Social Media in Clinical Practice by Bertalan Meskó [Book Review]

How to review a book on Medical Social Media written by an author, who has learned you many Social Media skills himself?

Thanks to people like Bertalan Meskó, the author of the book concerned,  I am not a novice in the field of Medical Social Media.

But wouldn’t it be great if all newcomers in the medical social media field could benefit from Bertalan’s knowledge and expertise? Bertalan Meskó, a MD with a  Summa Cum Laude PhD degree in clinical genomics, has already shared his insights by posts on award-winning blog ScienceRoll, via Twitter and Webicina.com (an online service that curates health-related social media resources), by giving presentations and social media classes to medical students and physicians.

But many of his students rather read (or reread) the topics in a book instead of e-learning materials. Therefore Bertalan decided to write a handbook entitled “Social Media in Clinical Practice”.

This is the table of contents (for more complete overview see Amazon):

1. Social media is transforming medicine and healthcare
2. Using medical search engines with a special focus on Google
3. Being up-to-date in medicine
4. Community sites Facebook, Google+ and medical social networks
5. The world of e-patients
6. Establishing a medical blog
7. The role of Twitter and microblogging in medicine
8. Collaboration online
9. Wikipedia and Medical Wikis
10. Organizing medical events in virtual environments
11. Medical smartphone and tablet applications
12. Use of social media by hospitals and medical practices
13. Medical video and podcast
14. Creating presentations and slideshows
15. E-mails and privacy concerns
16. Social bookmarking
17. Conclusions

As you can see, many social media tools are covered and in this respect the book is useful for everyone, including patients and consumers.

But what makes “Social Media in Clinical Practice” especially valuable for medical students and clinicians?

First, specific medical search engines/social media sites/tools are discussed, like (Pubmed [medical database, search engine], Sermo [Community site for US physicians], Medworm [aggregator of RSS feeds], medical smartphone apps and sources where to find them, Medical Wiki’s like Radiopaedia.
Scientific Social media sites, with possible relevance to physicians are also discussed, like Google Scholar and Wolphram Alpha.

Second, numerous medical examples are given (with links and descriptions). Often, examples are summarized in tables in the individual chapters (see Fig 1 for a random example 😉 ). Links can also be found at the end of the book, organized per chapter.

Fig 1. Examples represented in a Table

Third, community sites and non-medical social media tools are discussed from the medical prespective. With regard to community sites and tools like Facebook, Twitter, Blogs and Email special emphasis is placed on (for clinicians very important) quality, privacy and legacy concerns, for instance the compliance of websites and blogs with the HONcode (HON=The Health On the Net Foundation) and HIPAA (Health Insurance Portability and Accountability Act), the privacy settings in Facebook and Social Media Etiquette (see Fig 2).

Fig. 2 Table from “Social Media in Clinical Practice” p 42

The chapters are succinctly written, well organized and replete with numerous examples. I specifically like the practical examples (see for instance Example #4).

Fig 3 Example of Smartphone App for consumers

Some tools are explained in more detail, i.e. the anatomy of a tweet or a stepwise description how to launch a WordPress blog.
Most chapters end with a self test (questions),  next steps (encouraging to put the theory into practice) and key points.

Thus in many ways a very useful book for clinical practice (also see the positive reviews on Amazon and the review of Dean Giustini at his blog).

Are there any shortcomings, apart from the minimal language-shortcomings, mentioned by Dean?

Personally I find that discussions of the quality of websites concentrate a bit too much on the formal quality (contact info, title, subtitle etc)). True, it is of utmost importance, but quality is also determined by  content and clinical usefulness. Not all websites that are formally ok deliver good content and vice versa.

As a medical  librarian I pay particular attention to the search part, discussed in chapter 3 and 4.
Emphasis is put on how to create alerts in PubMed and Google Scholar, thus on the social media aspects. However searches are shown, that wouldn’t make physicians very happy, even if used as an alert: who wants a PubMed-alert for cardiovascular disease retrieving 1870195 hits? This is even more true for a the PubMed search “genetics” (rather meaningless yet non-comprehensive term).
More importantly, it is not explained when to use which search engine.  I understand that a search course is beyond the scope of this book, but a subtitle like “How to Get Better at Searching Online?” suggests otherwise. At least there should be hints that searching might be more complicated in practice, preferably with link to sources and online courses.  Getting too much hits or the wrong ones will only frustrate physicians (also to use the socia media tools, that are otherwise helpful).

But overall I find it a useful, clearly written and well structured practical handbook. “Social Media in Clinical Practice” is unique in his kind – I know of no other book that is alike-. Therefore I recommend it to all medical students and health care experts who are interested in digital medicine and social media.

This book will also be very useful to clinicians who are not very fond of social media. Their reluctance may change and their understanding of social medicine developed or enhanced.

Lets face it: a good clinician can’t do without digital knowledge. At the very least his patients use the internet and he must be able to act as a gatekeeper identifying and filtering thrustworty, credible and understandable information. Indeed, as Berci writes in his conclusion:

“it obviously is not a goal to transform all physicians into bloggers and Twitter users, but (..) each physician should find the platforms, tools and solutions that can assist them in their workflow.”

If not convinced I would recommend clinicians to read the blog post written at the the Fauquier ENT-blog (refererred to by Bertalan in chapter 6, #story 5) entiteld: As A Busy Physician, Why Do I Even Bother Blogging?

SM in Practice (AMAZON)

Book information: (also see Amazon):

• Title: Social Media in Clinical Practice
• Author: Bertalan Meskó
• Publisher: Springer London Heidelberg New York Dordrecht
• 155 pages
• ISBN 978-1-4471-4305-5
• ISBN 978-1-4471-4306-2 (eBook)
• ISBN-10: 1447143051
• DOI 10.1007/978-1-4471-4306-2
• $37.99 (Sept 2013) (pocket at Amazon)

Related articles

• “Social Media in Clinical Practice” Handbook Is Published! (scienceroll.com)
• Social Media in Clinical Practice: Chapter 1, The Introduction (scienceroll.com)
• Here comes Bertalan Meskó’s book on ‘social media’ (aplaceofmind.ubc.ca)
• My Book, Social Media in Clinical Practice, To Be Released on the 8th of August! (scienceroll.com)

• Berci’s New Book Is A Winner (blogs.ubc.ca/dean/)

• Social Media in Clinical Practice: Chapter 3, Being Up-to-Date in Medicine (scienceroll.com)

Medpedia, the Medical Wikipedia, is Dead. And we Missed its Funeral…

In a post about Wikipedia in 2009 I suggested that initiatives like Ganfyd or Medpedia, might be a solution to Wikipedia’s accuracy and credibility problems, because only health experts are allowed to edit or contribute to the content of these knowledge bases.

MedPedia is a more sophisticated platform than Ganfyd, which looks more like a simple medical encyclopedia. A similar online encyclopedia project with many medical topics, Google Knol, was discontinued by Google as of May 1, 2012.

But now it appears Medpedia may have followed Google KNOL into the same blind alley.

Medpedia was founded in 2007 [2a] by James Currier, an entrepreneur and investor [2b], and an early proponent of social media. He founded the successful Tickle in 1999, when the term Web 2.0 was coined, but not yet mainstream. And his list of  investments is impressive: Flickr, Branchout and Goodreads for instance.

On its homepage Medpedia was described as a “long term, worldwide project to evolve a new model for sharing and advancing knowledge about health, medicine and the body.”
It was developed in association with top medical schools and organizations such as Harvard, Stanford, American College of Physicians, and the NHS. Medpedia was running on the same software and under the same license as Wikipedia and aimed both at the public and  the experts. Contrary to Wikipedia only experts were qualified to contribute to the main content (although others could suggest changes and new topics). [3, 4 , 5, 6] In contrast to many other medical wikis, Medpedia featured a directory of medical editor profiles with general and Medpedia-specific information. This is far more transparent than wikis without individual author recognition [5].

Although promising, Medpedia never became a real success. Von Muhlen wrote in 1999 [4] that there were no articles reporting success metrics for Medpedia or similar projects. In contrast, Wikipedia remains immensely popular among patients and doctors.

Health 2.0 pioneers like E-Patient Dave (@ePatientDave) and Bertalan Meskó (@berci) saw Medpedia’s Achilles heel right from the start:

Bertalan Meskó at his blog Science Roll [7]:

We need Medpedia to provide reliable medical content? That’s what we are working on in Wikipedia.

I believe elitism kills content. Only the power of masses controlled by well-designed editing guidelines can lead to a comprehensive encyclopaedia.

E-patient Dave (who is a fierce proponent of participatory medicine where everyone, medical expert or not, works in partnership to produce accurate information), addresses his concern in his post

“Medpedia: Who gets to say what info is reliable?” [8]

The title says it all. In Dave’s opinion it is “an error to presume that doctors inherently have the best answer” or as Dave summarizes his concern: “who will vet the vetters?”

In addition, Clay Shirky noted that some Wikipedia entries like the biopsy-entry were far more robust than the Medpedia entries [9,10 ].

Ben Toth on the other hand found the Atrial Fibrillation-Medpedia item better than the corresponding Wikipedia page in some respects, but less up-to-date [11].

