Grand Rounds Vol 8 nr 5: Data, Information & Communication

26 10 2011

Welcome to the Grand Rounds, the weekly summary of the best health blog posts on the Internet. I am pleased to host the Grand Rounds for the second time. The first time, 2 years ago, was theme-less, but during the round we took a trip around the library. Because, for those who don’t know me, after years of biomedical research I became a medical librarian. This also explains my choice for the current theme:

DATA, INFORMATION & COMMUNICATION

The theme is meant to be broad. According to Wikipedia:

Information in its most restricted technical sense is a message (utterance or expression) or collection of messages that consists of an ordered sequence of symbols, or it is the meaning that can be interpreted from such a message or collection of messages. Information can be recorded or transmitted (…) as signs, or conveyed as signals by waves. Information is any kind of event that affects the state of a dynamic system. (…) Moreover, the concept of information is closely related to notions of … communication.. dataknowledge, meaning, .. perception. .. and especially entropy.

I am pleased that there were plenty submissions on the topic. I love the creative way the bloggers used the theme “information”. In line with the theme the information will be brought to you according to the Rule of Entropy, seemingly chaotic. Still all information is meaningful and often a pleasure to read. Please Enjoy!

INDIA, WISDOM & IMAGESIMAGING

From: IBN-live (India): Book News: “Kama Sutra is about sexual & social relations”

IMAGES are a great way to tell information, especially if you don’t understand the language. The picture above is from the Kama Sutra, an ancient Indian Hindu work on human sexual behavior in Sanskrit literature. Did you know the original Kama Sutra is not all about sex and does not have any pictures? Only words, no graphic. And sadly, as a text, it isn’t widely read.

Yes, we start our trip where it ended last week, in INDIA

Our host of last week, Sumer Sethi of Sumer’s Radiology Site, shows very clear (MRI)-images of partially recanalized internal jugular vein thrombosis, in a patient with MS, possibly supporting the theory that MS is a result of chronic venous insufficiency. As readers of this blog know Laika is not impressed by n=1 data, although it may be a good starting point. However, Sumer underpins this link with a paper in J Neurol Neurosurg Psychiatry 2009. Still, a quick look at the citing papers shows many new studies don’t confirm the association of MS with cerebrospinal venous insufficiency…

Another great radiologist, also from India, isVijay Sadasivam (@scanman). No recent posts, but at Scanman’s Casebook you will find an archive of interesting radiological cases, in the form of case reports.

The quite tech savvy surgeon Dr. Dheeraj (aka Techknowdoc) explores the alternatives to the invasive and uncomfortable colonoscopy procedure at Techknowdoc’s Surgical Adventures! This post is a short illustrated guide, visualizing the differences between regular colonoscopy, capsule endoscopy and Virtual Colonoscopy. It is not hard to imagine which approach people would prefer.

Pranab (aka Skepticdoctor) makes an urgent appeal to fellow Indians to help Amit Gupta and other Indian people to get a bone marrow transplant when they need one. Amit has Acute Leukemia, but South Asians are very poorly represented in bone marrow registries, so his odds of getting a match off the registries in the US are slim. The chances are even worse for the less well-off Indians. Read at Scepticemia how you can help. For Amit, for India, for you, or worse, someone you love more than yourself….

Dr. Jen Gunter ridicules Cosmo’s to-go version of the Kama Sutra in a short series! For the “sex positions of the days” are just an offensive alliteration and woeful ignorance of female anatomy… Looking up medical information is the 3rd most common on-line activity. While there are good sites with great information that can help people be empowered about their health, there are also tons of terrible sites marred by bias and rife with the stench of snake oil. In an other post at Dr. Jen Gunter (wielding the lasso of truth) Jen reveals 10 red flags that will help you separate the wisdom from the woo.

THE POWER OF WORDS, MUSIC AND VISUAL ARTS

http://www.flickr.com/photos/isfullofcrap/5147100521/

Yes, a picture is worth a thousand words. And this is also true for other audiovisual arts. 

Yet, some Medical Bloggers master the art of storytelling, they convey of events in words, images and sounds. And here, words have the same powerful strength. Often these posts of these storytellers are about communication and they know how to communicate that.

