn from, poor, rural women."23 Organisers could be pressed to organise similar experiences to complement plenary sessions. This would be hard work and increase costs, but it would be more constructive than hiding behind our computer screens and pretending that this is helping the planet.

Competing interests:JOD travels about three times a year as a consultant to the World Health Organization’s "Making Pregnancy Safer" programme.

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