An ASH Annual Meeting Post-Vivum

C. Beau Hilton
Fourth-year medical student at Cleveland Clinic Lerner College of Medicine

“So, what did you learn from ASH?” asked my advisor a couple of weeks after I returned from my first American Society of Hematology (ASH) annual meeting. I attended the 2018 annual meeting as a medical student researcher courtesy of the ASH HONORS (Hematology Opportunities for the Next Generation of Research Scientists) award.

I answered his question by rambling for a while and then I trailed off, lost in thought. It was a verbal version of my wanderings around the San Diego Convention Center and satellite meeting locations, trying to figure out which Hilton (no relation) housed my next meeting.

This far-from-complete list is an attempt to construct a somewhat cohesive and navigable reflection on an enlivening, inspiring, and exhausting week.

These people really exist, and they really are people.

Over the course of the conference, I met many researchers whose work I admire and whose papers I have read and cited. I talked with them at dinners, in the halls, after their sessions, and during Lyft rides – everywhere I looked: brilliance. I was, I’m clichéd to say, starstruck.

But, after a while, I realized that these people are human. They have foibles and bladders, and occasional bits of black pepper in their grins. (Speaking of bladders, I gleefully noted the general level of care given to handwashing upon lavatory exit – I wonder how often the San Diego Convention Center is stuffed to bursting with people who spend their days around the immunocompromised?)

If these folks can deal with the tyranny of physicality and humanity, the perfect imperfection of their own bodies and biases, and still do such good in the world, then maybe there’s hope for me. Maybe I should get over myself and finish writing that manuscript on the research I presented …

ASH cares about trainees.

I pity those who missed ASH-a-Palooza at Petco Park. To give away my age and provenance: it was freaking rad. First things first, #freefood. One of my favorite things about hanging out with other medical trainees is the utter lack of self-consciousness about excitement over free food. I saw fellows and students stumbling to stadium chairs while double-fisting pretzels, shoving foil-wrapped hot dogs in their pockets, and paradoxically hugging diet Cokes to their chests. It was beautiful.

Beau Hilton (top right) with fellow trainees at ASH-a-Palooza. (Top, left to right: Vera Adema, Cassandra Kerr, Christina Snider. Bottom, left to right: Anjelica Saulsberry, Sophia Colombari Figueroa, Ann Kim.)

Beyond the caffeine-and-carbohydrate fest, the sessions themselves matched the concerns and style of the attendees. We had speed-dates with mentors, booths with tchotchkes, and kind fellows demonstrating best practices for bone marrow biopsies. There were 5-minute standing presentations on everything from managing acute leukemia to starting a family as a trainee and 20-minute talks from luminaries. Someone (a lot of someones) thought carefully about how to make trainees feel welcomed, valued, and respected – and it worked.

This trend continued during the meeting, with a variety of targeted interactive trainee sessions scattered throughout the schedule. Most important, I got to meet a wonderful variety of other trainees. These are my colleagues, with whom I am already laughing, arguing, scheming, and texting ever-stranger combinations of emojis.

ASH cares about education.

I had a candid chat with a friend who was scheduled to give several talks at the meeting, one of which was at an education session. The education session stressed him out more than anything else, by a long shot. The expectations were highest, the audience biggest, and he would be speaking among a lineup of some of the most respected minds in a sea of respected minds. This is in sharp contrast to other conferences I’ve attended, where education sessions are (almost?) an afterthought.

I spoke with a mentor about his annual meeting experiences, and he confirmed my hypothesis: You start off mostly going to education sessions, then get specialized and cruise the posters and orals, and, before you know it, you’re on committees and working behind the scenes, but, whenever you can, you still hit the education sessions. They’re that good.

The education sessions, for trainees and beyond, are the gateway drug;  like any smart dealer, ASH makes sure the first hit is the good stuff. That people at the top of their fields take the time not only to meticulously prepare, but also to attend these sessions, speaks to (and creates) the reliability of the dopamine rush.

