Medical Meetings in Canada: Playing by the Rules

Thinking of having your next medical meeting in Canada? You're not alone. According to Convene's 15th Annual Meetings Market Survey, Canada ranks first among international destinations planners consider for meetings. Planning a Continuing Medical Education (CME) gathering north of the 49th parallel is not a seamless affair, however. Although the language is the same (except in the belle province of Quebec), some of the rules and codes of conduct are not.

As practices within the pharmaceutical industry have come under increasing scrutiny from media and government, the industry has responded by implementing self-policing measures. Rx&D is the Canadian equivalent of the Pharmaceutical Research and Manufacturers of America (PhRMA). It's a self-regulatory body with a membership that comprises 50 major pharmaceutical companies such as Pfizer Canada, Merk Frosst Canada, Eli Lilly Canada, and Roche Bayer. Much like PhRMA's Code on Interactions with Healthcare Professionals (introduced in 2002), Rx&D's Code of Conduct (in place since 1988) ensures members do business in an ethical and transparent way.

Rx&D takes its cue from the mission statement of the International Federation of Pharmaceutical Manufacturers Associations (IFPMA), a non-governmental organization active in 51 countries: "To promote and support the continuous development, throughout the pharmaceutical industry, of ethical principles and practices voluntarily agreed upon." Part of Rx&D's code outlines acceptable practices for pharmaceutical sponsors who come into contact with health care professionals at medical meetings.

PhRMA Code Versus Rx&D

Rx&D code is similar to, but stricter than the PhRMA code. For instance, Rx&D does not allow gifts of any kind, or distribution of a wide range of service-oriented promotional items adorned with logos, from pens, bookmarks, calendars, and Post-it notes, to stirrup covers, stress/rehabilitation balls, and fridge magnets. Acceptable service-oriented items are defined as "items whose primary goal is to enhance the health care professional's/patient's understanding of a condition or its treatment. Such items may bear the corporate name and logo of the donor, but must not bear the name of any medicine." Examples of permitted articles would include educational graphs and charts. (For more details, see sidebar on page 32.)

Who Has to Play by Rx&D Rules?

Perhaps one of Rx&D's most frequently fielded queries has to do with who must follow its code of conduct. If an American medical association, with American sponsors, decides to meet in Canada, does it follow American or Canadian rules? The Rx&D Web site, www.canadapharma.org, answers the question this way: "Compliance and enforcement are the responsibility of member companies. The Rx&D Code applies only to member companies of Rx&D. If a meeting is being held in Canada, but is not being convened by an Rx&D member, either wholly or in part, Rx&D cannot enforce the code."

According to Rx&D President Russell Williams, however, since most of the major American pharmaceutical companies have Canadian subsidiaries, "an American sponsor should be advised of the code by its Canadian sister company and we would expect them to adhere to its provisions while in Canada."

On the other hand, if a Canadian sister company is not involved with support, the code may not be an issue. When asked if bags or badge holders with the association logo and the supporters' company logos were permissible, the Rx&D reply was, "The code applies to member company activities. Distribution of items with conference names and logos that are: (a) not subsidized by member companies; and (b) which do not display member company names, logos, and other identifiers may not be subject to the code."

Why Now?

In the past, Rx&D's Code of Conduct was elastic, with many gray areas. Generally, American associations simply complied with PhRMA's code of ethics during their meetings in Canada and there was no problem. But with increased pressure from the public and government for ethical vigilance and transparency, the code has altered. As of January this year, Rx&D revised five sections: perceptorships, hospitality, service-oriented items, advisory boards/consultants, and enforcement. Plus, it begins with 11 new "Guiding Principles" that provide more specific guidelines. "They clarify how members can remain ethical and above reproach," Williams explained. "The 11 principles capture the spirit of the code very clearly. Members must judge for themselves if it fits or not when planning to be involved in events and meetings." He added that, along with an increase in penalties, there is an "aggressive enforcement mechanism" in place.

Some gray areas still exist. "The code is a living document and is open to some interpretations," said Williams. He advises meeting planners to submit any questions to an Rx&D member via the www.canadapharma.org Web site. It takes approximately one month to receive an answer, and he warned not to expect any waivers. "People try to receive pre-clearance for events but that is not possible since we are not fully aware of what is planned," he said.