In her Medpedia review in the JMLA medical librarian Melissa Rethlefsen [5] concludes that “the content of Medpedia is varied and not clearly developed, lacks topical breadth and depth and that it is more a set of ideals than a workable reference source. Another issue is that Medpedia pages never ranked high, which means its content was hardly findable in today’s Google-centric world.

She concludes that for now (2009) “it means that Wikipedia will continue to be the medical wiki of choice”.

I fear that this will be forever, for Medpedia ceased to exist.

I noticed it yesterday totally by coincidence: both my Medpedia blog badge  and Mesko’s Webicina-“Medical Librarianship in Social Medicine”-wiki page were redirected to a faulty page.

I checked the Internet, but all I could find was a message at Wikipedia:

‘It appears that Medpedia is now closed but there is no information about it closing. Their Facebook and Twitter feeds are still open but they have not been updated in a few years. Their webpage now goes to a spam site.

I checked the Waybackmachine and found the “last sparks of life” at January 2013:

This morning I contacted Medpedia’s founder James Currier, who kindly and almost instantly replied to all my questions.

These are shown (with permission) in entirety below.

=============================================================================

[me: ] I hope that you don’t mind that I use LinkedIn to ask you some questions about Medpedia.

{James:] I don’t mind at all!

Is Medpedia dead? And if so, why was it discontinued?

For now it is. We worked on it for 6 years, had a fantastic team of developers, had fantastic partners who supported us, had a fantastic core group of contributors like yourself, and I personally spent millions of dollars on it. In other words, we gave it a really good effort. But it never got the sort of scale it needed to become something important. So for the last two years, we kept looking for a new vision of what it could become, a new mission. We never found one, and it was expensive to keep running.
In the meantime, we had found a new mission that Medpedia could not be converted into, so we started a new company, Jiff, to pursue it. “Health Care in a Jiff” is the motto. Jiff continues the idea of digitizing healthcare, and making it simple and transparent for the individual, but goes after it in a very different way. More info about Jiff here: https://www.jiff.com and here https://www.jiff.com/static/news. Jiff has taken our time and attention, and hopefully will produce the kinds of benefits we were hoping to see from Medpedia.

Why weren’t people informed and  was Medpedia quietly shut down?

We definitely could have done a better job with that! I apologize. We were under a tight time frame due to several things, such as people leaving the effort, technical issues around where the site was being hosted, and corporate and tax issues after 6 years of operating. So it was rushed, and we should have figured out a way to do a better job of communicating.

Couldn’t the redirection to the spam-site be prevented? And can you do something about it?

I didn’t know about that! I’ll look into it and find out what’s going on.*

Your LinkedIn profile says you’re still working for MedPedia. Why is that? Are there plans to make a new start, perhaps? And how?

Yes, I haven’t updated my LinkedIn profile in a while. I just made that change. We have no current plans to restart Medpedia. But we’re always looking for a new mission that can be self sustaining! Let me know if you have one.

And/or do you have (plans for) other health 2.0 initiatives?

Jiff is our main effort now, and there’s a wonderful CEO, Derek Newell running it.

I know you are a busy man, but I think it is important to inform all people who thought that Medpedia was a good initiative.

Thank you for saying you thought it was a good initiative. I did too! I just wish it had gotten bigger. I really appreciate your questions, and your involvement. Not all projects flourish, but we’ll all keep trying new ideas, and hopefully one will break out and make the big difference we hope for.

*somewhat later James gave an update about the redirection:

By the way, I asked about the redirect, and found out that that that page is produced by our registrar that holds the URL medpedia.com.

We wanted to put up the following message and I thought it was up:

“Medpedia was a great experiment begun in 2007.
Unfortunately, it never reached the size to be self sustaining, and it ceased operations in early 2013.
Thank you to all who contributed!”

I’m going to work again on getting that up!

============================================================================

I have one question left : what happened with all the materials the experts produced? Google Knol gave people time to export their contributions. Perhaps James Currier can answer that question too.

I also wonder why nobody noticed that Medpedia was shut down. Apparently it isn’t missed.

Finally I would like to thank all wo have contributed to this “experiment”. As a medical librarian, who is committed to providing reliable medical information, I still find it a shame that Medpedia didn’t work.

I wish James Currier all the best with his new initiatives.

References

1. The Trouble with Wikipedia as a Source for Medical Information
   (https://laikaspoetnik.wordpress.com) (2009/09/14)
2. [a] Medpedia and [b] James Currier , last edited at 6/30/13*  and 7/12/13 respectively (crunchbase.com)
3. Laurent M.R. & Vickers T.J. (2009). Seeking Health Information Online: Does Wikipedia Matter?, Journal of the American Medical Informatics Association, 16 (4) 471-479. DOI: 10.1197/jamia.M3059
4. von Muhlen M. & Ohno-Machado L. (2012). Reviewing social media use by clinicians, Journal of the American Medical Informatics Association, 19 (5) 777-781. DOI: 10.1136/amiajnl-2012-000990
5. Rethlefsen M.L. (2009). Medpedia, Journal of the Medical Library Association : JMLA, 97 (4) 325-326. DOI: 10.3163/1536-5050.97.4.024
6. Medpedia: Reliable Crowdsourcing of Health and Medical Information (highlighthealth.com) (2009/7/24)
7. Launching MedPedia: From the perspective of a Wikipedia administrator (scienceroll.com) (2009/2/20)
8. Medpedia: Who gets to say what info is reliable? (e-patients.net/) (2009/2/20)
9. Clay Shirky at MLA ’11 – On the Need for Health Sciences Librarians to Rock the Boat (mbanks.typepad.com) (2011
10. Wikipedia vs Medpedia: The Crowd beats the Experts (http://blog.lib.uiowa.edu/hardinmd/2011/05/31
11. Medpedia and Wikipedia (nelh.blogspot.nl) (2009/10/08)
12. Jiff wants to do for employer wellness programs what WordPress did for blogs (medcitynews.com)
13. Jiff Unveils Health App Development Platform, Wellness Marketplace (eweek.com)

#EAHIL2012 CEC 1: Drupal for Librarians

This week I’m blogging at (and mostly about) the 13th EAHIL conference in Brussels. EAHIL stands for European Association for Health Information and Libraries.

I already blogged about the second Continuing Education Course (CEC) I followed, but I followed a continuing education course at Mondays, one day earlier. That session was led by Patrice Chalon, who is a Knowledge Manager at KCE – Belgian Health Care Knowledge Centre.

The first part was theoretical and easy to follow. Unfortunately there were quite a few mishaps with the practical part (some people could not install the program via the USB-stick, parts of the website were deleted and the computers were slow), but the entire session was instructive anyway. Even though I was about the only person (of 6) lacking CMS or HTML knowledge (but rereading the course abstract I now realize that was a prerequisite….)

Drupal is a freely available, easy to use,  modular content management system (CMS), for which you don’t need to have extensive programming (or HTML) experience.

Drupal was created by a Belgium student (Dries Buytaert) in 2000. It evolved from drop.org (small news site with build-in web board to share news among friends)  to Drupal (pronounced as “droo-puhl”, derived from the English pronunciation of the Dutch word “Druppel” which means “drop”). The purpose was to enable others to use and extend the experimentation platform so that more people could develop it further.

Drupal.org is a well established and active community with over 630,000 subscribed members.

This web application makes use of PHP as a programming language and MySQL as a database backend.

In Drupal every “page” is a node. You can define as many nodes as you need (news, page, event etc) and create “child” pages if you like (and move them to another parent page if necessary).

The editing function is easy: you can easily edit the format without needing HTML (looks quite like WordPress) and add files as if were email. Therefore it could easily have a wiki function as well.

Drupal is fitted with a very good taxonomy system. This helps to organize nodes and menus.

Nodes, account registration and maintenance, menu management, and system administration all are basic features of  the standard release of Drupal, known as Drupal core.

But thanks to the large community, Drupal benefits from thousands of third party modules, to tailor Drupal to your needs. When choosing modules it is important to check for longevity (are modules still being adapted for new Drupal releases, how many downloads are there: the more downloads the more popular the module, the more likely the module is going to stay).

There are also different themes.

Drupal is used a lot by libraries and libraries in turn have developed specific modules apt to use for library-purposes.

The view-module enables you to provide a view of the metadata and you can use metadata as a filter to create lists. Patrick was very enthusiastic about the bibliographic function (“the ENDNOTE within the context management system). He showed that it was very easy to import and search for bibliographic records (and metadata) from PubMed, Google Scholar etc (and maintain correct links over time), i.e. just enter the PMID, DOI lookup etc. Keywords like MeSH are loaded correctly.

Forgive me if I don’t remember (and even may be wrong about) the technical details, but it really looked like a great tool with many possible forms of  uses.

If you need more information you can contact Patrick (Twitter: @pchalon) or consult Drupal and especially the Drupal Group “Libraries”  and Drupalib.

And as said, there is a large active community. For Drupal’s motto is “Come for the software, stay for the community.”