Business is business.

My dad is a lovely salt-of-the-earth kind of guy, a roll-up-his-sleeves banker who farms on the weekends in Hard Rock Cafe t-shirts and New Balance sneakers. You know the type. On long trips to check on properties in the wild Southwest, I would listen to his phone conversations with business partners. His two favorite utterances, spoken with equal sincerity and fervor, are “thank you” and “bullshit,” and he’s known in his field for loyalty and honesty.

When I started working in the hospital, I felt an unexpected familiarity as I watched the most effective doctors use the same strategies that my dad used in business deals to get the best tests and treatments for their patients – a consult from a busy specialist, a spot on the CT scan waiting list, a blood draw at an inconvenient time. They had truly human interactions, with persuasion, honesty, and jollity.

I shouldn’t have been surprised to see the same characteristics surface at the annual meeting. I watched deals being made to share huge cohorts of patient data at an open bar (a natural prerequisite to the formal data use agreement and Institutional Review Board process); “bullshit” bandied around to draw attention to methodologic or interpretive flaws, sometimes to the bullshitter’s face; handshakes and jokes and jibes and thank-yous left and right. These exchanges covered every purpose: advancement of science, betterment of patients, stroking of egos, and often all three. Although we have a guise of objectivity and sterility in the biomedical sciences, stuff gets done the same way it always has: with relationships of trust, open communication, and alcohol.

People are people, redux.

The meeting took place in 2018, and like everything in 2018, there was tension (often creative, sometimes destructive) between the old ways of doing things and the new ways.

The plenary session presentation on hydroxyurea in Africa was poignant to me for two reasons: First, unlike most of the ever-more-targeted and expensive therapies, this is a cheap drug that will change the lives of literally millions of people. Second, why the hell did this study come out in 2018 and not decades ago?

Recognizing the incredible scientific, political, and financial maneuvering that led to this study and its positive outcomes, we can do better. That it took this long to happen is a tragedy; that it happened at all is a triumph.

Next is my favorite #ASH18 Twitter theme: #SHEmatology and #WOMANcology. In addition to celebrating accomplishments, these pointed out the often-subtle forms of discrimination against women in medicine, such as the tendency at some conferences to refer to male presenters as “Dr. So-and-so” and female presenters by their first names (e.g., “Jennifer,” or worse, “Jenny” – especially if not even your mom calls you “Jenny”). In this culture and in these public meetings, respect is conveyed through titles. Until and unless we all get on a first-name basis (which I admit I would love), this particular intimation of inequality is unacceptable.

I also heard attendees judging female researchers more harshly for the style of their presentations, with comments like, “The research was great, but way she talked …” or “Really nice work, but did you see what she was wearing?” While I wouldn’t argue for a moratorium on discussing style, whether of speech or clothing or PowerPoint slides, for persons of any gender, I was frustrated by the vitriol that was directed, as far as I heard, solely toward women.

Every human, and every human organization, deals with some version of issues of bias, discrimination, nepotism, conflicts of interest, inequity, and iniquity. In all of this, we can do better. And, judging by the very existence of Dr. Tshilolo’s report on hydroxyurea and the Twitter hashtags, I think we are. But we have a long way to go. (Do you see how quickly I have been assimilated, and now speak in the inclusive “we”?)

The End?

I called this reflection on my first ASH annual meeting a post-vivum instead of a post-mortem because this meeting is a living organism, with homeostasis and dynamism. It is evolving and adapting, tissues and cells, groups and individuals. Many are in S phase, some are senescent, others apoptotic. (I did not appreciate any necrosis, but I do not deny that it may have been present.) As with anything that is real, it is gorgeous and disturbing, profane and celestial. I’m grateful to be a part of it. See you in Florida.

The 2019 ASH Annual Meeting will take place in Orlando, Florida, on December 7-10.