Picture of Domhnall MacAuleyDomhnall MacAuley is a CMAJ Associate Editor and a professor of primary care in Northern Ireland, UK


Looking at medical conferences as an outsider gives a different perspective. As tourists, visiting Toronto, our trip coincided with the American Psychiatric Association’s Annual Meeting. We had a lay person’s view of the medical conference machine. And, even as a family doctor very sympathetic to our psychiatry colleagues, I am not sure that I liked the image portrayed: an elite club for the wealthy where access to the exclusive sanctum -the convention centre- was granted only to those with a golden ticket conference pass. I know it’s probably the same with every conference group and perhaps I was overly sensitive as I watched my medical colleagues from the outside.

The Daily Bulletin, available freely at the front desk of our hotel was a glossy high quality throwaway, and looked good. There were lots of advertisements and perhaps the hard sell of Pharma was mitigated somewhat by those from bookstores and medical facilities, and the public would probably not have identified the Pharma promotions dressed up as education. The conference shuttle bus was entirely appropriate, but it still added to the impression of exclusivity. I felt very uncomfortable, and I am not sure why. Seeing well-dressed delegates in bars and restaurants and walking around the waterfront still wearing their conference badges, I resolved always to take mine off when leaving any future medical conference venue.

Like many visitors we went for an evening meal at the CN tower, which happened to coincide with conference delegates attending a benefit event for the American Psychiatric Foundation. It looked like free “jolly”, which it clearly wasn’t, but appearances do deceive and perhaps we need to think more about the impressions we create.

A few blocks down in another part of the city, we happened to wander into the “Psychiatry: An industry of death” exhibition at the St. Lawrence Centre for the Arts. I assume the timing was planned to coincide with the APA meeting although it wasn’t explicit. It was a staged exhibition made up of sequential booths, rather like a cross between the poster session and trade show at a conference. I could see its appeal to people who already had doubts about psychiatry. I too have some concerns about the potential overuse of medication in children with ADHD, and the widespread use of antidepressants, for instance. I am anxious about psychoactive medication use in elderly care homes, and the overall risk of harms from psychiatric drugs. But I would have been more sympathetic without the hyperbole. It was dramatic, overstated, emotive and, frankly, a bit scary. I didn’t pick up any leaflets or documentation and was happy to leave. Curious to know who curated the event, I noted afterwards that it was presented by the Citizens Commission on Human Rights (CCHR) founded by the Church of Scientology.

Both events made me feel uncomfortable. While I have concerns regarding how the APA conference appeared from the outside, I can understand and justify the position of my medical colleagues and the conference organisation. But, it is also important that we maintain a critical approach to psychiatry and be open to the risk that we could be doing harm. I sometimes felt uneasy prescribing medication, even within appropriate indications and professional guidelines, and I need to be sure that my psychiatric colleagues are not distanced from reality and remain fully in touch with patients. Let’s work on ensuring we don’t create barriers and always keep an open mind. Exclusivity doesn’t do us any favours.