One of the master storytellers is Bongi, a general surgeon from South Africa. He submitted the post die taal (that language), which is clearly about communication but in a language (“Afrikaans”), that I can understand, but many of you don’t. Therefore I choose another post at Other Things Amanzi, which is also about communication: “It’s all in the detail”

Another great storyteller, and the winner of the best literary medical blog category of Medgadget contest in 2009 and 2010 is StorytellERdoc. In the beautiful post The Reminder – EKG #6, he tells us how the 6th abnormal EKG in a presentation of one of the residents, brought back memories to the technician who made that EKG: “There is something more important about this EKG than it’s tracing, I began” ….

Robbo (Andrew Roberts) is a pharmacist from one of the most remote parts of Australia working full time in Aboriginal Health. His blog BitingTheDust often covers topics like aboriginal art and pharmacy. There is also a category “information-resources”. His latest post in this category explains how condoms are made and how they work. A video goes with it.

Øystein of  The Sterile Eye (Life, death and surgery through a lens) uses photos throughout his blog. His latest post is about a brochure “LEICA – Fotografie in der Medizin” (Photography in Medicine) that was published by Leitz in 1961.

Another blogger, unique in its kind, “raps” his stories. Yes I’m talking about Zubin, better known as ZDoggMD. Watch how he and his mates colleagues rap “Doctors Today!” where he “informs” folks of what it’s like to actually practice primary care medicine on the front lines. Want to know more about this medical rapper, then listen to this radio interview with a med-student run radio (RadioRounds). It’s about using video to “inform” patients and healthcare providers about health-related issues in a humorous way.

Movies are also a good way to “tell a story” and pass information. Ramona Bates reviews the Lifetime’s Movie “Five” at her blog Suture for a Living. Five is an anthology of five short very emotional (but not sentimental) films exploring the impact of breast cancer on people’s lives.

We have had pictures, music, videos and movies as data carriers. But here is a post that is based on the good old book. Dr. Deborah Serani (who has a blog of her own: Dr. Deb: Psychological Perspectives) submits a review from PsychCentral about her new book “Living with Depression.” My first intuitive response: how can a psychologist or psychoanalyst write about “living with“. But it seems that Deborah Serani has faced a lifelong struggle with depression herself. This memoir/self help book seems a great resource for anyone in the health field looking for information about mood disorders, treatments and recommendations. The review makes me want to read this book.

SOCIAL MEDIA & MOBILE APPS

http://www.flickr.com/photos/verbeeldingskr8/4507350257/

What about social media as a tool for medical communication and a source of information?

At Diabetes Mine Allison B. and Amy Tenderich review numerous new mobile apps for managing diabetes. Their reviews “Diabetes? There’s An App For That” and “Glooko: iPhone Diabetes Logging Made Super-Easy” may help to choose diabetes patients among the bevvy of diabetes apps.

Twitter is seen as offering more noise than signal, but there’s valid medical data that can be uncovered. Ryan DuBosar at the ACP internist blog highlights how a researcher uses Twitter to track attitudes about vaccination and how they correlate with vaccination rates. The study adds to a growing body of evidence that social networking can be used to track diseases and other natural disasters that affect public health.

Hot from the press, I can’t resist to include a post from the web 2.0 pioneer Dr. Ves at CasesBlog. Ves Dimov usually writes many short posts, but today he explains Social media in Medicine in depth and guides you “How to be a Twitter superstar and help your patients and your practice”. According to his interesting concept two Cycles, the cycle of Patient Education and the Cycle of Online Information and Physician Education, work together as two interlocking cogwheels.

Mayo Clinic started using social media for communication with patients well before all the recent hype and it organized tweetcamps back in 2009. David Harlow made the pilgrimage to Rochester, MN and spoke at the Mayo Clinic Center for Social Media’s Health Care Social Media Summit last week. According to David “A ton of information was presented, through traditional channels and through some multimedia demos as well”. He shares conference highlights in this post at HealthBlawg, like “It is impossible to transplant a successful program from one location to another without taking into account myriad local conditions”. And “health care providers will have to do more with less”. Therefore e-Patient Dave suggests in his closing keynote to “Let Patients Help”.

Nicholas Fogelson of Academic OB/GYN notes that an operating room without incentives is very expensive. He proposes to install a cheap digital toteboard in every operating room in the USA, that would read how many dollars have been spent on that case at that moment. The idea is that surgeons who know exactly what they are spending, would compete to spend less wherever they could.