Another good source of information is the Canadian Tourism Commission. (Specific inquiries may be directed to Dan Melesurgo, executive director, Canadian Tourism Commission, Meeting, Convention & Incentive Travel Sales, melesurgo.dan@ctc-cct.ca.)

A Learning Curve

Shirlyn Adkins, executive director of the American Association of Neuromuscular and Electrodiagnostic Medicine (AANEM) noted that her group has met in Canada three times since 1995 and is slated to go to Quebec City in 2010. "This is the first I've heard about Rx&D's code being different from PhRMA, although in the past we did not have a lot of pharmaceutical support," she said. The same goes for Lauren Kramer-Whelan, CMP, director of meetings for American Academy of Otolaryngology - Head and Neck Surgery (AAO-HNS), a group that is meeting in Toronto this fall. "I thought American association meetings in Canada were governed by American code. I've run medical meetings in Canada and never come across this before," she admitted.

In order to promote a clearer understanding of the code and its revisions, in January Rx&D rolled out an annual, national education program. At the training sessions (currently under way), members are brought up to speed on the changes so they can then share that information on a by-request basis from non-members, including American sister companies who can then forward it to meeting planners. "The goal of this new education program is to build greater awareness about our code and the guiding principles to be adhered to in our business practices with Canada's health care professions," Williams said. "We are also communicating with governments and health care professional associations across the country to inform them of the latest improvements."

What You Can Offer Sponsors

For American medical associations, it is important to know what can be promised to a sponsor at the initial selling stage to avoid costly missteps. "Our 2010 meeting is going to be in Quebec and it will have support from American companies such as Pfizer and Eli Lilly. We will have to check on what is acceptable," Adkins said. "In the past we never gave away tote bags or lanyards, but in the future we are hoping to upgrade the meeting and offer them with the help of our sponsors. If that isn't possible and our members really want lanyards, we'll have to supply them from our own budget."

According to the Rx&D Code of Conduct, tote bags with a single sponsor's logo are not acceptable. The use of multiple logos, however, is acceptable. "A bag can be given away, but it must have the logos of all participating sponsors," explained Michel Rousseau, Rx&D director of industry practices.

For a smaller group, such as AANEM's meeting that draws around 1,000 attendees annually, sponsorship restrictions definitely impact what can be offered. "Our budget is $2.1 million and bags cost at least $2 each. That might not make a difference for a larger association with a budget of $40 million, but for us it adds up," Adkins said.

In order to stay in compliance and still keep sponsors happy, meeting planners must walk a fine line. "Our board wants us to be ethical in our behavior, and that includes adhering to a self-policing pharmaceutical body's code. We must take the high road and keep up to the industry norm. If we are told 'here are the new rules,' we have to do the ethical thing and comply," she explained.

The Cost of Not Knowing

Last October, the 7,500-attendee meeting of the American College of Chest Physicians (ACCP) ran into an unforeseen snag. "We heard from an exhibitor who told us that it needed to live by the Rx&D rules while the meeting was in Canada," explained Alvin Lever, ACCP's executive vice president. Lever approached Rx&D for guidance, but was told it dealt only with members. "They said it was the Canadian pharmaceutical companies' responsibility to tell their U.S. counterpart what the rules were," he recalled.

All went well with the exhibits, as there were no giveaways with logos. "In a way it was good. We had great traffic in the exhibit hall and exhibitors handed out educational material and got better interaction with the physicians since they weren't just giving away tchotchkies," said Lever.

The trouble was with the tote bags, which had been ordered in advance and featured the name of one sponsor, as well as the name of the 2006 host city. "Our group's tote bags usually feature the name of the city where the meeting will be held the next year; we use it as an ad," explained Lever. "We had the bags stuffed and shipped to Canada and then we found out about the Rx&D rule of no single sponsors. At the last minute the Canadian counterpart of our sponsor said 'Oops, we overlooked this and if it's not fixed, we get fined.' This was one week before the meeting. Rx&D told us to make the sponsor pay, but we did things collaboratively instead. The sponsor provided new blank bags and we restuffed them - 7,000 bags in 24 hours. It cost us $9,000 in labor. We shipped back the other bags and we'll actually be able to use them this year in Salt Lake City. They won't go to waste," said Lever.

Lever felt it was money well spent. "If there was a complaint there would be a hearing and they would get a fine or a warning. We didn't want to see anybody hurt, so we recalled the bags. The goodwill that comes with an action like that is worth the cost."

