By offering a last minute 2-for-1 deal shortly before its annual meeting in Anaheim the American Heart Association signalled its desperation. During the meeting, as the tumbleweed rolled down the lonely halls of the Anaheim Convention Center, the reason for the deal was apparent to everyone. The lack of crowds, the low energy, the paucity of real news, all served to beg the question: Is there any reason to come to big medical meetings anymore?

There was a widespread feeling that these meetings no longer serve their original purpose. Anyone with an interest in the field can stay up to date by following the online news and commentary. Smaller subspecialty or regional meetings may be better for facilitating personal connections.

And, of course, swag from the exhibit floor has long disappeared. (No one travels to Anaheim for the free smoothies or espresso coffees that are still available on the exhibit floor, though I continue to be astonished at the sight of cardiologists lining up for them.)

There are of course other reasons why the AHA and other big meetings have suffered. Many foreign physicians have decided it’s no longer worth the hassle of traveling to the United States. This accounts for at least some of the growth of the European ESC meeting, which has occurred at the same time as the decline in the AHA and ACC meetings.

(Another important factor, often overlooked, is that the ESC is a much more industry friendly meeting, and permits companies to directly sponsor physician attendance at the meeting.)

But the most important reason is that the meetings no longer give attendees a compelling reason to come. This is because the meetings have failed to adjust to the changing needs of doctors and scientists. With their many thousands of abstracts and presentations most of the content, by necessity, is determined far in advance.

But the organizers and program directors need to find a way to be more flexible and responsive to the current scene. It is impossible to know with precision what exactly will be most interesting 6 months or a year later. The pace of information today means that the archaic format of these meetings is far less relevant and interesting.

The recent AHA meeting is a perfect example. The biggest story right now in cardiology is the ORBITA trial. Whether or not you like the trial, everyone in the field now knows that it will be the biggest source of discussion and controversy for the foreseeable future. ORBITA came out at the TCT meeting, 10 days before the AHA started.

The TCT organizers, for unclear reasons, scheduled the trial for the last day of the meeting, by which time nearly everyone had disappeared. So TCT lost the opportunity to host the discussion, which then exploded online.

Even if TCT had featured ORBITA more prominently there is good reason to think the trial would not have been adequately served. The general format for these presentation– a 10-12 minute presentation followed by a brief discussion section– is hardly adequate to address the multiple important questions raised by provocative trials like ORBITA. Again, the one-size-fits-all model of medical meetings needs to be reconsidered.

TCT’s loss could have been the AHA’s gain if the AHA had been more nimble. Perhaps, instead of the 2-for-1 deal, which screamed of desperation, the AHA could have put together a major symposium on ORBITA, including the trial’s investigators and representatives from the interventional and general cardiology communities.

Instead, there wasn’t a single representative of the ORBITA leadership anywhere in Anaheim. Perhaps the last minute addition of such a program wouldn’t have been able to boost meeting attendance in a significant way, but I think it would have enhanced the reputation of the meeting and signaled to everyone in the community that in the future they might miss something important by skipping the AHA meeting.

In the end, I think that would had a more lasting impact than a 2-for-1 deal.