Examples of Drupal Websites:

 http://www.cochrane.org/. The new face of the Cochrane was created by its webmaster Chris Mavergames, and it is far more inviting to read and more interactive then it’s boring predecessor. As a matter of fact it was Chris’ enthusiasm about Drupal and the new looks of the Cochrane site which raised my interest into Drupal. Chris has a website about Drupal (& web development, linked data & information architecture in general) and a Twitter list of Drupal folks you can follow.

Another example is http://htai.org/vortal, created by Patrick. Here is a presentation by Patrick that shows more details about this website (and Drupal’s versatility to create library websites).

This blogpost is largely based on the comprehensive course notes of Patrick Chalon’s “Drupal for Librarians” (CC), supplemented with my own notes.

Related articles

• #EAHIL2012 CEC 2: Visibility & Impact – Library’s New Role to Enhance Visibility of Researchers (laikaspoetnik.wordpress.com)
• Drupal Global Training Days This Friday, June 22 (drupal.org)
• How to upload applications written in C# onto a website using Drupal? (stackoverflow.com)
• Dynamic Semantic Publishing for Beginners, Part 3 (semanticweb.com)

#EAHIL2012 CEC 2: Visibility & Impact – Library’s New Role to Enhance Visibility of Researchers

This week I’m blogging at (and mostly about) the 13th EAHIL conference in Brussels. EAHIL stands for European Association for Health Information and Libraries.

The second Continuing Education Course (CEC) I followed was given by Tiina Heino and Katri Larmo of the Terkko Meilahti Campus Library at the University of Helsinki in Finland.

The full title of the course was Visibility and impact – library’s new role: How the library can support the researcher to get visibility and generate impact to researcher’s work. You can read the abstract here.

The hands-on workshop mainly concentrated on the social bookmarking sites Connotea, Mendeley and Altmetric.

Furthermore we got information on CiteULike, ORCID,  Faculty of 1000 Posters and Pinterest. Also services developed in Terkko, such as ScholarChart and TopCited Articles, were shortly demonstrated.

What I especially liked in the hands on session is that the tutors had prepared a wikispace with all the information and links on the main page ( https://visibility2012.wikispaces.com) and a separate page for each participant to edit (here is my page). You could add links to your created accounts and embed widgets for Mendeley.

There was sufficient time to practice and try the tools. And despite the great number of participants there was ample room for questions (& even for making a blog draft ;)).

The main message of the tutors is that the process of publishing scientific research doesn’t end at publishing the article: it is equally important what happens after the research has been published. Visibility and impact in the scientific community and in the society are  crucial  for making the research go forward as well as for getting research funding and promoting the researcher’s career. The Fig below (taken from the presentation) visualizes this process.

The tutors discussed ORCID, Open Researcher and contributor ID, that will be introduced later this year. It is meant to solve the author name ambiguity problem in scholarly communication by central registry of unique identifiers for each author (because author names can’t be used to reliably identify all scholarly author). It will be possible for authors to create, manage and share their ORCID record without membership fee. For further information see several publications and presentations by Martin Fenner. I found this one during the course while browsing Mendeley.

Once published the author’s work can be promoted using bookmarking tools, like CiteULike, Connotea and Mendeley. You can easily registrate for Connotea and Mendeley using your Facebook account. These social bookmarking tools are also useful for networking, i.e. to discover individuals and groups with the same field of interest. It is easy to synchronize your Mendeley with your CiteULike account.

Mendeley is available in a desktop and a web version. The web version offers a public profile for researchers, a catalog of documents, and collaborative groups (the cloud of Mendeley). The desktop version of Mendeley is specially suited for reference management and organizing your PDF’s. That said Mendeley seems most suitable for serendipitous use (clicking and importing a reference you happen to see and like) and less useful for managing and deduplicating large numbers of records, i.e. for a systematic review.
Also (during the course) it was not possible to import several PubMed records at once in either CiteULike or Mendeley.

What stroke me when I tried Mendeley is that there were many small or dead groups. A search for “cochrane”  for instance yielded one large group Cochrane QES Register, owned by Andrew Booth, and 3 groups with one member (thus not really a group), with 0 (!) to 6 papers each! It looks like people are trying Mendeley and other tools just for a short while. Indeed, most papers I looked up in PubMed were not bookmarked at all. It makes you wonder how widespread the use of these bookmarking tools is. It probably doesn’t help that there are so many tools with different purposes and possibilities.

Another tool that we tried was Altmetric. This is a free bookmarklet on scholarly articles which allows you to track the conversations around scientific articles online. It shows the tweets, blogposts, Google+ and Facebook mentions, and the numbers of bookmarks on Mendeley, CiteULike and Connotea.

I tried the tool on a paper I blogged about , ie. Seventy-Five Trials and Eleven Systematic Reviews a Day: How Will We Ever Keep Up?

The bookmarklet showed the tweets and the blogposts mentioning the paper.

Indeed altmetrics did correctly refer to my blog (even to 2 posts).

I liked altmetrics*, but saying that it is suitable for scientific metrics is a step too far. For people interested in this topic I would like to refer -again- to a post of Martin Fenner on altmetrics (in general).  He stresses that “usage metrics”  has its limitations because of its proness  to “gaming” (cheating).

But the current workshop didn’t address the shortcomings of the tools, for it was meant as a first practical acquaintance with the web 2.0 tools.

For the other tools (Faculty of 1000 Posters, Pinterest) and the services developed in Terkko, such as ScholarChart and TopCited Articles,  see the wikipage and the presentation:

*Coincidentally I’m preparing a post on handy chrome extensions to look for tweets about a webpage. Altmetric is another tool which seems very suitable for this purpose

Related articles

• A New Social Network For Science Could Change How We Make Discoveries (fastcoexist.com)
• All Researchers To Be Allocated Unique IDs (news.slashdot.org)
• Orcid (programmableweb.com)
• An inventory of experts, but beware (montagueinstitute.wordpress.com)
• Scholars are quickly moving toward a universe of web-native communication (blogs.lse.ac.uk)
• Mendeley: a “Facebook for Researchers”? (scienceintelligence.wordpress.com)
• Social Bookmarking finally comes to serious cancer journals? (pharmastrategyblog.com)
• Mendeley: A new good tool for our computers (litteramedia.wordpress.com)

Even the Scientific American Blog Links to Spammy Online Education Affiliate Sites…

On numerous occasions [1,2,3] I have warned against top Twitter and Blog lists spread by education affiliate sites.
Sites like accreditedonlinecolleges.com, onlinecolleges.com, onlinecollegesusa.org, onlinedegrees.com, mbaonline.com.

While some of the published Twitter Top 50 lists and Blog top 100 lists may be interesting as such (or may flatter you if you’re on it), the only intention of the makers is to lure you to their site and earn money through click-throughs.

Or as David Bradley from Sciencebase said it much more eloquently than I could:
(in a previous comment) 

“I get endless emails from people with these kinds of sites telling me I am on such and such a list…I even get different messages claiming to be from different people, but actually the same email address.They’re splogs and link bait scams almost always and unfortunately some people get suckered into linking to them, giving them credence and publicity. They’re a pain in the ‘arris.

These education sites do not only produce these “fantabulous” top 50 and 100 lists.
I also receive many requests for guest-authorships, and undoubtedly I’m not the only one.

Recently I also received a request from mbaonlinedegrees to post an infographic:

“While searching for resources about the internet, I came across your site and noticed that you had posted the ‘State of the Internet’ video. I wanted to reach out as I have an infographic about the topic that I think would be a great fit for your site.”

But this mba.onlinedegrees infographic was a simple, yes even simplistic, summary of “a day at the internet”:

How many emails are sent, blog posts are made, how many people visit Facebook and how many updates are updated, and so forth and so on. Plus: Internet users spend 14.6 minutes viewing porn online: the average fap session is 12 minutes…
(How would they know?)

Anyway not the kind of information my readers are looking for. So I didn’t write a post with the embedding the code for the infographic.

Thus these online education affiliate sites produce top 50 and 100 lists, blogposts, guestposts and infographics and promote their use by actively approaching bloggers and people on Twitter.

I was surprised to find¹, however that even the high quality Scientific American science blog “Observations“ (Opinion, arguments & analyses from the editors of Scientific American) blindly linked to such a spammy infographic (just adding a short meaningless introduction) [4].

That is an easy way to increase the numbers of blog posts….

And according to an insider commenting to the article the actual information in the infographic is even simply wrong.

“These MBAs have a smaller brain than accountants. They don’t know the difference between asset, revenue and income”.

If such a high authority science blog does not know to separate the wheat from the chaff, does not recognize splogs as such, and does not even (at the very least) filter and track the information offered, …. than who can…. who will….?³

Sometimes I feel like a miniature version of Don Quixote…

————-

NOTES

1.  HATTIP:

Again, @Nutsci brought this to my attention:

I see infographics from sketchy online education affiliate sites all the time. They get boosts when linked http://t.co/16jl6DWf cc @laikas

— Colby Vorland (@nutsci) May 26, 2012

2. In response to my post @AdamMerberg tweeted a link to a very interesting article in the Atlantic by Megan McArdle issuing a plea to bloggers to help stop this plague in its track. (i.e. saying:  The reservoir of this disease of erroneous infographics is internet marketers who don’t care whether the information in their graphics is right … just so long as you link it.). She even uses an infographic herself to deliver her message. Highly recommended!

