Debate outcome clouded by allegations of audience skulduggery

Controversy flared over the outcome of the "Showdown at the Gables Corral: East versus West" debate during Bascom Palmer Eye Institute's Glaucoma Mid-Winter Symposium at the Biltmore Hotel, Coral Gables, FL, Jan. 26 and 27, 2007.

Key Points

The Stars of the East, coached by Douglas Anderson, MD, were declared the winners of the 10-round debate competition versus the Best of the West, headed by Robert Weinreb, MD. The East team members included Donald Budenz, MD, MPH; Steven Gedde, MD; Alana Grajewski, MD; David Greenfield, MD; Elizabeth Hodapp, MD; Anna Junk, MD; Richard Lee, MD, PhD; Paul Palmberg, MD, PhD; Carolyn Quinn, MD; and Sarah Wellik, MD. The West team members were Anne Coleman, MD, PhD, Felipe Medeiros, MD, Don Minckler, MD, and Kuldev Singh, MD, MPH.

No sooner had the final results been announced then vehement protests were lodged with the moderator/scorekeepers Francisco Fantes, MD, and Richard K. Parrish II, MD. "We couldn't believe the accusations," said Dr. Parrish. Reportedly, one member of the voting audience was seen with four key pads, and team members on both sides were overheard plotting a strategy of initially voting against their own team's assigned position so they could change their vote on the post-debate ballot to demonstrate a "swing in opinion," the way in which the winner of each showdown was determined. "At least," said Dr. Parrish, "we have absolutely no evidence of influence-peddling or vote-buying by any of the corporate sponsors at this continuing medical education event: Alcon Laboratories Inc., Allergan Inc., Advanced Medical Optics, Merck & Co Inc., or Pfizer Ophthalmics."

10 topics debated

In the third showdown, each team offered "tips to diagnose progression in glaucoma." The East triumphed by offering strategies to facilitate use of visual field analysis, and the West provided insight on how to use optic nerve evaluation to judge progression. The difference was a slim 6%.

The most hotly contested debate, the fourth showdown, centered on the statement, "Writing a target IOP is necessary to manage glaucoma patients." Dr. Palmberg, largely given credit-or perhaps blame-by the opposing West team for popularizing this strategy, failed to convince audience members that they always should take the trouble to record a target pressure, although a strong consensus existed that the approach is valid and helpful. Some were fearful that indicating a goal in charts might have medicolegal implications. Dr. Singh argued that the concept, although based on clinical trial results, had not been shown to his satisfaction to be of proven value in clinical practice. Interestingly, no panel member or audience participant was aware of the "target pressure" theme being used in medical malpractice or quality assurance to date. The West was the narrow winner of this round.