Since Elon Musk purchased Twitter and installed himself as its chief executive officer, the negative news regarding 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 headquarters or published about the platform in the mainstream media has been non-stop. This frenzy has been fueled by the “overpoliticalization” of a wide range of political or social issues “discussed” within the “Twittersphere.” We miss the remarkable benefits of Twitter when we focus solely on these controversial issues, or people.
Twitter has been — and still is — a global “town square,” where many of the best and brightest scientists and doctors announce discoveries, debate research, and engage with citizens (including patients) around the world and across diverse disciplines and backgrounds.
We must work hard to make sure it stays that way.
One of us (Bernstein) serves as the social media editor of “Spine,” one of the globe’s most-cited and prestigious spine surgery journals, and sees the benefits of Twitter firsthand. Scientific advancements, which used to be locked behind paywalls and only read by a select (and small) group of experts in the field, are now openly accessible without associated subscription charges. Hundreds, if not thousands, of people now see these discoveries. Many readers are spine surgeons, but others are doctors, scientists, policymakers, and patients with different expertise and experiences.
When it comes to tweets from “Spine,” some Twitter users (such as spine surgeons or other doctors) may find the content practically useful or simply interesting, while others (such as patients) may realize they have a medical condition that can be addressed or that there may be a new treatment technique that could be beneficial. These patients may — for the first time — seek help or adjust how they seek care.
Spine surgeons may review tweets that highlight something they otherwise may have missed (or been delayed in seeing) in the field. This could change their view on a topic or even how they treat patients. Advice or insights from others (spine surgeons or not) can also be shared, leveraging the expertise of many and potentially improving the multidisciplinary care of patients digitally.
As a patient, wouldn’t you want the debate of, as well as input and insight shared by, hundreds or thousands of experts on a treatment or intervention to occur before your doctor shares their recommendations with you? Twitter allows that to happen in a much more efficient manner that previously possible.
The “high yield” points of medical and scientific advancements that were once available only if you sat down and read a hard copy peer-reviewed journal from cover to cover can be captured — in essence — by scrolling through your Twitter feed. You want to know more? You can search the contents of the tweet or click on any included links to view the full article or examine the data source.
The use of Twitter to share scientific and medical advancements has the potential to help our medical system move closer to truly being patient-centered and inclusive.
But Twitter is certainly not without flaws, especially as it relates to health care and science. Twitter can exacerbate mental health crises (a topic for another article), while promoting the spread of medical misinformation and disinformation. Without any guardrails, this can have real physical consequences to the health of people globally. We have seen this play out, and it is unacceptable.
On the flipside, free speech is central to democracy. It allows you to disagree with others — whether your family, neighbor, or the President of the United States of America — without fear of retribution. Or it should. Such free exchange is central to the progress of humanity and for solving some of society’s most challenging and perplexing issues.
In trying to address misinformation and disinformation, we often find ourselves seeking to make a false choice between free speech, which is central to many of the freedoms we cherish, and science and health care. But we can have both. There are immediate steps that Twitter can take to ensure the safety of its users (that is, the global public) by tackling misinformation and disinformation, while simultaneously ensuring the protection of free speech
First, Twitter can create a revamped and focused health care and science advisory board that improves upon the large (100-member), unfocused Trust and Safety Council that was recently dissolved. The composition of this new expert advisory panel is crucial. It should include recognized health care professionals and scientists as diverse as the “Twitterverse” itself, including membership across sociodemographic factors, experience, and political spectrum. This is crucial, as at least one-third of tweets from U.S. adults are political. All conflicts of interest should also be publicly available.
Meetings of this board — including all discussions — should be transparent and publicly available. Not only should disclosure of recommendations that could potentially impact users be detailed to Twitter leadership but to the public more broadly as well. The advisors “in favor” and the cohort “opposed” should write clear statements of support and dissent, respectively. These statements would be similar to the United States’ Supreme Court case documents. Participation on this board should be term-limited to ensure novel voices and insights are frequently being shared.
Second, for “hot”, (potentially) controversial health care and science topics, Twitter should improve its ability to help foster healthy, yet vigorous, debate and discussion. This can be accomplished by providing links to or suggestions of articles or data that counter the comment or position being posted. These can be presented as “banners” to tweets. The language of this “banner” would not be accusatory or make definitive claims. A list of contradictory articles or data can be approved by the focused health care and science advisory board outlined above and then randomly assigned by Twitter using an open-source algorithm. Mediation methods led by Twitter leadership can occur if disagreements rise. This approach provides Twitter users with multiple angles of a given debate without them having to search for the “other side” themselves. Overall, this can help foster a social media environment that better informs and bridges divides rather than polarizes. This may help tamper the “echo chamber” that is debilitating our world.
Lastly, Twitter can support research and inquiry into the role of social media in promoting democracy, protecting free speech, and curbing misinformation and disinformation by providing more complete and transparent data to researchers, policymakers, and the public. Not only would this benefit the platform itself through a likely increase in users as trust builds, but the global community which it serves. It also would demonstrate that Twitter acknowledges the issue and that it wants to be part of the solution, not the problem. Scholarly and evidenced-based proposals in the health care and science sphere could be evaluated and approved by the health care and science advisory board outlined above.
With over 368 million monthly active users globally, it is fair to say the world is on Twitter. The range of users — politicians to celebrities, “mom-and-pop” shops to global conglomerates, community hospitals to world-renowned health systems, and everyone in between — demonstrates that so many realize the power of Twitter, whether they want to acknowledge it or not. It is not perfect, and no one — including Elon Musk — would claim that it is. Given the power and influence that Twitter wields, it cannot be a “free-for-all hellscape.”
As the policies of Twitter are revisited and adapted under its new leadership, it is crucial to remember that despite all the concerns about the platform, it can truly play a remarkably positive role in creating a more dynamic, inclusive, and democratized health care and science ecosystem.
David N. Bernstein, MD, MBA, MEI is a resident physician at the Harvard Combined Orthopaedic 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 health care transformation, and he is the Social Media Editor for Spine, one of the most prestigious scientific spine journals worldwide.
Victor Agbafe is a Deans and Medical Innovation Scholar at the University of Michigan Medical School and a joint MD/JD candidate at the University of Michigan Medical School and Yale Law School. He has published pieces in USA Today, Newsweek, STAT, The Root POLITICO, Health Affairs, Fox News, and Medpage Today. Follow him on Twitter @VictorAgbafe