The incident did not dampen ACCP's enthusiasm for Canada. "It was one of our most successful meetings. We had 25 percent more attendees than in Seattle the year before. We quadrupled our Canadian attendees and doubled the international attendees," said Lever, who noted the college is booked to meet in Vancouver in 2013.

Canada Less Restrictive Than Europe

Jim Gantenberg, executive director and CEO of the American Society of Neuroradiology (ASNR), has had similar successes in Canada. "Vancouver, Toronto, and Montreal are always top draws," he said. "Last year we had a total attendance of around 3,000 in Toronto. Our doctors are extremely diligent at the meetings but some come early and stay late to enjoy the destination," he said, adding that since 1963, ASNR has met in Canada seven times, and will return to Vancouver in 2009.

Previously employed with an international medical society, Gantenberg noted that CME meetings held in Europe and England faced "far more restrictions" than Canada. Adhering to Canada's Rx&D code has never been a problem for ASNR. "Our sponsors are mostly multinational companies in the medical equipment field, such as Phillips, GE, and Siemens, so when we go into Canada the Rx&D code compliance issue is minimal. If there are any questions, we don't hesitate to call our Canadian members who serve as a resource for us in understanding the issues."

While it is not the society's responsibility to make sure sponsors and exhibitors are in compliance, Gantenberg noted, "If a company is dinged at our show, we get a black eye and it does not reflect well on us. Thankfully, I can't cite one instance of infraction since I joined the society in 1993."

CME and Rx&D

How does the Rx&D code impact CME accreditation? Like PhRMA in the United States, the Rx&D code is a set of rules for its pharmaceutical company members to follow. Also like PhRMA, it reflects the standards enforced by Canada's continuing medical education accreditation body, but it does not govern them. In the case of American medical associations offering CME to American health practitioners during a meeting in Canada, it is the ACCME's guidelines and standards that must be followed strictly, not PhRMA or the Rx&D code. Generally, the ACCME standards and the industry guidelines do dovetail, but they are not identical and the industry codes (and penalties) are applied to industry members only.

"For the ASNR, the locale of the meeting does not alter our adherence to the policies and procedures of the Accreditation Council for Continuing Medical Education (ACCME), the organization that sets and administers standards and criteria for continuing medical education providers of quality CME for physicians and related professionals," explained Lora Tannehill, CMP, ASNR's director of scientific meetings. "The ASNR must adhere to the ACCME standards and guidelines for all its educational activities for live meetings and online CME education and these regulations do not change for the meeting locale. Even though we hold meetings in Canada, we do not adhere to any Canadian-based regulation body for CME credit. We recently went through our six-year analysis with the ACCME accounting people. For our meetings in Canada in two years, we had no citation pointing out we didn't comply with Canadian policies."

Bonuses When Going North

In addition to the favorable exchange rate in Canada (around 14 cents on the dollar), the Goods and Services Tax (GST) rebate is an additional incentive for groups to meet north of the border.

The GST rebate process generates additional paperwork, but it can be diminished if handled properly. "We set up a bank account in Canada so we can pay our vendors in Canadian dollars; it's easy and we leave the accounts there," said Gantenberg.

For Tannehill, who gets between a $40,000 and $60,000 rebate per meeting, the extra accounting is worth it. "Our budget is under $2 million, so it really helps and makes us decide to use Canadian vendors for such things as decorating, security, and printing. Some vendors, like the convention center and the headquarter hotel, asked in advance if we filed for GST and then did an auto deduct. They never even billed us, which was helpful because getting the rebate can take up to six months."

The AAO-HNS's Kramer-Whelan concurs. "With the GST rebate, we're guaranteed a substantial savings on some of our vendor costs," she said.

Tax legislation is a little different in each province and Tannehill advises planners to approach the Canadian Tourism Commission for up-to-date information. Custom brokers are also an important consideration. "People are afraid of it, but crossing the border just means a few extra documents. Hire a broker that is experienced with medical meetings and you shouldn't run into any trouble," Kramer-Whelan advised.

Contributing Editor Maureen Littlejohn is a freelance writer in Philadelphia.