According to Bryan Vartabedian the social and technological innovations cause doctors to slowly change from analog physicians to digital physicians. He mentions 6 differences between these doctors. The first is that the information consumption of the digital physician is web-based, while the analog doctor consumes information through paper books and journals, often saying curious things like, “I like the smell of paper” or “I’ve gotta be able to hold it.” By the way, Bryan’s blog 33 Charts is all about social media and medicine.

Blogging doctors are digital doctors per definition, but that doesn’t mean they don’t want to discuss things and see each other in real life. Dr. Val of Better Health and cofounder of this Grand Rounds announces a blog conference in Los Angeles, the Blog World Expo, on November 4th, 2011. Her talk is about “physicians engaging online in social health”, but she is actually hoping that many members of the medical blogging community will be out there IRL! At her blog you can get discount tickets.

The online presence of doctors at social media places can have serious drawbacks. The post of Anne Marie Cunningham about derogatory and cynical humour as displayed by medical personnel at Twitter and Facebook has made it to the Daily Telegraph, other UK newspaper, and to my blog…. This post at Wishful thinking in medical education is a must read for healthcare providers embracing social media.

Many physicians have an online presence, but do they really use social media for decision making, wonders Chris Nickson. From his post and the ensuing reactions at Life in the Fast Lane it appears that tools like Twitter and the comments sections on blogs enable a constant, ongoing dialogue with emergency physicians and critical care experts around the world regarding puzzling clinical issues. Rarely, however, there is a direct ‘tweet’ for clinical help. Rather Twitter contributes to the serendipitously finding of relevant and significant information.

Perhaps direct clinical questions are not asked because Twitter (and Facebook to some extent) are open social media. Bertalan Mesko of ScienceRoll mentions that some French doctors actually perform case presentations on Google+, taking advantage of the very simple privacy settings of Google+. They upload information about the case, discuss it with other peers and get to a final diagnosis.

E-Patient Dave announced a seven hour event about information transfer during transitions of care. This event was webcasted, tweeted and discussed on Google+. (also see Brian Ahier’s post about it on Government Health IT). Dave gives some examples that highlight that without reliable information transition, the care transition can become dangerous. Yes, good IT can help.

DATA, DATABASES, OPEN ACCESS, EBM

http://www.flickr.com/photos/verbeeldingskr8/4029292954/

We now arrive at a clinical librarian topic, medical information via databases, journals and the role of EBM.

The first post bridges this and the previous topic. Jon Brassey is co-founder of  the TRIP-database, a clinical search tool designed to rapidly identify the highest quality clinical evidence for clinical practice. At his blog Liberating the Literature he expresses his view that search is -at best- a partial solution. He is passionate about answering clinician’s questions and would rather see an answer machine than a search engine. Jon is very tempted to allow users to upload their own Q&As, thereby creating an open repository of clinical Q&As. I am more skeptical, because this kind of EBM sharing might be at the expense of the quality of evidence.

What do you think? Can social media and EBM reinforce each other or not? Please tweet your ideas to Anabel Bentley (@doctorblogs at Twitter) who is giving a talk at Evidence 2011 (#ev2011) tomorrow on social media & EBM and asks for your input. You might also want to read my older post about The Web 2.0-EBM Medicine split.

Dean Giustini reviews PubMed Health at The Search Principle Blog. Dean describes PubMed Health as follows. It is as a consumer version of PubMed – a metasearch tool that gathers evidence from Cochrane Collaboration, Nice and other EBM sources to see clinical studies and “what works” in human health. One major benefit of PubMed Health is that any search performed on PubMed Health also runs in PubMed.” Sounds like worth trying.

The invitation to join the editorial board of a relatively new online, open access journal, without receiving any compensation triggered Skeptic Scalpel to ponder about the tangible benefits of open access publishers (coined as “predatory open access” by a commenter) and about how many journals are really needed? Who has the time or interest to read 25 journals on a relatively specialized topic? And what about the quality of the articles in all these journals?

Indeed as The Krafty Librarian explains  the “good guys” (open access) are making just as much profit as the “bad guys.”  They both are for profit. Open Access is not the panacea that many think it is.

Tasha Stanton of Body in Mind asks the intriguing question what to do if systematic reviews on the same topic don’t all give us the same conclusions, whereas you would expect they would collate the same evidence. Tasha finds this disconcerting as for some conditions this could take ages before we could ‘trust’ the evidence. In the example discussed here an Umbrella review was helpful in assessing the evidence. Also the quality of systematic reviews is improving.

