Ever since Elon Musk bought Twitter and took over as CEO, negative news about the global social media platform has skyrocketed. First, there were reports of an increase in hate speech in the hours immediately after Musk took the helm. Shortly thereafter, the company announced massive layoffs of thousands of employees.
There are always two sides to every story, and the “news” coming out of Twitter HQ or published on the platform into the mainstream media has been constant. This frenzy has been fueled by the ‘overpoliticisation’ of a wide range of political or social issues ‘discussed’ within the ‘Twittersphere’. We miss out on Twitter’s significant advantages when we focus solely on these controversial issues or people.
Twitter was – and still is – a global “town square,” where many of the best and brightest scientists and physicians announce discoveries, debate research, and interact with citizens (including patients) around the world and across many disciplines and backgrounds.
We have to work hard to make sure it stays that way.
One of us (Bernstein) serves as the social media editor of “Spine,” one of the most cited and prestigious spine surgery journals in the world, and sees the benefits of Twitter firsthand. Scientific advances that were once locked behind paywalls and read only by a select (and small) group of industry experts are now openly accessible with no associated subscription fees. Hundreds, if not thousands, of people now see these discoveries. Many readers are spine surgeons, but others are physicians, scientists, politicians, and patients with diverse skills and backgrounds.
When it comes to tweets from “Spine,” some Twitter users (like spine surgeons or other doctors) might find the content practically helpful or just plain interesting, while others (like patients) might realize they have a medical condition that can be addressed or that there may be a new treatment technique that could be helpful. These patients may, for the first time, seek help or change the way they seek care.
Spine surgeons can review tweets that highlight something they might otherwise have missed (or been delayed seeing) in the field. This could change their opinion about a topic or even how they treat patients. You can also share advice or insights from others (spine surgeons or not), leveraging the expertise of many and potentially digitally improving multidisciplinary patient care.
As a patient, wouldn’t you want the debate, as well as the shared input and insight from hundreds or thousands of experts about a treatment or intervention, to happen before your doctor shares his or her recommendations with you? Twitter allows this to happen in a much more efficient way than was previously possible.
“High-yield” points of medical and scientific advances that were once only available if you sat down and read a cover-to-cover peer-reviewed paper journal can be captured — essentially — by scrolling through your Twitter feed. Want to know more? You can search the contents of the tweet or click any included link to view the full article or examine the data source.
Using Twitter to share scientific and medical advances has the potential to help our medical system move closer to being truly patient-centric and inclusive.
But Twitter certainly isn’t without its flaws, especially when it comes to healthcare and science. Twitter can exacerbate mental health crises (a topic for another article), while promoting the spread of medical disinformation and misinformation. Without any guardrails, this can have real physical consequences for people’s health globally. We have witnessed this game and it is unacceptable.
On the other hand, freedom of speech is fundamental to democracy. It allows you to disagree with others, whether it’s your family, neighbor or the President of the United States of America, without fear of retaliation. Or should. Such free trade is critical to human progress and to solving some of society’s most challenging and perplexing problems.
In trying to deal with misinformation and disinformation, we often find ourselves trying to make the wrong choice between free speech, which is central to many of the freedoms we cherish, and science and healthcare. But we can have both. There are immediate steps Twitter can take to keep its users (aka the global audience) safe by addressing misinformation and disinformation, while ensuring that free speech is protected.
First, Twitter can create a revamped and focused health and science advisory board that enhances the large (100-member) and fuzzy Trust and Safety Council that was recently disbanded. The composition of this new expert advisory group is crucial. It should include recognized healthcare professionals and scientists as diverse as the “Twitterverse” itself, including membership of sociodemographic factors, experience, and political spectrum. This is crucial, as at least a third of US adult tweets are political. All conflicts of interest should also be disclosed.
The meetings of this council, including all discussions, should be transparent and publicly available. Not only should the disclosure of recommendations that could potentially impact users be detailed for Twitter leadership, but also for the wider public. The “for” advisers and the “against” cohort should write clear statements of support and dissent, respectively. These statements would be similar to US Supreme Court case documents. Participation in this council should be limited in time to ensure new voices and insights are shared frequently.
Second, for “hot,” (potentially) controversial science and health topics, Twitter should improve its ability to help foster healthy, yet vigorous debate and discussion. This can be achieved by providing links or suggestions of articles or data that conflict with the comment or position posted. These can be presented as “banners” to tweets. The language of this “banner” would not be accusatory or make definitive statements. A list of contradicting articles or data can be approved by the Focused Healthcare and Science Advisory Board described above and then randomly assigned by Twitter using an open source algorithm. Mediation methods led by Twitter leadership can occur if disagreements escalate. This approach gives Twitter users more perspectives on a given debate without having to search for “the other side” themselves. Overall, this can help foster a social media environment that better informs and bridges divisions rather than polarizing. This can help tamper with the “echo chamber” that is debilitating our world.
Finally, Twitter can help fund scientific research into the role of social media in promoting democracy, protecting free speech, and curbing misinformation and disinformation. This would benefit not only the platform itself, but also the global community it serves. It would also show that Twitter recognizes the problem and wants to be part of the solution, not the problem. Twitter can “put its money where its mouth is” in this case. Academic and evidence-based proposals in the sphere of health care and science could be evaluated and approved by the health care and science advisory board described above.
With over 368 million monthly active users worldwide, it’s fair to say the world is on Twitter. The range of users – from politicians to celebrities, from “mom and pop” shops to global conglomerates, from community hospitals to world-renowned healthcare systems and everything in between – demonstrates that so many understand the power of Twitter, whether they want to acknowledge or not. It’s not perfect, and no one, including Elon Musk, would claim it is. Given the power and influence Twitter wields, it can’t be a “free hell for all.”
As Twitter’s policies are revisited and adapted under its new leadership, it’s vital to remember that despite all the concerns about the platform, it indeed can play a tremendously positive role in creating a more dynamic, inclusive and democratized healthcare and science ecosystem. .
David N. Bernstein, MD, MBA, MEI is a resident physician in the Harvard Combined Orthopedic Residency Program at Massachusetts General Hospital, Brigham and Women’s Hospital, Beth Israel Deaconess Medical Center, and Boston Children’s Hospital. He is an expert in value-based healthcare transformation and is the Social Media Editor for Spine, one of the most prestigious spine science journals in the world.
Victor Agbafe is Deans and Medical Innovation Scholar at the University of Michigan Medical School and joint MD/JD candidate at the University of Michigan Medical School and Yale Law School. He has had articles published in USA Today, Newsweek, STAT, The Root POLITICAL, Health Affairs, Fox News and Medpage Today. Follow him on Twitter @VictorAgbafe