Medical Meetings in the Cross Hairs

Four years after the Pharmaceutical Research & Manufacturers of America Code on Interactions with Healthcare Professionals (better known as the PhRMA Code) grabbed the meeting industry's attention, health care meetings are still in the cross hairs of governments and public interest groups, says the Healthcare Convention & Exhibitors Association.

Consider these news stories from the last several months:

• California passes a law requiring that medical companies be compliant with the PhRMA Code and OIG Guidance, which means, in the view of many of the companies affected, they are responsible for tracking the value of any gifts or other spending on health care professionals from the state of California. For some, this means literally tracking who gets what giveaways at medical meetings.
• Canada's pharmaceutical industry trade association adopts a voluntary code of conduct with respect to the medical industry's interactions with Canadian doctors, potentially impacting medical meetings held in Toronto, Montreal, or Vancouver.
• The Journal of Public Health Policy publishes a study claiming that exhibitors at a health care convention are in violation of the association's and FDA rules for such things as "glaring lights" in the booth and "toys/stuffed animals" as giveaways.

By now, most meeting professionals working in the health care field are well aware of the PhRMA Code, its counterpart in the medical device industry, the AdvaMed Code, and the Compliance Program Guidance for Pharmaceutical Manufacturers published by the Office of Inspector General of the Department of Health and Human Services (better known as the "OIG Guidance"). These three documents made a significant impact on how medical companies participated in medical meetings (see Convene April 2004 issue, or visit the Convene archives at www.pcma.org/resources/convene/archives/).

But the beat goes on. Rising drug costs and concerns about possible "inappropriate" industry influence of CME keep fresh headlines in the press every week about medical company marketing practices, all of which have the potential to impact health care meetings at least as much as that which has gone before. Here's the latest:

The Pen is Mightier Than the Doc

Activist groups have taken to criticizing some tame marketing practices used by exhibitors in health care conventions, such as booth traffic-building giveaways like writing pens. It seems unlikely that a pen from a health care company will compromise a physician's integrity when it comes to practicing medicine, but one group at least, called No Free Lunch, has gone so far as to ask health care professionals to send in all their sponsored pens as a protest.

No Free Lunch is a group of health care professionals, including medical students, who oppose seemingly innocuous industry promotional activities like offering cappuccino in the exhibit booth. During at least two health care conventions in 2005, No Free Lunch handed out flyers on the exhibit floors promoting its anti-marketing agenda.

The medical industry has become such an inviting target that Michael Moore is reportedly getting into the act with a new project titled "Sicko," which purports to be an exposé on the health care industry. Rumors have swirled at more than one medical convention over the past year that Moore might actually be on site, filming segments for the project.

Whether individuals or groups that don't have a health care-related product or service to offer attendees - activist or not - should be allowed on an exhibit floor is a question health care associations should be asking themselves if they haven't already. Many associations have policies on this, which is a good move considering that activism like this may increase in the years ahead.

Government Scrutiny

The developments that generated probably the biggest news among health care exhibitors in the past year were the California Marketing Compliance Law and the Canadian Research-Based Pharmaceutical Companies (Rx&D) Code of Conduct.

The California law, which went into effect July 2005, was designed "to achieve the goals expressed in both the [PhRMA Code] and the [OIG Guidance] and to ensure greater adherence by pharmaceutical companies to both sets of existing guidelines by requiring pharmaceutical companies to adopt policies that ensure compliance with those guidelines." The law requires pharmaceutical companies to adopt a "Comprehensive Compliance Program" in accordance with the PhRMA Code and OIG Guidance. Each company's compliance program must include a specific annual dollar limit on gifts, promotional materials, and other items the pharmaceutical company may give to health care professionals. In addition, each "pharmaceutical company shall annually declare, in writing, that it is in compliance with" its compliance program. So now health care companies doing business in California have more paperwork to fill out, more internal processes to implement, and more cost and effort to go through to indicate that they are "compliant."

And California is not alone. As many as nine states have already passed, or are considering passing, new laws concerning gifts to physicians from the industry.