SCREENING & DIAGNOSIS. BALANCING BENEFITS & HARMS. 

From: http://www.naturalnews.com/025768_radiation_cancer_mammograms.html as seen at Science Based Medicine

Many people think screening is always a good thing and will prevent or cure a disease. But not every test is a good test and often there are both harms and benefits. It is difficult for patients to understand the true value of tests. 

Margaret Polaneczky, MD was touched by a beautiful essay in the NY Times written by a mother of a child born with Tay Sachs disease. While the mother in her loved the essay, the doctor in her cringed, because a single paragraph about the mother’s experience with prenatal screening had the potential to misinform and even frighten readers. Margaret writes a bit of a primer on Tay Sachs screening at the Blog That Ate Manhattan, mainly to set realistic expectations about what prenatal testing can and cannot accomplish.

David Williams at the Health Business Blog reasons that the US Preventive Services Task Force (USPTF) recommendations against routine use of the PSA blood test in healthy men should not have been delayed because of the the firestorm of controversy created by the 2009 screening mammography guidelines… Because uh-oh well, PSA testing is different (and David is right)…  It’s all about what kind of info we can expect from screening and where it leads us.

This month is breast cancer awareness month, meant to highlight issues of breast cancer and try to call attention to new discoveries about breast cancer. Personally I have mixed feelings about the pink ribbon exploitation of this month”, but David Gorky at Science Based Medicine points at a worse misuse: quacks seize the opportunity to spread their message against science-based modalities for the detection and treatment of breast cancer and to promote their “alternative” methods. (see Fig. above).

BIOMEDICINE, BRAINS AND THE PROCESSING OF INFORMATION

http://www.flickr.com/photos/caseorganic/3675792814/ [CC]

Dr Shock MD PhD reviews a Dutch trial that shows that availability bias contributes to diagnostic errors made by physicians. Availability bias means that a disease comes more easily to the mind of a doctor who diagnoses this disease more often. This study also suggests that analytical or reflective reasoning may help to counteract this bias.

In an intriguing post counseling psychologist Will Meek, PhD covers some of the recent research on two information processing systems as identified by Daniel Kahneman: Intuition and Reasoning. A simple experiment confirms (in my case) that we use intuition for most of the day, and occasionally use reasoning to answer more complex problems. Some people may also frame this as “head vs heart”. Both systems have their pros and cons and both are needed to make good decisions. Otherwise common problems can arise.

David Bradley of ScienceBase discusses recent research by Gallant and colleagues who were able to reconstruct a video image presented to a subject in a functional MRI machine. David dreams of uploading our dreams to Youtube and of developing a mind-machine interface to allow people with severe disabilities to communicate their thoughts and control a computer or equipment. But David is more of a scientist than a dreamer and he interviews Gallant to find out more about the validity of the technique.

Computational Biologist Walter Jessen highlights “National Biomedical Research Day” at Highlight HEALTH. “National Biomedical Research Day” was proclaimed by Bill Clinton in 1993 on the 160th anniversary of Nobel’s birth. This day celebrates the central role of biomedical research  in improving human health and longevity.

MISINFORMATION, WRONG INFORMATION AND LACK OF INFORMATION

http://www.flickr.com/photos/truthout/3901813960/
This image was paired with the story: Insurers Shun Those Taking Certain Meds

Philip Hickey at Behaviorism and Mental Health discusses homosexuality. Philip: “homosexuality is a complex phenomenon which defies simplistic explanations. Unfortunately in this field valid information and communication often take a back seat to bigotry and prejudice.”

In his post “Want go Dutch…or German…or French?” at HUB’s LIST of medical fun facts Herbert Mathewson, MD argues that “Before trying to copy other nation’s health care systems we should probably actually learn about them.” The outcomes of the Dutch switch from a system of mandatory social insurance administered by nonprofit sick funds to mandatory basic insurance that citizens had to buy from private insurance companies (“managed competition”) are appalling! I can imagine that the idea that the Dutch reforms provide a successful model for U.S. Medicare seems bizarre. (Herbert’s post is based on a NEJM article “Sobering Lessons from the Netherlands”).

