Why I love the late breaking abstracts Save

Every year I love the late breaking abstracts. It’s consistently my favourite part of the meeting program, by some distance.

I’m not shy about this, and usually I request that with RheumNow’s EULAR and ACR coverage that I get on the daily recap on the last day so I can tell our full listening audience as much – although this year was the exception, because I foolishly let my flight scheduling back to Australia get in the way. My greatest disappointment from this ACR was that I was on a flight eating mini pretzels while Mike Putman was having all the fun, discussing the late breaking abstracts on the RheumNow daily recap.

Many ACR attendees don’t make it to the session. It’s almost always early in the morning on the last day of the meeting, and the temptation for an extra few minutes of sleep at the end of a long conference is strong. Many people aren’t even in town – the saddest part of in person meeting attendance for me is that many people get on a flight home before the last day of the meeting, with limited leave from the demands of work and family, and prioritizing a program which is often front-heavy. Not for me, though – we all have our priorities, and I will fight to be there on the last morning.

Why do I love it so much, and why should you love it too? The late breaking abstracts (here and here) are high-impact, high-drama, flawed and brilliant and composed and chaotic, all at the same time. If we accept that ACR Convergence is a little bit about entertainment in amongst raw utility and scientific discourse, then the late breaking abstracts are an electric amalgam of all of that in one short session. Unless you’re in town purely for the shopping or the catch-ups, then this is where you want to be.

In a previous era, or so I am told, the big breakthroughs of the day in rheumatology were delivered first and foremost to crowded plenary halls at ACR. Months and months before the paper journal reached your library, the results were projected on the big stage for the scrutiny of the rheumatological world. These sessions were the frontier of progress in our speciality, and years later people recall the moments in rheumatological history that they witnessed from the back of a dark conference hall, with the eyes and ears of the whole speciality trained in anticipation on what was being revealed at the front.

Digital connectivity has diluted that drama. When something comes to the fore now, news sites like RheumNow appear as an alert in your email inbox during your lunch break, in your weekly podcast as you drive home from work, or on your social media feed, and soon after the journal alert lets you access the online manuscript. Yet the big conferences still represent a chance to announce things to the world on a stage never replicated online, and the late breaking abstracts are on the biggest of those stages.

To be selected is a rare honour, and it itself is an endorsement of the potential impact of your work, but brings the pressure of intense scrutiny. Why is this work worthy, how is it going to change the field? The expectation yields a pressure cooker environment in which only the strongest prevail, and the rest are in awe.

And yet, there is a raw side to the session. To submit a late breaking abstract usually implies that the process is not complete, not curated, but there is an imperative which cannot wait. The investigators have some urgency to disseminate the results, but not all the time to refine or reinforce them. Sometimes the driver is financial, but if so this is a risk, because to be exposed can have powerful negative consequences, too.

The tete-a-tete moves swiftly. A weakness in the way that the analysis is presented, and the vultures will circle before the conclusions slide. If momentum moves against the abstract then the mood can swing in seconds. Public opinion is powerful and substantive matters are at stake. And just as quickly, it is over, without an opportunity for rebuttal, and the die is cast, the narrative heavily drafted.

This year’s late breaking abstracts were a perfect example of the genre. It was plausible, on the face of it, that any of the abstracts could be seen as a critical moment in time in five or ten years, a moment to stand back and proudly regale others about witnessing. Each piece of work deserves enormous respect, potentially the highlight of a storied career. And yet, in all my discussions after the session with a wide variety of people, each abstract could and was critiqued with a long list of caveats, some major, some not, some robust, some not. This outcome was underwhelming, that outcome was limited. Why did they do this? How come they didn’t say that? Everyone has an opinion, me included, and that is the mark of respect in this academic discourse.

From the cheap seats of the spectator, I get excited about the potential of each one, while acknowledging in my mind the chance of imperfection. For those who have invested time (many years) and skill (top of their fields) and financial and emotional capital into each, it is much more.

Statistically, I would estimate that at best 30% of late breaking abstracts lead to robust innovation. The chance of (relative) failure is high. Yet, in a high-stakes game, the value of success is large.

What’s not to love about that?