Why Twitter may not be good enough for scientific information and discussion

I appreciate the re-tweet below but I did not say anything remotely close to this sentence:

@sevinfo Reading "top" journals only distorts your world - Argument for scrapping peer review at BMJ blogs via @DrVes & @KentBottles

http://twitter.com/sevinfo/status/10929698882

My original tweet:

@DrVes The naïve concept that the “top journals” publish the important stuff and the lesser journals the unimportant http://goo.gl/utJ5

http://twitter.com/DrVes/status/10892767666

My expanded citation on Google Buzz:

The false idea that only the “top journals” publish the important stuff

From the former Editor-in-Chief of BMJ:

The naïve concept that the “top journals” publish the important stuff and the lesser journals the unimportant is simply false. People who do systematic reviews know this well. Anybody reading only the “top journals” receives a distorted view of the world. Unfortunately many people, including most journalists, do pay most attention to the “top journals.”

http://blogs.bmj.com/bmj/2010/03/22/richard-smith-scrap-peer-review-and-beware-of-%E2%80%9Ctop-journals%E2%80%9D/

http://www.google.com/buzz/110859855629071891085/TPmyVKjvZS9/The-false-idea-that-only-the-top-journals-publish

Please click the Buzz link above to see how much more "richer" the comments there are as compared to Twitter where the microblog updates (tweets) are limited to 140 characters.

This little example adds to the opitinion that many times Twitter is not good enough for scientific information and discussion.

Follow-up:

@sevinfo: yoicks! I was agreeing to need to read both "top" & less exciting ; not saying that reading science distorts your world! For record - @DrVes points out that text on last link open to misinterpretation - Keep reading science journals both top & less glamourous!

Comments from Google Buzz (March 23-24):

Kathy Mackey - Appreciate the followup Dr. Ves. I read the article yesterday on BMJ on scientific journals and felt I was missing something. It is true that 140 characters can be difficult to relay important information to the public

Brian Ahier - This is a problem that can not be adequately addressed because of the character limitation in Twitter. But it is an opportunity for a service like Buzz to be a bridge for longer commentary and discussion. I suggest we have more conversations in Buzz and then tweet a link to the post.

Ves Dimov, M.D. - Agree. Works very well with some posts. However, the Buzz adoption rate is significantly lower than Twitter and seems to have plateaued a few week after its launch.

Brian Ahier - Quality vs. Quantity?
I have found a much higher quality conversation seems to be happening on Buzz. Perhaps some of the adoption will not be missed. I have yet to be bothered by a spam account on Buzz and many of the followers on Twitter soon become inactive.

Ves Dimov, M.D. - True. People put more thought into Buzz comments - the accounts are often tied to their "real" identity after all. Participation fatigue is a common occurrence among all services.

Brian Ahier - I am also fortunate that many of my higher profile followers like Tim O'Reilly, Richard MacManus, and Robert Sconle are active on Buzz. As Buzz matures I think we will see some interesting applications. Then when Google buys Twitter we'll be all set ;-)

Ves Dimov, M.D. - Yes. Although Evan Williams keeps saying that Twitter is not for sale not matter what the price...

Brian Ahier - Yeah, Ev is an idealist :-D

Ves Dimov, M.D. - You have to respect the guy - he brought two very important services to popularity and success - Blogger and Twitter. Even one would be enough for the Internet history books... :)

Ves Dimov, M.D. - @Brian Ahier - I'm sorry I deleted your comment by mistake and there is no "Undo" in Buzz. "You" was meant in general not for you in person. And, yes, I share the same opinion.

Brian Ahier - Buzz does need an undo - but as I said, I admire people who old to their ideals. Ev has made some outstanding contributions and has an amazing talent.

Neil Mehta - Some of my best online experiences have been on Buzz - feels like a civilized sit down dinner with a conversation. Twitter can leave one feeling like everyone is rushing around on a big field shouting "hello" to the world, hoping someone will reply and start a conversation - it is great when to find that stranger with whom you share an interest but that happens rarely and the conversation is usually very unsatisfactory. Understand the Twitter functionality was not designed for conversations......

Vamsi Balakrishnan - @Neil Mehta: It's exactly as Dr. Ves said though; Buzz is tied to your real identity more or less, which is especially true for those who have verified profiles. It's also easier to have conversations since there's no 140 character limit...and it goes to those who use twitter anyway if you've enabled it. So, for me at least, it was a seamless transition.

The only problem that exists though, which truth be told hasn't affected me yet, is that there's a 300 comment limit. 300 replies to a post can exist, no more.

Are doctors ready for virtual visits? Telemedicine may not be accurate enough

Are Doctors Ready for Virtual Visits? Many fear telemedicine will jeopardize the doctor-patient bond. NYT http://bit.ly/7c2RA8

Telemedicine has a place for second opinion when initiated by a physician but primary assessment is more problematic. One successful example of telemedicine is Cleveland Clinic's second opinion service for physicians abroad. For reference, please see our blog post from a few years ago: Cleveland Clinic Offers a Second Opinion Online for $565 http://bit.ly/4NQyer

The accuracy of teledermatology was inferior to real-life clinic dermatology for melanoma diagnosis http://bit.ly/8A4oiu.



CNN Video: Doctor will see you now -- on Webcam. Telemedicine takes a new turn. Now you can see the doctor while you shop, as CNN's Elizabeth Cohen reports.

Related:

Melanoma - JAMA Patient Page illustrates the ABCDE of diagnosis, 2011.
Skin cancer in the USA - follow Australia's successful "Slip Slop Slap Seek Slide" campaign - The Lancet, 2011.
Telemedicine boosting dermatology care: improved outcomes, with better diagnosis and disease management. AMA News, 2012.