Henry Stern of InsureBlog notes that as far as RomneyCare© (Massachusetts health care reform) is concerned it’s not so much lack of information per se that’s the problem. It’s information that’s wrong that gets you in trouble.

Robert Centor of Medrants simply submitted one sentence:
“I am a physician, not a provider, and Groopman agrees. - http://www.medrants.com/archives/6505″
This distinction between physicians and providers is similar to the distinction between consumers and patients, and I agree.

Rich Fogoros (DrRich) of The Covert Rationing Blog discusses recent article in the New York Times about whether nurses with a doctorate degree ought to be addressed as “doctor.” Most doctors think calling a nurse “doctor” is not appropriate and confusing for patients.
A medical student running the blog The Reflex Hammer agrees: medical students with a doctoral degree don’t introduce themselves as “Doctor” to a patient either, don’t they?
Dr Rich, an old hand, thinks otherwise. While it is indeed comforting that doctors should be so concerned about patients knowing everything they’re supposed to know, the fact (according to dr. Rich) is that the doctor-nurse controversy is a distraction.

INFORMATION YOU NEED


http://www.flickr.com/photos/nirak/1386793065/
credit: mattahan.deviantart.com/
Note: this is a librarian!!

And of course you always hope that you find the information you need or that you can inform people the right way.

Medaholic wonders whether you still would be a medical doctor if you knew that it didn’t pay as much? What sorts of information would help you determine whether this is a career worth pursuing?

The post, by Chris Langston, at the John A. Hartford Foundation blog, Health AGEnda details how interested health professionals can get information about how to apply for a new fellowship with the Center for Medicare & Medicaid Innovations office, and urges health professionals interested in improving health care for older adults to apply.

Hospital antimicrobial stewardship programs are prompting more appropriate prescribing of antibiotics, leading to improved patient care, less microbial resistance and lower costs, three studies show. The trick is how to convey this information so hospitals will implement these programs, as only one-third of U.S. facilities currently do. Read more at ACP Hospitalist, in the second contribution of Ryan DuBosar to this round.

We all know that adherence to prescriptions is a problem. But will the Star Ratings system increase adherence? The big question, according to Georg van Antwerp, author of Enabling Healthy Decisionsis whether consumers care about Star Ratings or just focus on lowest price point and access to pharmacies or specific medications.

Louise of the Colorado Health Insurer Insider summarizes her submission quite aptly: “Our submission is about the new Health Insurance Exchanges that will be starting here in the US soon. This post discusses how consumers will get INFORMATION about the health plans through the exchanges. Currently, consumers get their information through health insurance brokers or directly through the insurance carrier. If there are people to answer questions for consumers with the exchanges, how will the plans be more or less expensive”

The post that Reflex Hammer submitted (the one above was just picked by me) concerns informing young children about vegetables. A few weeks ago he and a classmate were invited to give a presentation to 1st graders at an inner-city school. Wishing to combat obesity, they developed a lesson plan about vegetables. They were heartened by how much the adorable kids already knew about vegetables and how enthusiastic they became about eating their greens. An adorable initiative and a great post to end this Grand Rounds, since it illustrates the importance of doctors who enjoy to take their time to inform people.

I just want to mention one other post, by Mike Cadogan at Life at the fast Lane. Mike doesn’t blog a lot lately, because he is preparing presentations for an important Emergency Medicine meeting. But Mike does share some of this journey with us in The 11 Phases Of Grief  Presentation Preparation. Reading these 11 stages, the similarities between writing a lecture and writing for Grand Rounds struck me. Except that beer had to be replaced by wine….

Mike is in stage 7-9, I am in stage 10-11. Stage 11 is Evaluation: What will I do different next time? First, I won’t go for two blog carnivals at the same time, I won’t plan a Grand Round when I’m away for the weekend* (I just need a lot of time) and I should refrain from adding posts that weren’t even submitted….

Will you remind me next time?

I hope that you enjoyed this Grand Rounds and that it wasn’t too much information. I enjoyed reading and compiling all our posts!

Related articles





Silly Saturday #22 – A Picture is Worth a 1000 Words.

17 04 2010

This post is my submission for the Grand Rounds to be hosted at Sterile Eye.
This upcoming edition has the theme VISUAL COMMUNICATION.

You know I love visualizations, they are so easy to understand.

No lengthy post here, because a picture is worth a 1000 words…..

