Twitter used to be an invigorating and informative place
for physicians. I could count on reasonable discussions and literature
references by daily participation and focusing on specific colleagues. In
psychiatry – there is a chronic misinformation problem dating back to Szasz,
Foucault, and others in the 1970s. They
created tropes and memes that are still repeatedly used by antipsychiatrists
today to deny the reality of mental illness and the real function and value of
psychiatry. In many ways this sort of criticism has generalized to the rest of
medicine and that became very clear during and after the pandemic. The takeover of Twitter by Elon Musk and his
so-called “free speech” policies made that site a fountain of
misinformation. The amount of
misinformation would be embarrassing to anyone concerned with the truth or
reality but these days those constraints clearly do not apply. The truth is of little value in much of what
can be read on X. I would go as far as
saying the truth is actively devalued on X and you can read falsehoods about
settled areas of science, medicine, and public policy.
There is a clear positive correlation between the
transition in management and an increase in misinformation, hate speech, hate
speech and antisemitism. Problems also
existed before that transition and some were highlighted during the pandemic.
Misinformation about vaccinations, masks, and public health personnel were
clear problems. Despite what happened during the pandemic that misinformation
has clearly increased. The day before I
started writing this post there was a great deal of misinformation about how
“jabs” (misinfospeak for COVID immunizations) cause blood clots and that there
would be a tsunami of deaths from thromboembolic diseases. Several physicians posted clearcut evidence
to refute this misinformation. Most physicians
are also aware of the fact that immunization are the single most effective
intervention to prevent death in large populations. That evidence, including
the evidence for COVID-19 immunization effectiveness is indisputable. Medical research on Long-COVID or chronic
symptoms following infection with the virus is also clearer now. Trying to
avoid that chronic state and the associated disability is another good reason
to get immunized. Practicing
physicians have a healthy respect for respiratory viruses. We have all seen healthy young people die
from infections with what are considered common cold viruses.
A great solution for physicians and scientist would be a
medical or scientific Twitter. It seems
like a simple matter but I suppose maintenance and day-to-day fees would need
to be covered in addition to the original programming. To prevent the vulgarians
shouting in the city square behavior of X – a simple model of behavior
consistent with what would be expected in a medical or scientific staff meeting
should suffice. No personal attacks, gaslighting, ridiculing, etc. and active
moderation. People would certainly be
able to debate the merits of climate change and other controversial topics –
but the arguments would need to be based on facts and scientific merit rather
than political rhetoric. People would not be allowed to post baseless claims
about another person, a theory, or a piece of research.
The defenders of name calling, gaslighting, and
misinformation all tend to hide behind the First Amendment. There is plenty of
evidence in the current news that there is no absolute right to say whatever
you want to say about a person or a business.
Hundreds of millions of dollars have been assessed as legal penalties
for those statements in several high-profile civil suits. Litigation is a crude
and expensive instrument for keeping discourse focused and civil. A specific environment is a much better approach.
Instead of proclaiming a web site as having absolute free speech – it is far
better to have the exchanges moderated according to specific rules. Hence the
staff meeting approach. I have certainly
been in staff meetings where tempers flared, but there was no name calling or
threatening behavior. There was disagreement about information but at no point
was there any question about deliberately misrepresenting the information or
repeatedly lying about it. The largest
professional staff I worked with was about 35 psychiatrists. The entire time I worked there I had no doubt
about the integrity or sincerity of my colleagues – even though some of the disagreements
were intense.
Who might run such a Twitter-like operation? The American Psychiatric Association (APA)
ran an email listserv that I participated in for decades. They decided to stop this in the past
year. It had probably run its
course. The number of new participants and
total participants was low. Discussion
by email tends to become too diffuse and they are difficult to reference later.
There were also limitations on discussions based on the charitable status of
the organization – no political discussions.
Twitter seemed like an ideal format for discussions, educational
threads, and daily reviews. I doubt that the APA or AMA have the resources for
a Twitter like platform but they might and it could be seen as a benefit to
potential members. Doximity comes to mind.
Currently Doximity has threads that are posted as news updates
presumably by their editors. They tend to be much less interesting than good
Twitter threads and discussions. A
Twitter like platform would be a greater asset in attracting physicians to the
site. LinkedIn tends to have the same
constraints as Doximity but it does allow member to start new threads. All of
the commercial threads suffer from commercialization and overly intrusive
members. I don’t want to see an endless
sequence of friend or connection requests when it is obvious that I have
nothing in common with those requestors.
On Twitter – the commonalities were obvious and I knew who to
follow.
The competitors that were started based on Twitter’s
obvious demise – Blue Sky, Threads, and Mastodon just don’t seem to have active
physician communities at this point. As
more physicians leave Twitter – there is a clear socialization and discussion
gap. It is probably obvious that I have no clear solutions for that gap – other
than a hope that somebody with enough resources and insight to the value of
Twitter for physicians can get a platform established. Alternately – more networked and focused
discussions on Blue Sky and Threads is still a possibility. Either way – I think we need a functional
blue bird back in one form or another….
Happy New Year!
George Dawson, MD, DFAPA
