DÜSSELDORF, Germany – The United States is represented at the world's largest trade fair by an impressive delegation of perhaps as many as 500 companies, with almost 100 exhibiting independently and slightly over 400 doing business here in one of several American pavilions coordinated by the U.S. Department of Commerce that are spread out among the 16 exhibition halls.

The Messe Düsseldorf organization, which operates the huge MEDICA show, officially reports 411 companies with USA addresses are exhibiting, but Edward Fantasia, director of the U.S. Commercial Service for the American Consulate General located in Düsseldorf, noted that "there are an unknown number with products being shown by distributors," and his guesstimate is that the 500 number is a reasonable figure.

The Commerce Department has 162 companies in the three U.S. pavilions, plus 23 in the CEO Room.

It is a MEDICA moment to stop and realize that the entire U.S. delegation makes up just 11% of the total number of companies here and that the home team continues to dominate, with almost 1,300 German companies exhibiting.

Americans can take comfort, however, knowing that Germans, and the rest of the world for that matter, prefer to "Buy American," as the U.S. holds a huge 50% share of the worldwide market for medical devices, valued at $190 billion.

All the countries of Europe combined account for a 30% share of those revenues, while Japan holds down third place with a 10% share.

"In this sector of commerce, we hold a healthy trade balance," Fantasia said

Until 2002, the U.S. enjoyed a $6 billion surplus between exports and imports, he said. "Then it dropped significantly and ran even at a deficit in some years, but today we are up again and should finish around $1.8 billion ahead."

The reasons for the fluctuations are difficult to pin down but a key factor, Fantasia said, "is ... that the U.S. market is so attractive to foreign companies that more and more are selling in America."

He added: "Here in Germany, for example, 60% of all production is exported, with a substantial part of that going to the United States.

"European companies, and Germans especially, have been hit earlier and hit harder with cost-containment reforms in their own countries that essentially forces them to grow their exports, especially into the U.S.," he said.

The American Consulate in Düsseldorf is an exception to the American wisdom that the worse thing a business executive can hear is "Hello, I am from the government and am here to help."

The participation of about 45% of all U.S. companies coming to MEDICA is a powerful testament to the value of the services coordinated by the U.S. Commercial Service.

"Trade shows, generally, are a key to doing business in foreign markets," Fantasia said, adding that it is part of the European business mentality and a preferred way to do business.

"For U.S. companies, it costs a lot to have even the smallest booth at this show and MEDICA is usually sold out anyway" he said, so the Commerce Department takes the risk of carving out a vast exhibition space and then renting out booths to companies.

For companies exhibiting at MEDICA, the Düsseldorf consulate provides country-specific market research and counseling and then a pre-show promotion across its Europe-wide network of commercial attach s in U.S. embassies and consulates to invite targeted distributors or potential customers to visit a company's booth.

Commerce also advises U.S. companies on how to protect designs being exhibited and how to take action against foreign companies that copy designs and trademarks.

Fantasia's office organizes each year the large U.S. pavilion that takes up about a third of Hall 16 and a smaller one focused on in vitro diagnostic devices in Hall 3.

A new pavilion for U.S. companies is located in the Compamed show for upstream medical device manufacturing, held in parallel in Hall 8.

An even lower-risk program that has grown over the past five years from 12 companies to 23 this year is the CEO Room, where Fantasia spends most of his time at MEDICA. Participating companies typically have less than $10 million in sales and fewer than 50 employees, he said.

For $5,000 a company in the CEO Room has a presence at the show as it were exhibiting, including a listing in the all-important MEDICA catalog, but displays no product and avoids all the heavy logistic costs.

Instead the company has a four-seat table in a large office set up on the exhibition floor for meetings, what Fantasia calls a "B-to-B platform." Commerce connects the company with 35 trade specialists from as many different markets and countries.

"These people are the experts who really know their country and can advise a CEO interested in doing business there," he said.

Most advisers also bring delegations from their market, "who are not here to wander around MEDICA and get lost but are kept in a tight group, with structured activities for meetings, presentations and booth visits," he said.

The Saudi Arabian delegation counts 18 potential customers, for example.

"The Middle East is a very significant block for business and a great source right now for business leads, Fantasia said, adding that "Russia is also a particularly hot market right now for U.S. companies."

CEO Room participants also are provided with a trade assistant for the duration of the show.

After serving several months as an intern with the Düsseldorf consulate, these multi-lingual assistants translate documents and sometimes conversations for a U.S. executive and work the exhibition halls to find customers and competitors for their assigned company and set up meetings.

Anette Salama, senior commercial specialist with the Commerce Department in Düsseldorf, coordinates the CEO Room program and said companies who participated in past years have "graduated" from the program by taking up exhibition booths this year, or have secured distributors for their products who are regular exhibitors at MEDICA.

Fantasia, who reports to Congress on the activities of the Düsseldorf office, said that last year, 200 export activities were attributed to the CEO Room, or roughly 10 transaction events per participating company.

"That is our key performance indicator," he said, adding "that does not take into account the hundreds of sales leads that are generated, plus whatever else the companies don't tell us about."