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I

250lbs versus 120 lbs

The body scans side by side of 250 lb. woman versus 120 lb. woman.
Source: Bored Panda

Hattip: @EvidenceMatters, @rlbates & @streetanatomy who referred to a repost on LikeCool

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II

Planes or Volcano?

We were wondering this today (April 16, 2010)

Source: Information is Beautiful

Hattip: Bitethedust & @mpesce “Turns out that a little volcanic action is surprisingly good for planet Earth They referred to a repost at The Daily Wh.at.

I’m a real fan of Information is Beautiful with its beautiful visualizations. See previous post on evidence for health supplements

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III

Real Eyeballing

Source: Wolfram Demonstrations Project

Contributed to Sterile Eye ;) : An interactive project showing hows the interaction between an eyeball and two of the muscles connected to it. Muscles deform as the eyeball rotates. You can download a live version.





Information is Beautiful. Visualizing the Evidence for Health Supplements.

21 03 2010

In a world driven by data, we need a simple means of digesting it all. Visualization of data may help to coop with the information overload. Good visualizations enable people to look at vast quantities of data quickly.

Bram Hengeveld at Geriatric Care (geriatricare.wordpress.com) told me of Snake Oil, a fantastic visualization of scientific evidence for popular health supplements. A well chosen name too, because Snake oil  is both a traditional Chinese medicine, as a  term for “medicines” that are fake, fraudulent, quackish, or ineffective. The expression is also applied metaphorically to any product with exaggerated marketing but questionable or unverifiable quality or benefit. (Wikipedia).

Snake oil is just one visualization at Information is Beautiful (link), the site created by David McCandless, a London-based author, writer and designer who wrote for The Guardian, Wired and others, and nowadays an independent data journalist and information designer. His passion: visualizing information – facts, data, ideas, subjects, issues, statistics, questions – all with the minimum of words (see about).

When you see snake oil you intuitively understand it all.

The image is a “balloon race”. The larger the bubble the higher its popularity in terms of number of Google hits. Orange bubbles look promising but have (yet) a low evidence.

The higher a bubble, the greater the evidence for its effectiveness. But the supplements are only effective for the conditions listed inside the bubble. Evidence is only shown for supplements, taken orally by an adult with a healthy diet.

Some supplements may be represented by multiple bubbles, one for each condition:  after all, the evidence may vary across conditions. For example, there’s strong evidence that Green Tea is good for cholesterol levels. But evidence for its anti-cancer effects is conflicting.

Another nice thing about Snake oil is that it is interactive. You can show (filter) the results for specific conditions or supplement types. Below I selected cardio. Most bubbles disappear. The evidence seems strong for green tea, fish oil and red yeast rice and low for vitamin E and omega-3. When you move your mouse over a bubble it pops up and you can read the supplements name and the condition to which the evidence applies.

Truly amazing.

One might ask how GOOD are the data on which these bubbles are based?

Well I haven’t checked, but the visualization generates itself from this Google Doc. The Google spread sheet shows all the data on which the visualization is based. These can be PubMed Records, Cochrane Systematic Reviews, Medline Plus or a full text paper. The image is automatically regenerated when the google doc is updated with new research that has come out.

The only thing that strikes me as a information specialists is that the way the evidence is retrieved is not stated. Probably this isn’t done in an evidence based way, because each piece of evidence is based on ONE article only. The choice of the paper seems rather random. And some supplements are rather vague. What is meant with “anti-oxidants?” Many of the supplements have anti-oxidant activity for instance.

But the idea in itself is great. Suppose we could gather the evidence in a more evidence based way, share it in Google Docs, appraise it and visualize it. Wouldn’t that be wonderful?





Twitter goes Viral: Swine Flu Outbreak – Twitter a Dangerous Hype?

30 04 2009

twitter-network-and-virusTwitter has been praised for its actuality and news breaking character. Remember the earthquakes and the two recent airplane crashes (Hudson River, Schiphol). Twitter often was the first to bring the news.

Twitter’s power lies in its simplicity, -the 140 character limit-, its speed and it’s domino-effect. Tweets (twitter messages) can be read by your followers (I have appr. 650). If they find something important, funny or whatever they could “RT” or Retweet (i.e. resend) the message, and their friends could retweet it as well. Via these secondary networks Twitter can go viral (in its replication and spread).

