[caption id="attachment_10797" align="alignright" width="300"] Skyline[/caption]CHICAGO is the 6^th largest city in the US of A, with its own lakeshore full of boats and even beaches, a thriving downtown of sky scrapers and museums and a failing football team….how like London is that? But this weekend (15^th -17^th Sept.) in Chicago was all about the biggest paediatric and child health meeting in the world  the  “AAP Experience”. Where were you? The American Academy of Pediatrics hold a convention in early Fall every year and under this umbrella the oldest paediatric surgical organisation holds its meeting as the “Section of Surgery - SoSu”.  This was my first time in a big American meeting and I wanted to learn the things they do well and how to avoid the pitfalls. For instance, the section has an unusual treadmill approach to its executive – with six members and each rotating to become Chair in their sixth year. Rebecka Meyers from Utah is the current incarnation and is a noted liver surgeon with Michael Caty from Yale preceding her last year. [caption id="attachment_10798" align="alignright" width="289"] Newly constructed Marriott Marquis Hotel venue[/caption]The event as a whole was certainly ginormous with lots of parallel paediatric sessions with some great titles….”The Acute Scrotum: groans from the groin”, “TB or not TB? Who to test”; “Rhinitis, it’s not just snot!” and so on. The surgeons were accommodated in a separate newly built hotel and presented there, accident or design you choose, and it almost had a family atmosphere, even with upward of 200 people in the audience. There were 2 ½ days to fill and only about 40 oral and 40 poster presentations and 4 invited symposia so no concession to the populist, all-inclusive approach of some meetings I could mention. Lot of science and mice-work of course. Every surgeon of note has a lab together with a host of post-grads and technical staff with enviable NIH grants to keep them liquid. There wasn’t much squabbling though as it seems each tries to niche down into discrete areas e.g. short bowel, NEC, diaphragm models, biliary atresia models, stem cell technology, oncoscience etc. The artificial placenta (still in lambs as yet) from the Mychaliska Lab in Michigan impacted on my cortex this year, remember ECMO started here in the Midwest.  A worrying statistic, again from the Midwest, suggested that 4-5% of those undergoing straightforward elective surgery such as cholecystectomy during adolescence were still having persisting opioid prescriptions for “pain” at 3 months and upwards post-surgery. Once you start, you can’t get off or so it appears. More recognisable clinical concerns were also present and correct with major efforts to present regional and consortial data (e.g. Midwest Pediatric Surgical Consortium)in lieu of institutional data. There were also some interesting reviews of very successful telemedical practice from Kansas for instance, which really deserve consideration in geographically challenged parts of the world or even in our “specialist” out-patient follow-up clinics where we spend at best 10 minutes talking to parents who will have to endure a 100 mile round trip for the privilege.  Most the presenters were youthful, full of bounce and incredibly confident in their delivery and handling of any questioner.  The symposia drew in allied specialties such as neonatologists, and haematologists with reviews of current practice in NEC and splenectomy respectively.  This did fill the hall but there wasn’t too much actual audience participation and debate such as in our famous BAPS vs. IPEG sessions weren’t really in evidence. I was there to deliver the Stephen L Gans Overseas Lecture on “Biliary atresia: Revolution, Evolution and the Theory of Marginal Gains” explaining its  connection with British Cycling - honestly there is a connection!  Of all the mainstream pathology, and despite the resolutely decentralised approach they have this is not really a hot topic – only a single abstract  in the rest of meeting (from the Wang Lab in LA). I followed in the footsteps of Simon Kenny and Paul Johnson of the relatively recent generation of BAPS members as invitees. [caption id="attachment_10799" align="alignright" width="300"] Members of the AAP - Michael Klein at back, Rebecka Meyers sitting[/caption]They too have a Gold Medal named after a lauded ancestor, William Ladd, and this year’s was awarded to Michael Klein. Interesting career and so different from ours taking in his over 40 year practice spells in Detroit, Michigan,  New Mexico, San Francisco and even becoming President of the APSA and the Vice-President of the AAP (as a surgeon that’s not bad). Apparently he has also “hiked across Wales” – now that is the real challenge! [caption id="attachment_10800" align="alignleft" width="300"] American Gothic - Chicago Institute of Art[/caption]     And the differences….Well though money drives the American health system like no other – 15% of GDP is spent in health care compared to about 8-9% in Western Europe – it wasn’t much in evidence.  No equipment manufacturers, surgical instrument makers etc.  were in evidence at all. What there were, were corralled in an “exhibition” in the paediatric side of the AAP so no-one went.  The coffee-breaks were sponsored by the big children’s hospitals and here and in the daily exhibit guide one could see naked competition red in tooth and claw. “Consistently ranked among the nation’s best”, “Children’s National is #1 in newborn care…”Ranked the top hospital for pediatric cancer…(St Jude)” . I have yet to see “Hull Royal Infirmary… ranked among the Top 5 hospitals in East Yorkshire”, though this may be on Jeremy Hunt’s agenda to increase competition. The friendliness of the Mid-west specifically really shone through, though I appreciated “Have Great Day” from lift attendants, hotel employees, cleaners, shop assistants, bus drivers less as the days passed.  This was in marked contrast to my experience in New York earlier in the summer where it would have been more like ….”Have a Great Day…..asshole!” Prof Mark Davenport ChM FRCS (Paeds) POBAPS