@nutsci @laikas Ending the Infographic Plague: http://t.co/kJYOv7zd

— Adam Merberg (@AdamMerberg) May 28, 2012

3. This doesn’t mean that Scientific American doesn’t produce good blog posts or good scientific papers. Just the other day, I tweeted:

Looks like a magazine @SciAm is more sensible than @TheLancet editorial that advises all over 50 to take statins http://t.co/8YOkEtjd

— Laika (Jacqueline) (@laikas) May 21, 2012

The referred article Scientific American puts a new meta-analysis of statins and an accompanying editorial in the Lancet in broader perspective. The meta-analysis suggests that healthy people over 50 should take cholesterol-lowering drugs as a preventative measure. Scientific American questions this by also addressing the background risks (low for most 50+ people), possible risks of statin use, cost-effectiveness and the issue of funding by pharmaceutical companies and other types of bias.

References

1. Health and Science Twitter & Blog Top 50 and 100 Lists. How to Separate the Wheat from the Chaff. (laikaspoetnik.wordpress.com)
2. Beware of Top 50 “Great Tools to Double Check your Doctor” or whatever Lists. (laikaspoetnik.wordpress.com)
3. Vanity is the Quicksand of Reasoning: Beware of Top 100 and 50 lists! ((laikaspoetnik.wordpress.com)
4. What’s Smaller than Mark Zuckerberg? (blogs.scientificamerican.com/observations/)

Health and Science Twitter & Blog Top 50 and 100 Lists. How to Separate the Wheat from the Chaff.

Recently a Top 100 scientists-Twitter list got viral on Twitter. It was published at accreditedonlinecolleges.com/blog.*

Most people just tweeted “Top 100 Scientists on Twitter”, others were excited to be on the list, a few mentioned the lack of scientist X or discipline Y  in the top 100.

Two scientist noticed something peculiar about the list: @seanmcarroll noticed two fake (!) accounts under “physics” (as later explained these were: @NIMAARKANIHAMED and @Prof_S_Hawking). And @nutsci (having read two posts of mine about spam top 50 or 100 lists [1, 2]) recognized this Twitter list as spam:

Beware of "top 100 scientists" and similar lists passing around twitter. See @laikas posts on why http://t.co/N8dSrSD7

— Colby Vorland (@nutsci) March 18, 2012

It is surprising how easy it (still) is for such spammy Top 50 or 100 Lists to get viral, whereas they only have been published to generate more traffic to the website and/or to earn revenue through click-throughs.

It makes me wonder why well-educated people like scientists and doctors swallow the bait. Don’t they recognize the spam? Do they feel flattered to be on the list, or do they take offence when they (or another person who “deserves” it) aren’t chosen? Or perhaps they just find the list useful and want to share it, without taking a close look?

To help you to recognize and avoid such spammy lists, here are some tips to separate the wheat from the chaff:

1. Check WHO made the list. Is it from an expert in the field, someone you trust? (and/or someone you like to follow?)
2. If you don’t know the author in person, check the site which publishes the list (often a “blog”):
   1. Beware if there is no (or little info in the) ABOUT-section.
   2. Beware if the site mainly (only) has these kind of lists or short -very general-blogposts (like 10 ways to….) except when the author is somebody like Darren Rowse aka @ProBlogger [3].
   3. Beware if it is a very general site producing a diversity of very specialised lists (who can be expert in all fields?)
   4. Beware if the website has any of the following (not mutually exclusive) characteristics:
      1. Web addresses like accreditedonlinecolleges.com, onlinecolleges.com, onlinecollegesusa.org,  onlinedegrees.com (watch out com sites anyway)
      2. Websites with a Quick-degree, nursing degree, technician school etc finder
      3. Prominent links at the homepage to Kaplan University, University of Phoenix, Grand Canyon University etc
   5. Reputable sites less likely produce nonsense lists. See for instance this “Women in science blogging”-list published in the Guardian [4].
3. When the site itself seems ok, check whether the names on the list seem trustworthy and worth a follow. Clearly, lists with fake accounts (other then lists with “top 50 fake accounts” ;)) aren’t worth the bother: apparently the creator didn’t make the effort to verify the accounts and/or hasn’t the capacity to understand the tweets/topic.
4. Ideally the list should have added value. Meaning that it should be more than a summary of names and copy pasting of the bio or “about” section.
   For instance I have recently been put on a list of onlinecollegesusa.org [b], but the author had just copied the subtitle of my blog: …. a medical librarian and her blog explores the web 2.0 world as it relates to library science and beyond.
   However, sometimes, the added value may just be that the author is a highly recognized expert or opinion leader. For instance this Top Health & Medical Bloggers (& Their Twitter Names) List [5] by the well known health blogger Dean Giustini.
5. In what way do these lists represent *top* Blogs or Twitter accounts? Are their blogs worth reading and/or their Twitter accounts worth following? A nobel price winner may be a top scientist, but may not necessarily be a good blogger and/or may not have interesting tweets. (personally I know various examples of uninteresting accounts of *celebrities* in health, science and politics)
6. Beware if you are actively approached and kindly requested to spread the list to your audience. (for this is what they want).It goes like this (watch the impersonal tone):
   

   Your Blog is being featured!

   Hi There,

   I recently compiled a list of the best librarian blogs, and I wanted to let you know that you made the list! You can find your site linked here: […]

   If you have any feedback please let me know, or if you think your audience would find any of this information useful, please feel free to share the link. We always appreciate a Facebook Like, a Google +1, a Stumble Upon or even a regular old link back, as we’re trying to increase our readership.

   Thanks again, and have a great day!

While some of the list may be worthwhile in itself, it is best NOT TO LINK TO DOUBTFUL LISTS, thus not  mention them on Twitter, not retweet the lists and not blog about it. For this is what they only want to achieve.

But what if you really find this list interesting?

Here are some tips to find alternatives to these spammy lists (often opposite to above-mentioned words of caution) 

1. Find posts/lists produced by experts in the field and/or people you trust or like to follow. Their choice of blogs or twitter-accounts (albeit subjective and incomplete) will probably suit you the best. For isn’t this what it is all about?
2. Especially useful are posts that give you more information about the people on the list. Like this top-10 librarian list by Phil Bradley [6] and the excellent “100+ women healthcare academics” compiled by @amcunningham and @trishgreenhalgh [7].
   Strikingly the reason to create the latter list was that a spammy list not recognized as such (“50 Medical School Professors You Should Be Following On Twitter”  [c])  seemed short on women….
3. In case of Twitter-accounts:
   1. Check existing Twitter lists of people you find interesting to follow. You can follow the entire lists or just those people you find most interesting.
      Examples: I created a list with people from the EBM-cochrane people & sceptics [8]. Nutritional science grad student @Nutsci has a nutrition-health-science list [9]. The more followers, the more popular the list.
   2. Check interesting conversation partners of people you follow.
   3. Check accounts of people who are often retweeted in the field.
   4. Keep an eye on #FF (#FollowFriday) mentions, where people worth following are highlighted
   5. Check a topic on Listorious. For instance @hrana made a list of Twitter-doctors[10]. There are also scientists-lists (then again, check who made the list and who is on the list. Some health/nutrition lists are really bad if you’re interested in science and not junk)
   6. Worth mentioning are shared lists that are open for edit (so there are many contributors besides the curator). Lists [4] and [7] are examples of crowd sourced lists. Other examples are truly open-to-edit lists using public spreadsheets, like the Top Twitter Doctors[11], created by Dr Ves and  lists for science and bio(medical) journals [12], created by me.
4. Finally, if you find the spam top 100 list truly helpful, and don’t know too many people in the field, just check out some of the names without linking to the list or spreading the word.

*For obvious reasons I will not hyperlink to these sites, but if you would like to check them, these are the links

[a] accreditedonlinecolleges.com/blog/2012/top-100-scientists-on-twitter

[b] onlinecollegesusa.org/librarian-resources-online

[c] thedegree360.onlinedegrees.com/50-must-follow-medical-school-professors-on-twitter

Related articles

1. Beware of Top 50 “Great Tools to Double Check your Doctor” or whatever Lists. (laikaspoetnik.wordpress.com)
2. Vanity is the Quicksand of Reasoning: Beware of Top 100 and 50 lists! ((laikaspoetnik.wordpress.com)
3. Google+ Tactics of the Blogging Pros (problogger.net)
4. “Women in science blogging” by Martin Robbins ( http://www.guardian.co.uk/science)
5. Top Health & Medical Bloggers (& Their Twitter Names) List (blog.openmedicine.ca)
6. Top-10 librarian list by Phil Bradley (www.blogs.com/topten)
7. 100+ women healthcare academics by Annemarie Cunningham/ Trisha Greenhalgh (wishfulthinkinginmedicaleducation.blogspot.com)
8. Twitter-doctors by @hrana (listorious.com)
9. EBM-cochrane people & sceptics (Twitter list by @laikas)
10. Nutrition-health-science (Twitter list by @nutsci)
11. Open for edit: Top Twitter Doctors arranged by specialty in alphabetical order (Google Spreadsheet by @drves)
12. TWITTER BIOMEDICAL AND OTHER SCIENTIFIC JOURNALS & MAGAZINES (Google Spreadsheet by @laikas)

Grand Rounds: Evolving from Link-♥♥ to ♬♫-Links?