Meanwhile, north of the border, Canada's Research-Based Pharmaceutical Companies (Rx&D), the Canadian trade association of research-based pharmaceutical firms, revised its Code of Conduct relative to hospitality and donations to nonprofit organization (see previous article on page 28). The section on donations now says, "Where companies provide financial support to a charity and/or nonprofit organization through such avenues as the purchase of a table or tables at a dinner or other social event, or through the purchase of a foursome or foursomes at a golf tournament, or similar activity, individuals invited to sit at the corporate table(s), or to play golf as part of the foursome, should not be health care professionals." The code does allow donations provided to organizations involved in educational and health activities, among others. Rx&D members must make sure that such support is not undertaken for product promotional reasons. This code also has a detailed updated enforcement element, which includes potential expulsion from Rx&D for repeat violations. It's not as if this new code is mandating anything radically different from the others, but the devil is in the details. It's in the little ways that this code may vary from the PhRMA Code, or the little areas where they are unclear, where each might be open to a slightly different interpretation, that make exhibitors uneasy.

A Charged Atmosphere

In December 2005, the Journal of Public Health Policy published a study claiming to document violations of both association policy and FDA rules at an American Psychiatric Association meeting - from a convention held in April 2002. What's wrong with that? For one thing, April 2002 was right before all the new codes and guidance policies started taking effect. The environment has totally changed since then. Why publish this now? For another thing, what took them so long? The answer seems clear enough: The current environment has brought this issue to the forefront again.

The article's conclusion: "This study provides support to a complete prohibition on pharmaceutical company promotional activity at annual meetings." And keep in mind, to these authors, "promotional activity" includes exhibit space sales and symposia. The reason this matters to medical meeting planners should be clear enough: Imagine your meetings with no exhibit space or symposia sales.

What Now?

Should health care associations and meeting organizers do anything differently in view of these ongoing developments? Yes. For one thing, where appropriate, educate your attendees about exhibitors' interest in making their interactions with them professional and client-focused. Stress the importance of the exhibit hall as an educational component of your meeting. HCEA research has shown that education is the top reason that doctors visit the exhibit floor. Exhibits will keep that educational emphasis when both exhibitors and attendees stay focused on it.

The Healthcare Convention & Exhibitors Association (HCEA) is a trade association of nearly 700 organizations united by their common desire to increase the effectiveness and efficiency of health care conventions and exhibitions as an educational and marketing medium. HCEA (www.hcea.org) promotes the value of exhibits as an integral part of health care meetings.

Prescribing the Rigth Location: Site Selection for Medical Meetings

The prognosis is good: Over the past several years, medical events have occupied higher percentages of net square feet and featured an increasing number of exhibitors, compared to shows in other industry segments. Cities and facilities everywhere are doing everything they can to win this lucrative and prestigious segment of the meetings and convention business. Planners, meanwhile, should be doing everything they can to make sure their next meeting destination has the right prescription for success.

The proliferation of medical specialties and the need for specialists to attend both customized and general conferences is on the rise. In the pharmaceuticals sector, the reliance on events as a key component for industry announcements, education, and alliances continues to surge. Life science has only begun to scratch the surface with breakthrough products, and new events are coming online to support the new advances. As destinations compete to win this business, medical and pharmaceutical meeting planners - like the industries they serve - need to be increasingly "scientific" in their approach to venue selection. Here are some guidelines to follow.

1. Location, Location, Location The first consideration is the accessibility of the destination - air, rail, and highway - for meeting attendees. How close is the meeting venue to the airport for air travelers? What is the highway access for car commuters and day-trippers? If the event has an overseas attendee base, the city of choice must be well connected, have an international airport, and be a desirable venue for overseas visitors.

"The American Association for the Study of Liver Diseases (AASLD) and American Transplant Congress (ATC) have both experienced success and growth by holding their events in the right venues," explained Pam Ballinger, vice president of meetings and exhibits for Association Headquarters. "We look for a city that has great accessibility for attendees including European participants, so our international attendance is greater."

2. Critical Mass Many medical events need to consider what percentage of U.S. physicians and other health care professionals are based within a two- or three-hour travel radius of the host city. The strongest destination choices are those located in a region that is home to the infrastructure of the industry, such as teaching hospitals, research centers, universities, medical device manufacturers, pharmaceutical companies, life and science research companies. This kind of built-in industry presence helps attract an even higher quantity and quality of attendees.

3. Track Record Planners should review a listing of a city's recent, current, and future events. One key factor to look for is the percentage of medical and pharmaceutical events relative to a city's overall bookings. Is the city a leader in hosting events for these industries, and is it attracting more meetings than ever? Look for similar meetings in your particular discipline and inquire about attendance results and other success criteria.

