Having just returned from a medical conference this past week, I decided to reflect on my experience from last year at the same congress, just before the promotional guidelines went into effect.  I admit, I have vivid memories of convention floors and seeing the mass of colored bags, each bigger and better than the last one.  I also must confess, that I have seen a particular “giveaway” and asked where it came from, and headed off to that particular company’s booth—not because I was at all interested in their product, but because I was lured by the attractive bag, backpack, or whatever.  I dutifully listened to the message and collected my “treasure” and felt obligated to fill it with literature or other giveaways, only to return to my hotel room and realize there was no way that this collection would fit into my luggage, and was certainly not worth the extra baggage charges if I had to check it. So I abandoned several items of my treasure as I checked out of my hotel.  I am sure I am not the only one who has done this, but I may be one of the few who will ’fess up.

So does the current environment stimulate healthcare professionals’ interest in the exhibit hall?  The primary shift I observed was an increase in pre-meeting invitations to visit a company’s exhibit booth to learn about a procedure, or a product’s place in a therapeutic algorithm, or to participate in a drawing for a medically relevant prize. There are fewer colored bags filled with literature slung over shoulders of congress attendees tempting me to ask, “Where did this come from?” This does, however, make it easier to negotiate the convention floor.  Overall, I found myself more selective of the exhibits I visited and more focused on the content.

It’s not often that I think that enacted legislation is beneficial, but the bottom line is, I think we have managed to elevate our profession and focus on the content— the real reason we come to the exhibit floor.

So my question is, “Is the printed page dead or dying?” We certainly have the need, and, in fact, increasing demand for information from publications. How are we getting this information? Are we all going online to retrieve the information we want? And is it available online? Where are the ads?

Certainly the recent trend of exclusively online journals and open access articles has impacted medical publishing. Online journals have challenged the publishing industry, forcing many journals that were print-only to offer their content online as well to be competitive. If you don’t have a subscription and access to the journal, you can usually pay for a download of the article, again minimizing the need to have a printed journal subscription. A significant number of journals provide free access to many, if not all, of the articles through author-paid fees or decision of the publisher to provide open access. In keeping with our immediate need to know, many journals provide “provisional” pre-publication downloads, so articles can be sourced even before they are officially “published,” again reducing the need to read the printed journal.

This shift affects advertisers and publishers, for sure, but it has a broader reach. Many associations include with their membership a subscription to their respective journal and believe that this offering is the primary reason for membership. If they are forced to put the journal online and provide open access to be competitive, what happens to the membership of the association? Can they bring value to their members beyond the publication? Many associations are re-thinking their business model in light of this shift.

So the questions remain: Is it necessary to maintain subscriptions to specific journals? Will we need libraries to house periodicals? In the future will we download everything to a PDA or a Kindle? If so, where will advertising go? Will there be more banner ads and fewer print ads? Will the highly regarded scientific journals that now publish without advertising succumb to pop-up, Flash, and Google AdWords? Are we seeing the end of the printed page as we know it?

There are concerns that ghostwritten articles in peer-reviewed journals discussing unapproved indications encourage off-label use of a product. But don’t physicians read and draw their own conclusions from the literature? Of course, increased off-label use would increase sales of the product which may be another concern; however, if clinicians don’t see a response, would they continue prescribing the product?

So who should be held accountable for the publication of these articles? What about the journals’ responsibility? They have an editorial board and a peer review process. Isn’t it their responsibility to challenge the interpretation of the data, statistical tests, statements made in the discussion, and conclusions drawn?

Medical writers are essential in our industry. Nearly 50% of abstracts presented at medical meetings are never published as full manuscripts. Can you image what the percentage would be without medical writers? Few journals could survive without the manuscripts medical writers provide to healthcare publications.

It has been my experience with medical writers that their scrutiny of the data is far more thorough than that of the “authors.” Yes, it may be true that the authors, if they wrote the manuscript, would be as critical of the information, but relying solely on clinicians to publish would mean that fewer articles would make it into the medical literature — and certainly not in a timely fashion.

There is no doubt there is a need for transparency and disclosure of the role of a medical writer in the preparation of the manuscript. Significant efforts have been initiated by journals and associations of medical writers to make this happen. Medical publication practice guidelines were proposed in 1998 because of ghostwriting concerns. Revised guidelines, which encourage further transparency and recommend that all contributors be listed with the details of their contributions, will be published later this year. Then it becomes the responsibility of the pharmaceutical industry and healthcare publishing to abide by them so “ghostwriting” disappears from our vocabulary.

For those of you familiar with the process, think of the last speakers’ training meeting you attended, or perhaps organized. The obligatory pre-meeting binder with draft presentations and key references were shipped before the meeting, and attendees were expected to have at least reviewed the materials on the plane en route to the meeting. As attendees scurry to catch their planes on Sunday, hoping to salvage some of the day with their families, clutching their “binders of knowledge,” notes, and perhaps a flash drive of the approved presentation, company personnel heave a sigh of relief that the training is accomplished. Let the programs begin!

But wait, are these speakers really ready to deliver the information, weave a story, and leave behind the message the company has worked so hard to create? Countless hours go into developing the content from company personnel involving medical, marketing, regulatory, legal, and perhaps other departments. Additional agency hours go into making it presentable — choosing background colors of the slide template, reworking scientific charts and tables so they can be seen across the room, and perhaps incorporating animation to demonstrate the mode of action of a drug. But will it be memorable when it is delivered? More importantly, will the audience retain the information and change their behaviors? How many hours have gone into ensuring this?

Studies have shown that the effectiveness of spoken communication is based on the following:

• 55% of meaning is in facial expressions and other body language
• 38% of meaning is paralinguistic or the way the words are said (voice quality and tone)
• 7% of meaning is in the content or words

The bottom line is that communication is more often about performance or delivery of the content than the content itself. Scientific audiences will no doubt pay more attention to the content than Mehrabian’s model of 7%; however, his model should be a red light for us to stop and rethink how speakers deliver the content, and how little time we spend training them on these skills. Why don’t we include these skills more frequently in speakers’ training? Do we just assume that they have been trained because they have spoken for other companies or have delivered presentations at medical congresses? Are we afraid a training session may embarrass or insult them?

We have all experienced how the same content can dramatically differ depending on the speaker’s enthusiasm and level of engagement with the audience; yet, we give little credence to training our speakers on these presentation skills. Recall the presentations that stand out in your mind; maybe the speaker began with a provocative question or polled the audience, included his or her own experience, or engaged the audience by asking for their opinions. Most likely we remember it because of the way it was delivered.

Based on Mehrabian’s model, over 90% of meaning is derived from the speaker’s delivery of the content. Judging by that logic, shouldn’t the amount of time spent on delivery be commensurate with content? When speaking skills are included in the training meeting, usually only 1 hour or 2 hours are allocated to the topic. In this short period of time, speaking consultants skim through the various presentation skills, including:

• Pros and cons of standing behind versus aside the podium
• The importance of posture, body language, maintaining eye contact with the audience, and speaking slowly
• Development of a message map to ensure the core message is delivered succinctly
• How to summarize the key points of a complex slide
• Use of “trigger phrases” to bring back a wandering audience

Hopefully, after covering all of this information, the opportunity remains for each speaker to present and be critiqued on a few slides.

If greater focus is placed on basic speaking and presentation skills, I am sure we will have betters speakers, more interesting programs, higher attendance, and a change in behavior in the attendees. And after all, isn’t that our ultimate goal?