Grand Rounds is “the weekly summary of the best healthcare writing online”. I’ve hosted this medical blog carnival twice and considered it a great honor to do so.

I have submitted a lot of posts to the Grand Rounds. Often I even wrote a special blog post to fit the theme if there was one. Almost all my submissions have been accepted. I really enjoyed the compilations. There was a lot of outstanding creativity and originality in how the links to the blogs were “aggregated” and highlighted.

Usually I only read those posts that seemed the most interesting to me (the summary thus works as a filter). But through the Grand Rounds I read posts that I would never have read and I learned about bloggers I never heard of.

Why am I talking in the past tense? The Grand Round is still there, isn’t it?!

Yes, it is still there (luckily), but the organizers are thinking of a “rejuvenation of  this old dinosaur”. As the previous host, Margaret Polaneczky explained

“… Grand Rounds has dropped a bit off all of our radars. Many, if not most of us have abandoned the old RSS feed to hang out on Twitter, where our online community has grown from a few dozen bloggers to feeds and followers in the hundreds and even thousands.”

One of the measures is that the Grand Rounds editions should be more concise and only include the “best posts”.

I too go for quality, and think one should carefully select contributors (and hosts), but is the 7-year-old dinosaur to be saved by chopping him in pieces? Should we only refer to 10 posts at the max and put the message in a tweet-format like Margaret did in an experiment?
I was glad that Margaret gave a good old fashioned long introduction in the Dinosaur’s style, for that was what I read, NOT the tweets. Sorry tweets are NOT a nice compilation. They are difficult to read.
It also isn’t a solution to tweet the individual links, because a lot of those individual tweets will be missed by most of the potential readers. It is not coherent either. The strength of the Grand Rounds is in the compilation, in the way the host makes the posts digestible. I would say: let the host present the posts in an attractive way and let the reader do the selection and digestion.

Also important: how many of us will write blog posts specially for the Grand Rounds if there is a chance of 2 in 3 that it will be rejected?

It is true that the Grand Rounds is less popular than a few years ago and it is harder to get hosts. But that may partly have to do with advertising. My first Grand Rounds got far more hits than the second one, mainly because we sent a notice to great blogs that linked to us, like Instapundit (853 hits alone) and there was an interview with the host announcing the Grand Rounds at MEDSCAPE. In this way the main intended audience (non-blogging lay people) were also reached. The second time my post was just found by a handful of people checking the edition plus this blog own readers.
(I have to admit that this last Grand Rounds Edition might have been better if it had been more concise, but at least one person (Pranab of Scepticemia) spend  2 hours in reading almost all the posts of the round-up. So it wasn’t for nothing)

If some busy clinicians can be persuaded to host The Grand Rounds using a shorter format, that is fine. And it is good to be more concise and leave out what isn’t of high quality. But why make it a rule to include just 10 or 12? Even more important, don’t change blog posts for tweets. For I don’t think, as Margaret passed on, that the concept of the individual blog has been sometimes “overshadowed by Twitter and Facebook, whose continual unending stream demands our constant attention, lest we miss something important that someone said or re-said…” Even I have given up to constantly follow all streams, and I suppose the same is true for most clinicians, nurses etc. Lets not replace posts by tweets but lets use Twitter and Facebook to promote the Grand Rounds and augment its radius.

The main reason for writing this post is that I disliked the description by Bryan Vartebedian (host of the next round) rather off-putting, perhaps even arrogant:

Grand Rounds is evolving as a more focused, curated publication.  Rather than a 4,000 word chain-o-links, Nick Genes, Val Jones and others felt that a focused collection of recommendations would be more manageable for both readers and hosts.  This is Grand Rounds for quality rather than link love.

Bryan loves the word link-love. Two posts back he wrote:

It isn’t contacts, followers, friends, subscriptions, readers, link love, mentions, or people’s attention.  It’s time.  With time I can have all of these things.  

“Link love” and “chain-o-links” undervalue what blog carnivals are about. Perhaps some bloggers just want to be linked to, but most want to be read, and that is the entire idea behind the blog carnival. I can’t imagine that the blog hosts aim to include as many links as possible. At the most it is love for particular posts not “link love” perse.

Changing the format to tweets (♬♫) will only increase the link/text ratio. Links will become more prominent.

I would rather go for the ♥♥-links*, because I ♥ to blog and I ♥ to read good stuff.

——–

* Note that ♥♥-links is not the same as link-♥

——–

Here is a short Twitter Discussion about the new approach. I fully agree with Ves Dimov viewpoint, especially the last tweet.

https://twitter.com/#!/DrVes/statuses/155697725134995456

https://twitter.com/#!/rlbates/statuses/155698766945587200

@laikas Even if you submit to Grand Rounds, the post may not be included. Selection criteria are unclear, and change from host to host.

— Ves Dimov, M.D. (@DrVes) January 7, 2012

https://twitter.com/#!/Bongi1/statuses/155719544613240832

Related articles

• Medical Grand Rounds is Coming to 33 charts (33charts.com)
• A personal reflection on 2011 – the importance of diagnosis (medrants.com)
• Grand Rounds Vol 8 nr 5: Data, Information & Communication (laikaspoetnik.wordpress.com)
• Studying alternative medicine with federal dollars – latimes.com (gruntdoc.com)
• Physician online professionalism in social media (kevinmd.com)
• Twitter will eat itself (howtosurvivesocialmedia.wordpress.com)

Friday Foolery # 47 WTF, the True Spirit of Christmas

The true spirit of Christmas is in “loving” and to “do good for others”, ” thinking of” and “helping the less fortunate”.

However, many of today’s children,  weaned on luxury goods and gadgets, consider themselves as the “less fortunates” and thus are on the  “receiving” rather than the “giving” site. And are easily disappointed… and crossed if they don’t get the expected $$$ gift.

Am I exaggerating? I truly hope so.

But if you had searched Twitter for popular expensive gits “car”, “i-pad” or “i-phone” like comedy writer Jon Hendren (@fart) did, you had seen numerous dissatisfied tweets of extremely spoiled kids and adolescents:

https://twitter.com/#!/Tonimoretto/status/150701909479661569

https://twitter.com/#!/Bossybeegee/status/150985722730512384

https://twitter.com/#!/SamStandsFoSwag/status/150993796312739840

http://twitter.com/LeemyLeem_/status/150978171200745472

https://twitter.com/#!/dizzydentgirl/status/150980418718543872

https://twitter.com/#!/guhrace_/status/151039463672397824

My parents are the worst mother Fucking parents in the world fuck you mom and dad for not getting me a Iphone. FUCK YOU. FML. #Iphone

— MA, Glory (@vvvvv___vvvvv) December 25, 2011

https://twitter.com/#!/paulyandmolly/status/151053132498087936

———–

The tweets have even been compiled in a song by Jonathan Mann, the “Song a Day Man“. After seeing the tweets it should be no surprise that it is called “WTF?! I wanted an iPhone!”

———–

It makes me kind a sad. It is quite an anti-Christmas attitude.

The kids in this video below have every right to be disappointed though. (via Mashable)

———–

Sources

• ‘WTF?! I Wanted an iPhone!’ Entitled Christmas Tweets Put to Music [VIDEO] (mashable.com)
• Ungrateful Kids React to Bad Christmas Presents (mashable.com)

Related articles

• Friday Foolery #46 Bad Science: The Psychology Behind Exaggerated & False Results (laikaspoetnik.wordpress.com)
• Friday Foolery #45. What have you got in your head? (laikaspoetnik.wordpress.com)
• Friday Foolery #44. The Shortest Abstract Ever. (laikaspoetnik.wordpress.com)
• WTF! I Wanted an iPhone [Video] (collegecandy.com)
• Wanted an iPhone 4S / iPad / Pair of Jordans for Christmas And Didn’t Get It? (gottabemobile.com)

Silly Sunday #43 Know Your Numbers

As I touched upon in Grand Rounds 8.5 the Mayo Clinic Center held the 3rd Social Media’s Health Care Social Media Summit a few weeks ago. Lots of good information and resources were shared, including the video below. The video has already gone viral (it has been viewed appr. 24,000 times), but most important is that its message gets viral.

The song is a parody of 867-5309/Jenny, produced by the Mayo Clinic Center* to promote healthy heart awareness, especially among women:

Heart disease is the number one killer of men and women, but most women aren’t aware of this.

You need to know your numbers, don’t let them get too high: blood pressure, lipids and BMI

I love it & remember, know your numbers!

Go to http://knowyournumbers.me/ to calculate your heart risk (BMI and LDL-cholesterol) and see how you can lower it.

You can become a fan of Mayo Clinic at Facebook:
http://www.facebook.com/MayoClinic

* For this purpose, the band of Ron Menaker, the administrator for the Mayo Clinic Division of Cardiovascular Diseases, was renamed to “Tommy and the Heartbeats” (see The  Making of  Know Your Numbers) .