Below a friends of a friend network of a well known twitter personality Robert Scobleizer, as obtained by Twitterfriends. Only the “relevant network” is shown, directed to someone in particular: tweets beginning with @ (followed by the twitter name of your friend). The actual reach of tweets not starting with @ is greater, because they can be read by all followers.

3136982396_58537a66fb-foaf

Apart from following specific tweople one can also search for certain words or (hash)tags via Twitter Search or #hashtags.

Pushed by celebrities, such as Ashton Kutcher and Oprah Winfrey, who recently joined Twitter. Twitter’s traffic was poised to double and the number of tweeting people has steeply increased.

Twitter has been glorified by the stars. They created a real (meaningless) twitter mania.

But what raises high, can drop low.

Several sources dethroned Twitter because of it’s viral role in the recent swine flu outbreak. One of the first and most serious critiques came from a blog (Foreign Policy: Net Effect). It’s title: Twine flu: Twitter’s power to misinform.swine-flu-totThis is a serious allegation. Evgeny Morozov‘s main critiques:

  1. The “swine flu” meme has led to misinformation, fear and panic. Wrong info includes: fear that it “could be germ warfare” or “that one should not eat pork and certainly not from Mexico”.

  2. Unlike a simple Google search Twitter gives too much noise (irrelevant or wrong information).

  3. Messages from trustworthy sources have as much weight as those from uninformed people.

  4. There is very little context you can fit into 140 characters, even less so if all you are doing is watching a stream.

  5. Evgeny also worries about a future misuse of Twitter by cyber-terrorists shaping conversations on serious topics. A number of corporations are already monitoring and partially shaping twitter conversations about particular brands or products.

In addition some posts highlight that most of the Tweets belong to the category “witty or not so witty”. (also see this post)
And after these comments many similar comments were to follow: In fact these comments and critiques were going viral as well: take a look at this Google Search for Twitter Swine Flu and note the negative sound of most of the headlines.
The CNN website quotes Brennon Slattery, a writer for PC World,

“This is a good example of why [Twitter is] headed in that wrong direction, because it’s just propagating fear amongst people as opposed to seeking actual solutions or key information (..). The swine flu thing came really at the crux of a media revolution.”

Is Twitter just a hype and useless as an information source? Is it dangerous when a wide number of people would turn to Twitter in search of information during an emergency? Or have people just found a stick to beat the dog?

I will go to several aspects of the twitter flu coverage as I have encountered it.

Number of tweets

Indeed, as brought forward by Mashable, Tweets about “Swine Flu” are *now* at 10,000 per hour!!

Yesterday, 5 out of 10 twitter buzzwords were connected to Swine Flu:

  • # · Swine Flu
  • # · swineflu
  • # · Mexico
  • # · H1N1
  • # · Pandemic

Searching for information on Twitter
You can imagine that it is hardly useful to keep track of tweets mentioning *swine flu*, nor is searching for these buzzwords or hastags useful, if not combined with other terms or names, like CDC or laikas (just to find what you tweeted yourself).
I keep track of certain words via Tweetdeck in separate columns, accepting a certain “noise”, knowing this will only yield 20-50 tweets per day. It would not come to my mind to just blindly search for swineflu on Twitter.

The official media
It is said that Twitter doesn’t give useful or correct information, and indeed it hasn’t been designed for that (being merely a social Network). In its primitive form it is just online gossip or as The Register (UK) puts it- “it is not a media outlet. But odd enough, the official media did not behave differently. Cable television programmers went into crisis mode and a look at newspaper front pages and website home pages around the world showed a range of responses, from the almost hysterical to the concerned and more measured (Reuter’s Blog).

Look at this message from AJ Cann, that I retweeted :