Martina Navratilova Fighting Breast Cancer - ABC Video

In February 2010, the tennis legend was diagnosed with an aggressive form of ductal carcinoma in situ (DCIS), considered the earliest form of breast cancer. Navratilova had a lumpectomy in February, during which her doctors determined that the cancer had not spread to her lymph nodes. She says there is only a "very small chance of it coming back."

Navratilova's cancer was diagnosed during a routine mammogram, after not having one for four years, and she hopes that speaking out will inspire other women to get mammograms.

"The reason I wanted to speak about this is to encourage these woman to have mammograms," she said. "I just want to encourage women to have that yearly check-up."

References:
Martina Navratilova Fighting Breast Cancer

Eradication of nasal colonization with S. aureus associated with a decrease in postoperative surgical-site infections

Nasal carriers of Staphylococcus aureus are at increased risk for health care–associated infections with this organism.

Eradication of colonization with S. aureus by screening at admission and subsequent decolonization (with intranasal mupirocin and chlorhexidine skin washes) were associated with a decrease in postoperative surgical-site infections.

In a randomized, double-blind, placebo-controlled trial, S. aureus nasal carriers were treated with mupirocin nasal ointment and chlorhexidine soap.

A total of 6771 patients were screened on admission, 1270 nasal swabs from 1251 patients were positive for S. aureus. All the S. aureus strains identified on PCR assay were susceptible to methicillin and mupirocin.

The rate of S. aureus infection was 3.4% in the mupirocin–chlorhexidine group, as compared with 7.7% in the placebo group (relative risk of infection, 0.42). The effect of mupirocin–chlorhexidine treatment was most pronounced for deep surgical-site infections (relative risk, 0.21).

References:

Preventing Surgical-Site Infections in Nasal Carriers of Staphylococcus aureus. NEJM, 1/2009.
GIANTmicrobes in Toys & Games section of Amazon.com http://goo.gl/gMrf

Scaring physicians away from using social media

Is there a doctor who wants to spend 3 hours per day on social media while running the risk of being sued?

This useful critical review by a freelance journalist at the NEJMJobs site has a focus on some of the litigation risks inherent to the use of social media in healthcare:

http://www.nejmjobs.org/career-resources/social-media-and-physicians.aspx

"Dr. Pho, who spends up to three hours a day in social media activities, is surely in a minority of physicians who devote considerable time to blogging, Twittering, or engaging in Facebook updates.

Social Media Activity Risks Difficult to Predict

Despite the potential professional benefits of social networking participation, some physicians are approaching the social media realm with trepidation, for fear that personal and professional presences will overlap in a manner that increases liability exposure.

That’s a valid concern, because the medico-legal aspect of social media activities has been little explored and is not well understood. In addition, the obvious risks of incurring HIPAA violations should patients’ health information be unwittingly exposed are a deterrent. “The laws haven’t caught up with social media and networking, so to be safe I don’t blog about my patients,” Dr. Pho said. “Even though I think that interesting or challenging cases can be used as a learning tool, too much of my professional livelihood is at stake.”

None of the physicians interviewed for this article have accepted patients’ requests to become Facebook friends, and all cited concerns that doing so would “cross the boundary” between a personal and professional relationship.

"I think that very few doctors are interacting with patients directly on Facebook because we’re so terrified of being accused of practicing medicine and getting sued. Whatever you type is eternal and a perfect record of whatever you said,” she said. “That makes it all even more scary.”

“We’re concerned about this because there have been instances in which physicians have used Facebook in an inappropriate manner,” said David Troxel, MD, The Doctors Company’s medical director. “Social media networks are not HIPAA compliant and are just not appropriate for any physician-patient communication, so it’s a real liability threat because it’s so easy to lapse into a casual conversation.”

The NEJMJobs article linked in the paragraph above does not discuss the use of social media for medical education of students, residents and patients.

Another area that was not highlighted enough was the widespread use of Facebook "fan pages" by hospitals and physicians to attract patients and create relationships. Does this mean that the patients can be "your fans" but not "your friends"?

Overall, this article is a good review of some of the risks involved with the social media adoption in healthcare.

However, for a more nuanced approach to social media use by physicians, please review this detailed primer by the cardiologist Dr. Wes:

http://drwes.blogspot.com/2010/03/for-cardiologists-twitter-primer.html

Related:
Facebook Friend Request - A young doctor gets a message from a dying patient - NYTimes, 2010.

Social Media Raise Liability, Ethical Questions for Doctors as Internet is challenging traditional boundaries. Boston Globe, 2010.

Image source: OpenClipArt.org, public domain.

Updated: 04/13/2010

How To: Getting Smart During Your Daily Commute

"The average American spends a good 100 minutes per day commuting to and from work. That amounts to about 433 hours per year! Now imagine using that time to learn something new — to read a great book, to take a class from a top university, to learn a new language.

We highlight our free audio resources that will maximize your drive time. Before getting started, make sure you have a big mp3 player and a way to listen to your mp3 player over your car speakers."

References:
Getting Smart During Your Daily Commute | Open Culture

Related:

How does clinical evidence work?

Ben Goldacre's Moment of Genius on BBC4 radio:

"Clinical trials in medicine are designed to be free from bias. They test, as objectively as possible, the effectiveness of a particular intervention.

When you bring the results of all these individual trials together, however, how do you weigh up what evidence is relevant and what is not? In 1993, a method of "systematic review" was introduced that enables us to get the clearest possible view of the evidence."