Hattip: Scott Hensley (Facebook)

Related articles

• Friday Foolery #41. A Special Offer for the Major [#4square] (laikaspoetnik.wordpress.com)
• Friday Foolery #42 So You Think You Can Dance Your PhD Thesis? (laikaspoetnik.wordpress.com)
• Mayo’s Parody Video Invites You to Know Your Numbers: Blood Pressure, Lipids, and BMI (Sing to the tune of Jenny 867-5309) (managemypractice.com)
• Health Care Social Media Summit – Mayo Clinic Center for Social Media – Wrapup (healthblawg.typepad.com)
• Mayo Clinic Parodies ‘867-5309/Jenny’ Song To Promote Heart Health (huffingtonpost.com)

Friday Foolery #41. A Special Offer for the Major [#4square]

Foursquare (4square) is a web and mobile application that allows registered users to connect with friends and update their location. Points are awarded for “checking in” at venues. The user with the most number of *days* with check-ins at a specific place within the past 60 days qualifies to become the mayor of that place.
To foster brand loyalty some businesses are offering specials for the mayor of the venues. Recently I received a USB-stick for becoming the major of a computer shop.

Today at Department X of our hospital, I saw this Special offer:

Apparently it was unlocked….

OCT = Optical coherence tomography

Related articles

• My 4 points on 4square (aliciamphillips.wordpress.com)

Medical Black Humor, that is Neither Funny nor Appropriate.

Last week, I happened to see this Facebook post of the The Medical Registrar where she offends a GP, Anne Marie Cunningham*, who wrote a critical post about black medical humor at her blog “Wishful Thinking in Medical Education”. I couldn’t resist placing a likewise “funny” comment in this hostile environment where everyone seemed to agree (till then) and try to beat each other in levels of wittiness (“most naive child like GP ever” – “literally the most boring blog I have ever read”,  “someone hasn’t met many midwives in that ivory tower there.”, ~ insulting for a trout etc.):

“Makes no comment, other than anyone who uses terms like “humourless old trout” for a GP who raises a relevant point at her blog is an arrogant jerk and an unempathetic bastard, until proven otherwise…  No, seriously, from a patient’s viewpoint terms like “labia ward” are indeed derogatory and should be avoided on open social media platforms.”

I was angered, because it is so easy to attack someone personally instead of discussing the issues raised.

Perhaps you first want to read the post of Anne Marie yourself (and please pay attention to the comments too).

Social media, black humour and professionals…

Anne Marie mainly discusses her feelings after she came across a discussion between several male doctors on Twitter using slang like ‘labia ward’ and ‘birthing sheds’ for birth wards, “cabbage patch” to refer to the intensive care and madwives for midwives (midwitches is another one). She discussed it with the doctors in question, but only one of them admitted he had perhaps misjudged sending the tweet. After consulting other professionals privately, she writes a post on her blog without revealing the identity of the doctors involved. She also puts it in a wider context by referring to  the medical literature on professionalism and black humour quoting Berk (and others):

“Simply put, derogatory and cynical humour as displayed by medical personnel are forms of verbal abuse, disrespect and the dehumanisation of their patients and themselves. Those individuals who are the most vulnerable and powerless in the clinical environment – students, patients and patients’ families – have become the targets of the abuse. Such humour is indefensible, whether the target is within hearing range or not; it cannot be justified as a socially acceptable release valve or as a coping mechanism for stress and exhaustion.”

The doctors involved do not make any effort to explain what motivated them. But two female anesthetic registrars frankly comment to the post of Anne Marie (one of them having created the term “labia ward”, thereby disproving that this term is misogynic per se). Both explain that using such slang terms isn’t about insulting anyone and that they are still professionals caring for patients:

 It is about coping, and still caring, without either going insane or crying at work (try to avoid that – wait until I’m at home). Because we can’t fall apart. We have to be able to come out of resus, where we’ve just been unable to save a baby from cotdeath, and cope with being shouted and sworn at be someone cross at being kept waiting to be seen about a cut finger. To our patients we must be cool, calm professionals. But to our friends, and colleagues, we will joke about things that others would recoil from in horror. Because it beats rocking backwards and forwards in the country.

[Just a detail, but “Labia ward” is a simple play on words to portray that not all women in the “Labor Ward” are involved in labor. However, this too is misnomer.  Labia have little to do with severe pre-eclampsia, intra-uterine death or a late termination of pregnancy]

To a certain extent medical slang is understandable, but it should stay behind the doors of the ward or at least not be said in a context that could offend colleagues and patients or their carers. And that is the entire issue. The discussion here was on Twitter, which is an open platform. Tweets are not private and can be read by other doctors, midwives, the NHS and patients. Or as e-Patient Dave expresses so eloquently:

I say, one is responsible for one’s public statements. Cussing to one’s buddies on a tram is not the same as cussing in a corner booth at the pub. If you want to use venting vocabulary in a circle, use email with CC’s, or a Google+ Circle.
One may claim – ONCE – ignorance, as in, “Oh, others could see that??” It must, I say, then be accompanied by an earnest “Oh crap!!” Beyond that, it’s as rude as cussing in a streetcorner crowd.

Furthermore, it seemed the tweet served no other goal as to be satirical, sardonic, sarcastic and subversive (words in the bio of the anesthetist concerned). And sarcasm isn’t limited to this one or two tweets. Just the other day he was insulting to a medical student saying among other things:“I haven’t got anything against you. I don’t even know you. I can’t decide whether it’s paranoia, or narcissism, you have”. 

We are not talking about restriction of “free speech” here. Doctors just have to think twice before they say something, anything on Twitter and Facebook, especially when they are presenting themselves as MD.  Not only because it can be offensive to colleagues and patients, but also because they have a role model function for younger doctors and medical students.

Isolated tweets of one or two doctors using slang is not the biggest problem, in my opinion. What I found far more worrying, was the arrogant and insulting comment at Facebook and the massive support it got from other doctors and medical students. Apparently there are many “I-like-to-exhibit-my-dark-humor-skills-and-don’t-give-a-shit-what-you think-doctors” at Facebook (and Twitter) and they have a large like-minded medical audience: the “medical registrar page alone has 19,000 (!) “fans”.

Sadly there is a total lack of reflection and reason in many of the comments. What to think of:

“wow, really. The quasi-academic language and touchy-feely social social science bullshit aside, this woman makes very few points, valid or otherwise. Much like these pages, if you’re offended, fuck off and don’t follow them on Twitter, and cabbage patch to refer to ITU is probably one of the kinder phrases I’ve heard…”

and

“Oh my god. Didnt realise there were so many easily offended, left winging, fun sponging, life sucking, anti- fun, humourless people out there. Get a grip people. Are you telling me you never laughed at the revue’s at your medical schools?”

and

“It may be my view and my view alone but the people who complain about such exchanges, on the whole, tend to be the most insincere, narcissistic and odious little fuckers around with almost NO genuine empathy for the patient and the sole desire to make themselves look like the good guy rather than to serve anyone else.”

It seems these doctors and their fans don’t seem to possess the communicative and emphatic skills one would hope them to have.

One might object that it is *just* Facebook or that “#twitter is supposed to be fun, people!” (dr Fiona) 

I wouldn’t agree for 3 reasons:

• Doctors are not teenagers anymore and need to act as grown-ups (or better: as professionals)
• There is no reason to believe that people who make it their habit to offend others online behave very differently IRL
• Seeing Twitter as “just for fun” is an underestimation of the real power of Twitter

Note: *It is purely coincidental that the previous post also involved Anne Marie.

Other articles about this topic

• Storm brews across a pond (runningahospital.blogspot.com)
• Social Media and the Medical Profession (claireot.wordpress.com)
• What is acceptable language from health professionals online? (sarah-stewart.blogspot.com) neutral and well written piece by a midwife
• Online medics reveal secret names for patients and colleagues (telegraph.co.uk)

Related articles

• The one thing doctors can’t laugh off is bad care (telegraph.co.uk)
• Carry on, doctor (telegraph.co.uk)
• Facebook friends a no-no for doctors (guardian.co.uk)
• Etiquette Based Medicine (laikaspoetnik.wordpress.com)

#FollowFriday #FF @DrJenGunter: EBM Sex Health Expert Wielding the Lasso of Truth

If you’re on Twitter you probably seen the #FF or #FollowFriday phenomenon. FollowFriday is a way to recommend people on Twitter to others. For at least 2 reasons: to acknowledge your favorite tweople and to make it easier for your followers to find new interesting people.

However, some #FollowFriday tweet-series are more like a weekly spam. Almost 2 years ago I blogged about the misuse of FF-recommendations and I gave some suggestions to do #FollowFriday the right way: not by sheer mentioning many people in numerous  tweets, but by recommending one or a few people a time, and explaining why this person is so awesome to follow.

Twitter Lists are also useful tools for recommending people (see post). You could construct lists of your favorite Twitter people for others to follow. I have created a general FollowFridays list, where I list all the people I have recommended in a #FF-tweet and/or post.

