COMMENTARY

ENDO 2018: What to Expect

Richard M. Plotzker, MD

Disclosures

March 06, 2018

On March 17, the largest collection of endocrinologists in one place at one time will assemble for ENDO 2018, the annual meeting of the Endocrine Society. Over the past 100 years, the meeting has evolved from teasing out "internal secretions" to a global program covering molecular biology, sophisticated imaging, physiologic mechanisms of such puzzles as weight control and diurnal rhythms, and the public health needs of a literally and figuratively expanding diabetic population. Nobel laureates have spoken from its podium, and public officials at the forefront of scientific investment and health regulation have imparted their experience, wisdom, and vision to thousands.

Richard M. Plotzker, MD

Amid the many in attendance, we "nobodies" far outnumber the "somebodies."

In the poster exhibit area, people with pet projects get their hour of public time to present patients with exotic diseases that they thought were unique until two other random endocrinologists wander over and share that they had similar cases. That's how series are instituted and perhaps how camaraderie begins.

Fellows and their mentors go data mining in the hospital computer systems to see just how good the people at their institution are at following established guidelines.

Although I am far removed from the nomenclature of nuclear hormone receptors and walk right past those posters, except for a brief smile or nod to the fellow who worked all year with knock-out mice, there are others who understand the work well enough to engage in some chat.

Even the 'somebodies' wear badges with their first names in boldface letters, and I've never met one who would begrudge a less accomplished colleague a measure of his or her knowledge.

And many of us, particularly those from overseas who now comprise about one third of the attendees, can squeeze in a few hours to explore a locale we've never visited before or enjoy a hotel at our institution's expense. It is fun but it is also work—sometimes some very intense work.

For those of us who are the only endocrinologist at our facilities—and even more so for those who are the only one in town—this meeting may be a rare chance to engage with colleagues face to face or to pose a question to one of our specialty's giants.

Even the "somebodies" wear badges with their first names in boldface type, and I've never met one who would begrudge a less accomplished colleague a measure of his or her knowledge.

Ordering From the Menu

From the program outline, it is obvious why endocrinology textbooks are 2000 pages long and why some specialists may be experts in lipid metabolism but still a little uncertain about which organ makes thyroid hormone.

At the circus, you can see all three rings at the same time: the lion tamer in the middle, the trapeze artist on each side, and the clowns circling the three rings. Not so at a medical meeting. You can purchase videos or CDs of what you did not attend, but you cannot be in more than one place at one time, so you are forced to choose what you would like to brush up on.

Opinions are divided on whether to review the agenda ahead of time and decide what to attend, or pick up the meeting outline on site and choose sessions on the go. I usually decide the night before, with flexibility to change my mind if my chosen classroom is too full or if my next destination is not really worth a schlep from one corner of the cavernous convention center to another, compared with the session that is right next door.

Presentations fall into a few categories:

  • Plenary sessions, where invited guests of great scientific accomplishment tell us what they have done, why it is significant, and what the future directions may be.

  • Symposia, usually occupying two time slots a day with a choice of about eight sessions in each slot; each usually lasts 90 minutes, with three speakers on variations of the theme. They are typically held in large rooms and often deal with such subjects as transgender care, thyroid cancer, or obesity management, which by their very nature require more than one approach to a diverse array of patient presentations.

  • Meet-the-Professor sessions (my favorite), where an expert devotes 45 minutes to reviewing something common in practice that we'd like to manage better. Many of us are uncertain about how to manage someone who sweats too much, or someone who is still hyperglycemic on 300 units of insulin plus metformin plus an SGLT2 inhibitor. These professors have been there and done that.

Finally, we have the heart and soul of the meeting: the posters. Times are set aside for investigators to guide visitors through their work and answer questions. Many are young endocrine fellows and this represents their year's efforts.

The Endocrine Society does its best to keep these sessions truly interactive. People come from all over the world, reinforcing what we already knew: that meritorious work takes place everywhere on the globe. Little of this work may ever make it to the plenary-session level, but those invited to give plenary lectures may have gotten their start with poster presentations and a vision of what they might like to do next.

And Now a Word From Our Sponsors

I would be remiss if I ignored the commercial exhibits that appear alongside the posters. Those of you from my era remember the exhibits as more of a carnival than they are now.

We can no longer fill a drug logo tote bag with tchotchkes to take home to our secretaries and our kids. Maybe the Endocrine Society will let us take home a pen and a lapel pin that looks like a smiling thyroid.

We can help ourselves to espresso and bottled water and sometimes a frozen yogurt, except for those from Minnesota who are put on the honor system not to accept even these small "gifts." As a result, these exhibits have become much less well attended, even though we clinicians often depend on the commercialization of previous scientific efforts to offer our patients the best that we can. These companies sponsor the convention, and those funds put a cap on our own expenses.

At each opening session each morning, an hour or so before the exhibit hall opens, there is a screen announcement asking those in attendance to visit these exhibits, something done much less now that the kewpie dolls are no longer on display for the taking. The debate on the appropriateness of drug pricing that makes state-of-the-art treatment out of the reach of many is a very real one not to be dismissed, but there is also a time to be gracious to our commercial partners and benefactors.

I always take a few minutes to wander through, sip a cappuccino, give the company representative a chance to make his presentation, and then graciously head back to the posters or my next lecture.

That's an overview of what this annual effort entails. This meeting comes with some rewards: CME credit amounting to about 22 hours most years, and some knowledge and perspectives not readily available elsewhere.

In an era of medical pessimism and cynicism—well deserved in our daily experience—there is a place to admire so many people who have set aside time to do something more worthwhile than fighting with those functionaries that answer the phone on the preauthorization rejection appeals. When all is said and done, endocrinologists are a group of pretty worthy people.

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