4. Infrastructure to Accommodate Growth A destination city must have the convention facility, hotels, and transportation infrastructure to accommodate both a meeting's current size and its anticipated growth in the years to come. The American Association of Orthodontists (AAO) is a good case in point. "The AAO Annual Session can only be held in 10 cities in North America due to its size and scope. We need a city with the facilities and local support (such as orthodontic schools in the area), to provide a wonderful experience for the AAO members," according to AAO's Dr. Raymond George.

5. Cutting-edge Technology When it comes to assessing a convention facility, remember the No. 1 reason attendees go to events: to see and source new industry solutions. Facilities that are truly on the cutting edge of technological capabilities hold a distinct advantage here. Medical events require both the technology infrastructure and the flexibility to handle sophisticated new product presentations and complex show networks. Planners should look for facilities that have state-of-the-art exhibition halls, the most current IT and AV systems, and building-wide cell phone and wireless coverage, as well as on-site staffs of certified technology professionals to ensure smooth and uninterrupted operation.

The ability to host different types of intensive educational programs is also significant. Medical professionals such as physician assistants, nurse practitioners, and medical technicians are receiving additional CME education as their responsibilities increase. Buildings with a state-of-the-art meeting room complex offer the best options for these events. At the majority of medical events, planners need to execute a conference with simultaneous tracks and satisfy the most intensive technological support needs. Whether it's scientific paper presentations, birds-of-a-feather sessions, satellite-broadcasted keynotes, interactive panels, or a full agenda of primary sessions, a facility needs to be able to seamlessly handle every component.

6. Supporting Roles Of course, medical planners should look to the facility management team to provide their expertise and assistance in planning the other core activities necessary for any event. These include everything from the availability of function areas for special events to food and beverage needs.

The other key ingredient that impacts every part of the event experience is customer service. According to T.J. McCabe, CMP, director of convention services for the American Public Health Association, "A city needs to work very closely with us to ensure that our specialized needs are met."

Every city offers a different customer service package, and you should assess the one that's right for you. Many medical-related events include high-level attendees who demand an elevated set of service solutions. See which venues offer hands-on support in such areas as citywide housing solutions and customized convention services. Whatever the size and scope of your medical, pharmaceutical, or life sciences meeting, you have very specific challenges. The city you select should have the answers.

CSI for CSMs

The graphic biological nature of the hit TV series can be an everyday reality for convention services professionals, who often field 'unusual' requests from planners of events designed for the members of the medical community. Read on as members of the Association for Convention Operations Management (ACOM) share their stories on how they've assisted medical meeting planners.

Shuttle buses are a common sight at conventions, taking attendees from one event or session to another, and there are often signs on the bus identifying the group or session. This mundane occurrence took on a bit of the bizarre recently in St. Louis.

"Last November, we hosted the annual convention for the American Association for Laboratory Animal Sciences, which involved sessions held on and off site," explains Matt Brinkmann, convention services manager, St. Louis Convention & Visitors Commission. "There were shuttle buses to bring people back and forth to each location, and in order to ensure that people got on the correct bus, we had to include the names of the off-site seminars in the front windows of each shuttle bus. This was not your ordinary signage, though. For instance, there was a session titled, 'Jugular Blood Collection from the Un-anaesthetized Rat.' Consequently, a bus drove through town, on its way to Washington University Medical School, with a sign saying 'Jugular Blood Collection.' Imagine being a passerby and seeing that?" F

or the uninitiated (i.e., non-attendees), there probably wouldn't have been many hands raised to volunteer for that session. But volunteers are often critical to the success of medical conferences, as many health departments make it impossible to ship cadavers or body parts and store them anywhere around a hotel. And convention services professionals are often called on to help solicit volunteers.

"One time, we were working with the American Association for Neuromuscular and Electrodiagnostic Medicine and had to secure electrodiagnostic medical procedure volunteers. The planner sent requests to the local university medical school, and we put out flyers for our staff and hotel partners to try to find volunteers," explains Denise Suttle, CMP, assistant director of convention services for the Albuquerque Convention & Visitors Bureau. "Doctors wanted to do demonstrations using electrical impulses as part of their treatment for certain conditions. However, despite the offer to pay these volunteers for their time, we did not get many females to volunteer for the pelvic floor exam [as one might imagine]. Amazingly though, enough volunteers appeared at the last minute and just in time for the lectures. Local medical faculty and physicians were able to help us find patients willing to assist."