In this post I would like to take up the tradition of highlighting the #FF favs at my blog. .

This FollowFriday I recommend:  

Jennifer Gunter

Jennifer Gunter (@DrJenGunter at Twitter), is a beautiful lady, but she shouldn’t be tackled without gloves, for she is a true defender of evidence-based medicine and wields the lasso of truth.

Her specialty is OB/GYN. She is a sex health expert. No surprise, many tweets are related to this topic, some very serious, some with a humorous undertone. And there can be just fun (re)tweets, like:

LOL -> “@BackpackingDad: New Word: Fungry. Full-hungry. “I just ate a ton of nachos, but hot damn am I fungry for those Buffalo wings!””

Dr Jen Gunter has a blog Dr. Jen Gunther (wielding the lasso of truth). 

Again we find the same spectrum of posts, mostly in the field of ob/gyn. You need not be an ob/gyn nor an EBM expert to enjoy them. Jen’s posts are written in plain language, suitable for anyone to understand (including patients).

Some titles:

• How safe is the HPV vaccine? New data available.
• Some birth control pills have a higher risk of blood clots. Is yours one of them?

In addition, There are also hilarious posts like “Cosmo’s sex position of the day proves they know nothing about good sex or women“,where she criticizes Cosmo for tweeting impossible sex positions (“If you’re over 40, I dare you to even GET into that position! “), which she thinks were created by one of the following:

A) a computer who has never had sex and is not programmed to understand how the female body bends.
B) a computer programmer who has never has sex and has no understanding of how the female body bends.
C) a Yogi master/Olympic athlete.

Sometimes the topic is blogging. Jen is a fierce proponent of medical blogging. She sees it as a way to “promote” yourself as a doctor, to learn from your readers and to “contribute credible content drowns out garbage medical information” (true) and as an ideal platform to deliver content to your patients and like-minded medical professionals. (great idea)

Read more at:

• Blogging with integrity: what does that mean for doctors?
• To blog or not to blog? What’s the answer for you and your practice? (At OBG-management)

You can follow Jen at her Twitter-account (http://twitter.com/#!/DrJenGunter) and/or you can follow my lists. She is on:  ebm-cochrane-sceptics and the followfridays list.

Of course you can also take a subscription to her blog http://drjengunter.wordpress.com/

Related articles

• Twitter’s #FollowFriday #FF – Over the Top. Literally (laikaspoetnik.wordpress.com: 2009/09/11/)
• Laikas Followfriday #FF Twitter List (laikaspoetnik.wordpress.com 2009/11/13/)
• #FollowFriday #FF Dutch @Nutrigenomics @Beatis @TheSofa @DrShock @digicmb (laikaspoetnik.wordpress.com 2009/11/21/)
• #FollowFriday #FF the EBM-Skeptics @cochranecollab @EvidenceMatters @oracknows @ACPinternists (laikaspoetnik.wordpress.com 2009/11/27/)
• How safe is the HPV vaccine? New data available. (drjengunter.wordpress.com/ 2011/06/17/)
• Some birth control pills have a higher risk of blood clots. Is yours one of them? (drjengunter.wordpress.com 2011/05/24/)
• Cosmo’s sex position of the day proves they know nothing about good sex or women” (drjengunter.wordpress.com (2011/08/19)
• To blog or not to blog? What’s the answer for you and your practice? (OBG-management August 2011 · Vol. 23, No. 8)
• Follow Friday Has Become Spam Weekly (5minutesforblogging.wordpress.com)
• Stop Doing Follow Friday Wrong (chris.pirillo.com)

The Second #TwitJC Twitter Journal Club

In the previous post I wrote about  a new initiative on Twitter, the Twitter Journal Club (hashtag #TwitJC). Here, I shared some constructive criticism. The Twitter Journal Club is clearly an original and admirable initiative, that gained a lot of interest. But there is some room for improvement.

I raised two issues: 1. discussions with 100 people are not easy to follow on Twitter, and 2. walking through a checklist for critical appraisals is not the most interesting to do (particularly because it had already been done).

But as one of the organizers explained, the first session was just meant for promoting #twitjc. Instead of the expected 6 people, 100 tweople showed up.

In the second session, last Sunday evening, the organizers followed a different structure.

Thus, I thought it would only be fair, to share my experiences with the second session as well. This time I managed to follow it from start to finish.

Don’t worry. Discussing the journal club won’t be a regular item. I will leave the organization up to the organizers. The sessions might inspire me, though, to write a blog post on the topic now and then. But that may only work synergistic. (at least for me, because it forces me to rethink it all)

This time the discussion was about Rose’s Prevention Paradox (PDF), a 30 year old paper that is still relevant. The paper is more of an opinion piece, therefore the discussion focused on the implications of the Prevention Paradox theory. It was really helpful that Fi wrote an introduction to the paper, and a Points of Discussion beforehand. There were 5 questions (and many sub-questions).

I still found it very hard to follow it all at Twitter, as illustrated by the following tweet:

• laikas I think I lost track. Which question are we? #twitjc Sun Jun 12 20:07:03
• laikas @MsPhelps ik werd wel helemaal duizelig van al die tweets. Er zijn toch wel veel mensen die steeds een andere vraag stellen voor de 1e is beantwoord -9:47 PM Jun 12th, 2011 (about instant nausea when seeing tweets rolling by and people already posing a new question before the first one is answered)

I followed the tweets at http://tweetchat.com/room/twitjc. Imagine tweets rolling by and you try to pick up those tweets you want to respond to (either bc they are very relevant, or because you disagree). By the time you have finished your tweet, already 20 -possibly very interesting tweets- passed by, including the next question by the organizers (unfortunately they didn’t use the official @twitjournalclub account for this).

Well, I suppose I am not very good at this. Partly because I’m Dutch (thus it takes longer to compose my tweets), partly because I’m not a fast thinker. I’m better at thorough analyses, at my blog for instance.

But this is Twitter.  To speak with Johan Cruyff, a legendary soccer-player from Holland, “Every disadvantage has its advantage”.

Twitter may not favor organized discussions, but on the other hand it is very engaging, thought-provoking and easy accessible. Where else do you meet 100 experts/doctors willing  to exchange thoughts about an interesting medical topic?

The tweets below are in line with/reflect my opinion on this second Twitter Journal Club (RT means retweeting/repeating the tweet):

• laikas RT @themattmak: @fidouglas @silv24 Congratulations again on a great #twitjc. Definitely more controversial and debate generating than last week’s! -9:18 PM Jun 12th, 2011
• laikas @silv24 well i think it went well (it is probably me, I’m 2 slow). This paper is broad, evokes much discussion & many examples can B given -9:45 PM Jun 12th, 2011
• DrDLittle Less structure to #twitJC last night but much wider debate 7:41 AM Jun 13th, 2011
• amitns @DrDLittle It’s obviously a very complex topic, more structure would have stifled the debate. A lot of food for thought.#twitJC -7:45 AM Jun 13th, 2011

Again, the Twitter Journal Club gained a lot of interest. Scientist and teachers consider to borrow the concept. Astronomers are already preparing their first meeting on Thursday… And Nature seems to be on top of it as well, as it will interview the organizers of the medical and the astronomy journal club for an interview.

Emergency Physician Tom Young with experience in critically appraisal just summarized it nicely: (still hot from the press):

The two meetings of the journal club so far have not focussed in on this particular system; the first used a standard appraisal tool for randomised controlled trials, the second was more laissez-faire in its approach. This particular journal club is finding its feet in a new setting (that of Twitter) and will find its strongest format through trial and error. indeed, to try to manage such a phenomenon might be likened to ‘herding cats’ that often used description of trying to manage doctors, and I think, we would all agree would be highly inadvisable. Indeed, one of its strengths is that participants, or followers, will take from it what they wish, and this will be something, rather than nothing, whatever paper is discussed, even if it is only contact with another Tweeter, with similar or divergent views. 

Indeed, what I gained from these two meetings is that I met various nice and interesting people (including the organizers, @fidouglas and @silv24). Furthermore, I enjoyed the discussions, and picked up some ideas and examples that I would otherwise wouldn’t know about. The last online meeting sparked my interest in the prevention paradox. Before the meeting, I only read the paper at a glance. After the session I decided to read it again, and in more detail. As a matter of fact I feel inspired to write a blog post about this theory. Originally I planned to write a summary here, but probably the post is getting too long. Thus I will await the summary by the organizers and see if I have time to discuss it as well.

Related articles

• The #TwitJC Twitter Journal Club, a New Initiative on Twitter. Some Initial Thoughts. (laikaspoetnik.wordpress.com)
• Rose G. Strategy of prevention: lessons from cardiovascular disease. Br Med J (Clin Res Ed). 1981 Jun 6;282(6279):1847-51. PubMed PMID: 6786649; PubMed Central PMCID: PMC1506445.
• Introduction: Rose’s Prevention Paradox (twitjc.wordpress.com: 2011/06/12/)
• Week Two: Points of Discussion for this Evening’s #TwitJC (twitjc.wordpress.com: 2011/06/12/)
• Gamma Rays From The Galactic Center and the WMAP Haze: a brief summary (astrojournalclub.wordpress.com)
• Twitter journal club #twitjc (http://twsy.posterous.com)

The #TwitJC Twitter Journal Club, a New Initiative on Twitter. Some Initial Thoughts.

