AAP Conference: The good, the bad and ugly

I finished up my journey to San Francisco with presentations at the American Academy of Pediatrics (AAP) National Conference and Exhibition (NCE). I was simultaneously encouraged and dismayed.

Context is important here – understand that the AAP NCE followed a scintillating Pangea Conference, hosted by the Integrative Pediatrics Council. Two days of wonderful interdisciplinary dialogue about transforming children’s health, with emerson Matabele’s inspiring photographs surrounding us. We had a good turnout, but it was a relatively intimate setting and event compared to the AAP conference. And exhibition – and that’s a key theme, but more on that later. I want to start with the positives.

The good:

The AAP NCE attracted a record 11,000+ attendees this year. It’s an amazing educational forum. Our provisional section for integrative medicine hosted its first ever half-day session, featuring Dr. Scott Shannon’s inspiring presentation on the “Ecology of the Child” (how child behavior is tied in with the child’s habitat or environment) as well as round-table discussion about practice management/start-up issues for integrative pediatricians with a panel from across the U.S. (Dr. Valerie Miles in Florida, Dr. Elisa Song in Northern California, Dr. Sandy Newmark in Arizona, and me in NJ). It was encouraging to see the interest in our section from general pediatricians. Certainly more are needed in our communities to practice integrative primary care. Other CAM-related sessions at the NCE were also well-attended.

I was also encouraged by some of the press releases for recent developments the AAP chose to highlight.

1. A statement on the health effects in children of global warming

2. A statement encouraging standard early assessment for autism

3. A statement on paying more attention to lead levels less than 10 mcg/dl, the current “acceptable” limit

4. A keynote address by James J. Heckman, recipient of the Nobel Memorial Prize in Economic Sciences making the economic case for intervention in early childhood, especially for disadvantaged children.

The bad (and the ugly):

When the word “Exhibition” is in the title of the event, you get the sense it’s an important part of the proceedings to the AAP. There is no feeling other than severe nausea to describe how I felt walking into the Moscone Center, where the NCE is held, and witnessing a shameless display of pharma-sponsored booths and signs, everywhere. I’m not naive but the extent of the advertising was hard to believe. I was given my complimentary carrying case (which participants use to hoard freebies and give-aways from the exhibitors), and I noticed one whole side was stamped with an asthma product logo. Inside, my conference program was banded with one of those paper slips used for advertising – you have to rip it off to read the thing, you know? And to top it off, the advertisement was for Dimetapp. I actually laughed out loud when I saw this (a few folks looked at me a bit strangely, but I guess I didn’t seem too threatening). In the same week when the AAP (among others) came out in favor of the pending FDA ban on cold and cough medicines for young kids, this was the product they approved to advertise on the cover of their conference program? Unbelievable. I went to the exhibit hall to visit the Elsevier booth and drop off some flyers they printed for our upcoming Pediatric Clinics of North America CAM volume, and then looked around in amazement at the scope of the exhibitions. The amount of money spent on, and the environmental cost of , these monstrous booths, is mind-boggling. It was kind of like “Dawn of the Dead” – mindless pediatric zombies lining up for free pens. Not all was bad – I liked that Horizon Organic was there displaying copies of Dr. Alan Greene’s new book, “Raising Baby Green.” Still, I just kept feeling uncomfortable with idea of how much was spent on these over-the-top displays, at the same time attendees were listening to compelling presentations on growing health care disparities due to the impact of poverty on children’s health around the world, and on the difficulties of providing accessible and affordable health care for all children.

It’s not a simple issue, I know. Many of these companies spend significant dollars on good causes, and I know they’d say that R&D for new drug development costs so much, and so on. But it just seemed like too much. Did Pangea have exhibitors? Yes. We had six. All products for children from the CAM world. Are these companies trying to make a profit? Of course. And we are happy to have their support. But it didn’t feel overwhelming or in juxtaposition to the mission of the event. At a time when public trust in doctors and the health care system continues to erode, the appearance of conflicts of interest in our educational conferences, research studies and publications raises concern and fuels the fire of distrust. I think we can do a better job. I think we have to.