laikas: RT @AJCann Totally irresponsible #swineflu journalism in the Dail Mail http://tinyurl.com/cms3km (expand) >>and they say twitter evokes global panic!
Is there really no reason to be worried?
Let’s face it. We don’t know an awful lot about this new virus strain. While it is true that the common flue has killed 13,000 people in the US since in a rather unnoticed way, and while there are relatively few swine flu casualties yet, one never knows how this new H1N1 epidemic will evolve. It might just fade away or it could kill millions of people. We just don’t know. It is a new, deadly virus. Not for nothing (as I learn from Twitter), the WHO has just raised the current level of influenza pandemic alert from phase 4 to phase 5. But this is only meant to be prepared and to inform, not to cause panic.
who-message
AJCann (on twitter)Ben, a doctor writing for the Guardian, excelling in critically informing the public about science (and quack) and a real valibrity, was invited all over by the media to be a naysayer on the “aporkalypse”.
How to deal with Twitter Noise?
Suppose you would listen to all radio channels at once: that would be an unbearable noise. Usually you choose a channel, your favorite one, and just listen what comes next. But you may switch to another channel anytime. And for news you might just go to a specific channel that you know is the most informative.
It is exactly the same with Twitter. I don’t follow everyone. Since I use Twitter mostly for my work (medicine, library, science, web 2.0) and not primarily for a chat or wit, I choose the tweople I follow carefully. If they produce too much noise I might unfollow them. They are my human filter to the news.

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Furthermore among the ones I follow are News or Health Sources, like @CNN Health, sanjayguptaCNN, @BBC Health, @BreakingNews, @health and recently (because of retweets of friends): @WHOnews , @CDCemergency, Reuters_FluNews, Fluheadlines.

@BreakingNews and @health mentioning real casualties and the WHO calling an emergency meeting, I realized the seriousness of the problem. I was also pointed to @WHOnews and @CDCemergency, the most trustworthy sources to follow.
I also understood that the swine flu might be difficult to contain.

laikas: RT @BreakingNews: BULLETIN — WORLD HEALTH ORGANISATION CALLS EMERGENCY MEETING TO DISCUSS DEADLY SWINE FLU OUTBREAKS IN MEXICO AND THE U.S.

laikas: RT @health WHO, CDC concerned about possible epidemic following reports of 60+ people killed by new flu strain in Mexico http://bit.ly/d3JsO
laikas: RT @TEDchris: Swine flu outbreak. This is how it was SUPPOSED to have been contained. http://is.gd/us6r Worrying. >> WHO protocol
laikas: RT @BreakingNews: Reports of flu outbreak in New Zealand. 22 students may have been infected after a trip to Mexico. BNO trying to confirm. 3:25 AM Apr 26th from TweetDeck

laikas: RT @dreamingspires: RT @AllergyNotes Map of H1N1 Swine Flu of 2009 http://bit.ly/P2mcc (expand) 4:41 AM Apr 26th from TweetDeck

laikas: Map of H1N1 Swine Flu of 2009 http://bit.ly/P2mcc _ New Zealand added to the map. 4:42 AM Apr 26th from TweetDeck


Direct Link to H1N1 Swine Flu Google Map:

Somewhat later came the informative phase. Long before the official media were giving any useful information, some of my twitterfriends alerted me to their own or other (official) news.

@ajcann already wrote a post on his blog Microbiology Bytes (a blog with the latest news on microbiology) :10 things you should know about swine flu. (April 25th)

laikas: Reading @sciencebase Swine Flu http://bit.ly/y5Xqz 7:47 AM Apr 26th from web

laikas: RT @sanjayguptaCNN: I’ll answer your swine flu Q’s LIVE on CNN at 7:30a ET. call 1-800-807-2620. thanks 4he gr8 tweet Q so far.

laikas: RT @consultdoc: Great swine flu summary via @ubiquity http://bit.ly/DK0xV (expand) Thanks Greg.1:18 PM Apr 26th from TweetDeck

laikas: RT @BreakingNews: The WHO is holding a news conference on swine flu. Michael van Poppel is covering it live @mpoppel.
laikas: RT @stejules: RT @mashable HOW TO: Track Swine Flu Online http://tinyurl.com/dh68n8 (expand) (via @tweetmeme) (

At that point I became saturated with all information. I just follow the main news and read some good overviews

end-tweet-flu
Conclusion
For me, Twitter was the first and most accurate news source to get informed and updated on the swine flu pandemics. It was reliable, because “my friends” filtered the news for me and because I follow some trustworthy sources and news sites. Indirectly other tweople also pointed me at good and actual information.
And in my turn I kept my followers informed. The news has alarmed me, but I’m not in panic or frightened. I just feel informed and at the moment I can do nothing more than “wait and see”.

It has often been said: Twitter is what you make of it.
But keep in mind the golden rule:

Information on Swine Flu

News and Blogs

Photo Credits:

* wonderful those different names.








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