There is a new initiative on Twitter: The Twitter Journal Club. It is initiated by Fi Douglas (@fidouglas) a medical student at Cambridge,  and Natalie Silvey (@silv24)  a junior doctor in the West Midlands.

Fi and Natalie have set up a blog for this event: http://twitjc.wordpress.com/

A Twitter Journal Club operates in the same way as any other journal club, except that the forum is Twitter.

The organizers choose a paper, which they announce at their website (you can make suggestions here or via a tweet). Ideally, people should read the entire paper before the Twitter session. A short summary with key points (i.e. see here) is posted on the website.

The first topic was:  Early Goal-Directed Therapy in the Treatment of Severe Sepsis and Septic Shock [PDF]

It started last Sunday 8 pm (Dutch time) and took almost 2 hours to complete.

@twitjournalclub (the twitter account of the organizers) started with a short introduction. People introduced themselves as they entered the discussion. Each tweet in the discussion was tagged with #TwitJC (a so called hashtag), otherwise it won’t get picked up by people following the hashtag. (Tweetchat automatically provides the hashtag you type in).

Although it was the first session, many people (perhaps almost 100?!) joined the Journal Club, both actively and more passively. That is a terrific achievement. Afterwards it got a very positive Twitter “press”. If you know to engage people like @nothern_doctor, @doctorblogs, @amcunningham and @drgrumble and people like @bengoldacre, @cebmblog and @david_colquhoun find it a terrific concept, then you know that it is a great idea that meets a need. As such, enough reason to continue.

There were also not purely positive voices. @DrVes sees it as a great effort, but added that “we need to go beyond this 1950s model rather than adapt it to social media.” Apparently this tweet was not well received, but I think he made a very sensible statement.

We can (and should) asks ourselves if Twitter is the right medium for such an event.

@DrVes has experience with Twitter Journal Clubs. He participated in the first medical journal club on Twitter at the Allergy and Immunology program of Creighton University back in 2008 and presented a poster at an allergy meeting in 2009.

BUT, as far as I can tell, that Twitter Journal Club was both much more small-scale (7 fellows?) and different in design. It seems that Tweets summarized what was being said at a real journal club teaching session. Ves Dimov:

“The updates were followed in real time by the Allergy and Immunology fellows at the Louisiana State University (Shreveport) and some interested residents at Cleveland Clinic, along with the 309 subscribers of my Twitter account named AllergyNotes“.

So that is the same as tweeting during a conference or a lecture to inform others about the most interesting facts/statements. It is one-way-tweeting (overall there were just 24 updates with links).

I think the present  Twitter Journal Club was more like a medical Twitter chat (also the words of Ves).

Is chatting on Twitter effective?

Well that depends on what one wants to achieve.

Apparently for all people participating, it was fun to do and educative.

I joined too late to tell, thus I awaited the transcript. But boy, who wants to read 31 pages of “chaotic tweets”? Because that is what a Twitter chat is if many people join.  All tweets are ordered chronologically. Good for the archive, but if the intention is to make the transcribed chat available to people who couldn’t attend, it needs deleting, cutting, pasting and sorting. But that is a lot of work if done manually.

I tried it for part of the transcript. Compare the original transcript here with this Google Doc.

The “remix of tweets” also illustrates that people have their own “mini-chats”, and “off-topic” (but often very relevant) questions.

In addition, the audience is very mixed. Some people seem to have little experience with critical appraisal or concepts like “intention to treat” (ITT) and would perhaps benefit from supplementary information beforehand (i.e. documents at the TwitJC website). Others are experienced doctors with a lot of clinical expertise, who always put theoretical things in perspective. Very valuable, but often they are far ahead in the discussion.

The name of the event is Twitter  Journal Club. Journal Club is a somewhat ambiguous term. According to Wikipedia “A journal club is a group of individuals who meet regularly to critically evaluate recent articles in scientific literature”. It can deal with any piece which looks interesting to share, including hypotheses and preclinical papers about mechanisms of actions.

Thus, to me Journal club is not per definition EBM (Evidence Based Medicine).

Other initiatives are a critical appraisal of a study and a CAT,  a critical appraisal of a topic (sometimes wrongly called PICO, PICO is only part of it).

The structure of the present journal club was more that of a critical appraisal. It followed the normal checklist for an RCT: What is being studied? Is the paper valid (appropriately allocated, blinded etc ), what are the results (NNT etc) and are the results valid outside of the context of the paper?

Imo, official critical appraisal of the paper costs a lot of time and is not the most interesting. Looking at my edited transcript you see that half of the people are answering the question and they all say the same: “Clearly focused question” is answer to first question (but even in the edited transcript this takes 3 pages), “clear interventions (helpful flowcharts) is the answer to the second question.

Half of the people have their own questions. Very legitimate and good questions, but not in line with the questions of @twitjournalclub. Talking about the NNT and about whether the results are really revolutionary, is VERY relevant, but should be left till the end.

A twitter chat with appr. 100 people needs a tight structure.

However, I wonder whether this  approach of critical appraisal is the most interesting. Even more so, because this part didn’t evoke much discussion.

Plus it has already been done!!

I searched the TRIP database and with the title of the paper, to find critical appraisals or synopses of the paper. I found 3 synopses, 2 of which follow more or less the structure of this journal club here, here (and this older one). They answer all the questions about validity.

Wouldn’t it have better with this older key paper (2001) to just use the existing critical appraisals as background information and discuss the implications? Or discuss new supporting or contradictory findings?

The very limited search in TRIP (title of paper only) showed some new interesting papers on the topic (external validation, cost effectiveness, implementation, antibiotics) and I am sure there are many more.

A CAT may also be more interesting than a synopsis, because “other pieces of evidence” are also taken into consideration and one discusses a topic not one single paper. But perhaps this is too difficult to do, because one has to do a thorough search as well and has too much to discuss. Alternatively one could choose a recent systematic review, which summarizes the existing RCT’s.

Anyway, I think the journal club could improve by not following the entire checklist (boring! done!), but use this as a background. Furthermore I think there should be 3-5 questions that are very relevant to discuss. Like in the #HSCMEU discussions, people could pose those questions beforehand. In this way it is easier to adhere to the structure.

As to the medium Twitter for this journal club. I am not fond of  long Twitter chats, because it tends to be chaotic, there is a lot of reiteration, people tend to tweet not to “listen” and there is a constriction of 140 characters. Personally I would prefer a webinar, where people discuss the topic and you can pose questions via Twitter or otherwise.
Other alternatives wouldn’t work for me either. A Facebook journal club (described by of Neil Mehta) looks more static (commenting to a short summary of a paper), and Skyping is difficult with more than 10 people and not easy to transcribe.

But as said there is a lot of enthusiasm for this Twitter Journal Club. Even outside the medical world. This “convincing effort” inspired others to start a Astronomy Twitter Journal Club.

Perhaps a little modification of goals and structure could make it even more interesting. I will try to attend the next event, which is about Geoffrey Rose’s ‘Prevention Paradox’ paper, officially titled ”Strategy of prevention: lessons from cardiovascular disease”, available here.

Notes added:

[1] A summary of the first Twitter journal club is just posted. This is really valuable and takes away the disadvantages of reading an entire transcript (but one misses a lot of interesting aspects too)!

[2] This is the immediate response of one of the organizers at Twitter. I’m very pleased to notice that they will put more emphasis on implications of the Journal. That would take away much of my critic.

(Read tweets from bottom to top).

References

1. Welcome (twitjc.wordpress.com)
2. An important topic for the first Twitter Journal Club (twitjc.wordpress.com)
3. Rivers E, Nguyen B, Havstad S, Ressler J, Muzzin A, Knoblich B, Peterson E, Tomlanovich M; Early Goal-Directed Therapy Collaborative Group. Early goal-directed therapy in the treatment of severe sepsis and septic shock. N Engl J Med. 2001 Nov 8;345(19):1368-77. PubMed PMID: 11794169. (PDF).
4. The First Journal Club on Twitter – Then and Now (casesblog.blogspot.com)
5. Allergy and Immunologyclub on Twitter (allergynotes.blogspot.com)
6. The Utility of a Real-time Microblogging Service for Journal Club in Allergy and Immunology. Dimov, V.; Randhawa, S.; Auron, M.; Casale, T. American College of Allergy, Asthma & Immunology (ACAAI) 2009 Annual Meeting. Ann Allergy Asthma Immunol., Vol 103:5, Suppl. 3, A126, Nov 2009.
7. https://docs.google.com/document/pub?id=1qzk1WzjNO5fbWd0PAax6cIDdUGGg1sDn86FPT1li-sQ (short remix of the transcript)
8. Model for a Journal Club using Google Reader and Facebook OR if the prophet does not go to the Mountain…. bring the journal club to FB! (blogedutech.blogspot.com)
9. Astronomy Twitter Journal Club/ (sarahaskew.net)
10. A summary of week one: Rivers et al (twitjc.wordpress.com)