“I am urging all Americans to help slow the spread of health misinformation during the COVID-19 pandemic and beyond. Health misinformation is a serious threat to public health. It can cause confusion, sow mistrust, harm people’s health, and undermine public health efforts. Limiting the spread of health misinformation is a moral and civic imperative that will require a whole-of-society effort.”

Vivek Murthy, M.D., Surgeon General of the United States

---

There’s been a dramatic shift in the tone of online conversations on Twitter, and it’s not for the better. When the surgeon general of the United States speaks, people tend to listen. As you can see in the quote above, Dr. Murthy has identified medical misinformation as an urgent threat to public health. He has a point: Social media is at the heart of misinformation. Here’s a link to his 22-page report on the topic.

My initial involvement in medtwitter started as the result of a challenge presented to me by one of my younger colleagues at work. They said: “you’re supposed to be the guy discussing digital health and innovation. How can you do that effectively if you’re not engaged on social media where a lot of this is happening?”

So, I signed onto Twitter in 2013 with a strategy that I was only going to use the platform to share curated information on health care technology and learn from other health care professionals. I was not going to tweet personal information, political views, or religion. What I found pleasantly surprised me. I interacted with medical professionals I would never get the chance to meet in my professional capacity. I was able to get links to medical technology articles that I would never have found on my own. I learned from people on the front lines of care delivery how they implemented technology, what worked and what didn’t. And I was able to find resources that provided a wealth of information that would have taken hours to find myself. I still find this to be true. But over the last eighteen months, as the pandemic has been raging, I’ve noted a dramatic shift in the tone of tweets showing up in my timeline. So, I decided to look at the good, bad, and ugly of the current state of medtwitter.

First, the good – On Twitter, adding the hashtag #medtwitter to a tweet makes it visible to countless individuals interested in the latest updates in medicine. Social media also offers opportunities for various stakeholders such as politicians, venture capitalists, academics, and others to share their insights and find solutions for the most challenging issues of our time. Moving beyond the pandemic, this kind of cross-talk should be leveraged to create networks of professionals that share credible health information and ultimately chart a pathway for improved long-term public health.

“The pandemic is turning medics into social-media stars, but even the most successful say being a positive influence is difficult.”

Abby Ohlheiser, MIT Technology Review

Social media platforms serve as great ways for stakeholders to communicate primarily because these platforms have millions of users across multiple areas of expertise and are already optimized to facilitate interaction about shared interests. The general public also benefits because this joint feed enables cross-disciplinary virtual panels that have helped educate and disseminate credible updates about the pandemic. What would have taken multiple phone calls and emails can now take a single retweet, message, or comment.

Now, the bad – While Twitter has been a driving force behind the most prominent social movements of the past decade, including #MeToo and Black Lives Matter, it’s also been the crucible for some of the worst online behaviors. It has enabled targeted harassment since the earliest days of the service. A 2017 Amnesty International study found that an abusive tweet gets sent to female journalists and politicians every 30 seconds. Examining a decade of tweets, a 2018 study by the Massachusetts Institute of Technology found that false information spread six times faster than true information on the platform, and was 70% more likely to be retweeted. The flow of misinformation on Twitter is a function of both human and technical factors. If a tweet is retweeted, favorited, or replied to by enough first viewers, the newsfeed algorithm will show it to more users. At that point, it will tap into the biases of those users, too—prompting even more engagement, and so on. At its worst, this cycle can turn social media into a kind of confirmation bias machine, one perfectly tailored for the spread of misinformation. And the anonymity that Twitter can provide creates an environment where people can attack others without fear – which is unfortunately what most of our social discourse has become.

And finally, the ugly – The people who can get views for a medical message on social media aren’t necessarily the ones most qualified to craft it. How professionals handle disagreement in the time of a global crisis illustrates broader challenges we face with tribalism, virtue signaling, and politics. Medicine is rapidly becoming a tribal field. And in the ongoing debate on how to navigate the pandemic, this tribalism has increased to the point where medical professionals with different views have sunk to a new low of ad-hominem attacks and abuse. These attacks generally include cropped, out-of-context screenshots of someone’s Twitter feed with no context or completeness.

The most recent example that I’ve come across is the experience of Dr. Vinay Prasad. He faced a barrage of online criticism for expressing his opinions on how we in medical circles should advise people regarding restrictions after they get vaccinated. Here’s a link to his opinion piece on Medpage Today describing that experience. And below is a video of Dr. Zubin Damania and Dr. Prasad discussing the issue in more detail.

“The choice in the modern world where the wall between academia and the real world has crumbled is either uniformity and silencing of some views, or a plurality of voices and mixed ideas. I think there is no question in a free society that the latter is the only possible choice.”

Vinay Prasad, M.D, MPH

But Dr. Prasad isn’t the only physician facing personal attacks on medtwitter. Respected physicians like Eric Topol from Scripps, Marty Makary from Johns Hopkins, Peter Hotez from Texas Children’s, and John Mandrola, an electrophysiologist from Louisville, have all been targeted by other physicians, many of whom have nowhere near the credentials and experience.

---

So, what should we do? – Instead of reining in the use of social media, the medical community should go on the offensive and fight misinformation on social media domains by coordinating networks of reputable individuals who can serve as sources of credible information on these domains. This will allow students, attending physicians, epidemiologists, health care entrepreneurs, and many others to engage with family and friends within and outside of medicine to help spread truthful information in the same way leaders with large platforms can engage their spheres of influence. Most importantly, social media will allow anyone in medicine and health care more broadly to promote inclusive discussions that get at the heart of individual concerns.

This must be done by first considering the diversity of perspectives, experiences, and cultures that exist within the medical community itself and the broader society.

Fortunately, Twitter is taking steps to correct its problems. Twitter hired chief design officer Dantley Davis to detox the platform and shake up its corporate culture. His mandate: fix the toxicity on the platform and snap the company out of a decade-long product development slump, in part by shaking up its placid corporate culture. In the two years since his arrival, the service has launched an impressive number of features that begin to address some of its most insidious problems. He lobbied to get misinformation labels live on the feed in May 2020. His group has helped deactivate racist algorithms that prioritized white faces when auto-cropping photos. (Twitter now lets users post a photo in its original aspect ratio.) And he’s set up a team of 15 people to develop concepts to eliminate problems like targeted harassment. He’s also been rolling out products, including the audio-chat feature Spaces and a Tip Jar for creators, which prioritize nuanced and positive interactions on the site.

“Dantley joining this company is one of the most important inflection points I believe we’ve had.”

Kayvon Beykpour, head of consumer product, Twitter

So, I’m not giving up on medtwitter yet. To me, the benefits of connecting with an engaged community of physicians, health care executives, caregivers, and patients to understand the critical issues facing health care and sharing solutions that work far outweigh the negative aspects of the platform.