Suttle offers kudos to these volunteers and patients who agreed to get "up close and personal" in public by exposing the usually private parts of their anatomies, all for the laudable cause of extending medical knowledge.

Need a Hand?

Another time, Suttle had to find freezer space for surgical specimens. "Medical conferences sometimes demonstrate surgical procedures on specimen organs. So where do you store them? We ended up asking the catering kitchen to make a separate refrigerator-freezer available for the convention to use. That was a quick fix, but definitely unique."

Devon Sloan, director of events for Hilton Tucson El Conquistador Golf and Tennis Resort, recalls a similar situation. "When I first started in this business, the hotel I was working for at the time was hosting an event for a group of hand surgeons. I was fairly new to my position in convention services, and my meeting manager mentioned that a shipment of hands was going to be arriving soon, in time for an upcoming medical convention. She said these particular crates would have to be kept cold," recalls Sloan. "I told the shipping and receiving clerk that we would need the walk-in refrigerator to store crates that were coming in for this group. However, I neglected to tell him what was in the crates. You can only imagine the chef's surprise when he opened the crates one day - not remembering what he had ordered - and found a bunch of actual human hands!"

Obviously, this points to the need for careful packaging and labeling of unusually shipped or stored items.

A Knee-Jerk Response

A CVB services director in San Antonio had more than a hands-on relationship with unusual medical exhibits. "One time," recalls Kari Eustace, CMP, director of CVB services for the San Antonio CVB, "I was on site when a neurological group was moving in. We would be riding up and down the elevators with freezers that looked like the ones found in your typical kitchen. The difference was - and this is not for those with a weak stomach - that these freezers contained body parts such as human heads … frozen, of course, along with other body parts. It's shocking for most people, but understandably commonplace and necessary within the medical community.

"I've also worked with groups that had to do arthroscopic surgery, where they had human knees in every shape and size, stuck on posts at a specific angle, so that the doctors could practice surgery on them. This made me and some of the other staff a bit queasy … . I'll bet there were 20 rows of 20 each in the exhibit hall."

Something to think about when you've been on your feet all day and your knees ache: It could be much worse.

A Major Feat

Miami Beach recently played host to the American Academy of Asthma, Allergy & Immunology's annual meeting. "It was the first time I'd ever had a request for pig's feet, and not as a menu item," says Lyan Tassler, director of convention services, Greater Miami Convention & Visitors Bureau. "There was a scheduled program where they were going to practice injecting techniques, and it seems that this part of the pig somehow resembles the texture and consistency of human flesh." When the local grocery store could not provide them for a Saturday symposium (it is a predominately Jewish area where the kitchen is kept Kosher for the Sabbath, which means no pork on Friday and Saturday), we ultimately assisted the customer by making arrangements through the caterer at the Convention Center to deliver 33 fresh pig's feet for that morning's symposium."

The pig's feet were, of course, not pickled.

An Overly Sensory Experience

"Previously, I was a director of convention services in New York, where we had at least one medical convention per month, so seeing and handling all sorts of odd requests for either animal parts or human parts for sessions was commonplace," said David Dvorak, vice president catering and convention services, Starwood Hotels & Resorts. "There was one incident that stands out though, which is more like a bad movie because it involved full or upper torso cadavers. This was not a big deal until the truck they were traveling in broke down about 20 miles outside of the city," he explains.

"As you can well imagine, by the time they arrived at the hotel - combined with the unusually warm spring day - the need to ice down was vastly important. The unfortunate thing was that the damage was already done, as the ice in the coolers had already melted. Consequently, the next days' session was marked by an overwhelming stench from the cadavers, which had thawed for too long. As the doctors worked on these cadavers, we had to be creative in how we masked the odor, setting up large fans and air fresheners, and whatever we could find to diminish the smell. We ended up paying our housemen extra monies to mop the floors with ammonia as many were not only upset with the smell, but the entire event. The only saving grace was that this was the only group in the building, so we were able to isolate the odor to half of the floor in a meeting space. All in all it was a very successful event, but one that sticks not just in my mind but in my nose."

Lynn McCullough is executive director of the Association for Convention Operations Management (ACOM), responsible for the direction and management of the association, as well as membership recruitment and retention.