Tweet your story, doctor

Physicians sharing personal stories on Twitter are seen as being more effective in communicating COVID-19 recommendations than impersonal messages from federal officials. That’s the conclusion of a study just published online by Dr. Rachel Solnick and colleagues based on a randomized experiment conducted with more than 2000 US adults.

This timely study underscores one of the most important points made at the recent Canadian Immunization Conference, namely that physicians and other health care providers are the most effective communicators when it comes to communicating the importance of COVID-19 vaccines.

“You’re abandoning your patients and leaving them open to an incredible amount of disinformation if you don’t get involved on social media,” said Dr. Todd Wolynn, a Pittsburgh pediatrician speaking at the meeting, during a session on countering the anti-vaccination movement. At the session, Dr. Wolynn was accompanied by Dr. Philipp Schmid, a behavioral scientist at the University of Erfurt in Germany who in 2016 literally helped write the book (along with Canadian pediatrician and former dean Dr. Noni MacDonald and others) on publicly responding to vocal vaccine deniers.

This and other sessions at the immunization conference came as public health experts and others plan on how to effectively disseminate vaccines against COVID-19 at a time when COVID-19 deniers and anti-science advocates are running rampant on social media.

The anti-vaccination movement is one of the older and most dangerous of the anti-science movements for its attempts to sway a number of well-meaning parents against life-saving vaccinations for their children. In recent months in Canada I have seen two other examples of physicians coming under virulent personal attacks as a result of their defense of public health initiatives.

The first was at the Canadian Cardiovascular Congress in late-October when I tweeted remarks from Drs. Stanton Glantz and Andrew Pipe on the negative impact of vaping which drew the ire of pro-vapers throughout North America on Twitter that did not subside for more than 24 hours. The second came just days ago when the Canadian Medical Association promoted the award it had given Dr. Najma Ahmed, a trauma surgeon in Toronto, co-founder of Canadian Doctors for Protection from Guns. The tweet from @CMA_Docs prompted days of attacks on Dr. Ahmed, other physician gun-control advocates and the CMA with many attempting once again to apply misdirection by referencing opioid overdoses, medical errors and physician privilege as reasons to discredit physician views.

These two recent incidents demonstrate just what can be involved for physicians who choose to take public health stances on social media that draw the ire of a segment of the social media population that is not afraid to stoop to any tactic to defend their views and discredit the opposition. It also underscores that the fact despite the acknowledged need for physicians to speak up on Twitter, this may come at a price that many are not willing to pay.

Physicians who choose to advocate for evidence-based public health initiatives to improve population health have to remember, as Drs Schmid and Wolynn pointed out, that their audience, is the general public and not the zealots posting against them. Social media and especially Twitter have never been the place for a full and frank debate about an issue so don’t expect to win any one-on-one arguments there.

Even knowledge or science itself is not a talisman against attackers. Your enemies will use science against you even if it is the science of the pre-print, press release, retracted paper or cherry-picking of evidence. More importantly, as Dr. Frédéric Bouchard, dean of arts and science at the University of Montreal, pointed out at another session during the immunization conference, “we must accept that scientific expertise is not just about facts and methods but also about building trust and working with integrity.”

Unfortunately it is when physicians are pitted against other physicians on social media that discussions often become most heated and upsetting.  Many Canadian physicians currently face lawsuits for challenging a colleague who they felt had published inaccurate and potentially dangerous views about COVID-19 treatments. Whether these suits are valid or not they raise the specter of libel chill which can dissuade even the most well-meaning physician advocate from venturing onto social media. But trite though it may sound, truth is an absolute defence against libel in virtually every jurisdiction in Canada.

The reality is that social media is where information is being most widely shared and disseminated these days. And to quote the brilliant English fantasy writer Terry Pratchett “a lie can run around the world before the truth has its boots on.”

Physicians such as Dr. Jennifer Gunter and academics such as Tim Caulfield are proof that people can survive or even thrive in the face of the anti-science movement. “Hide, ban or delete” is an effective method of dealing with comments from those who would mount ongoing personal attacks against you, your family and your motives on social media, as Dr. Wolynn pointed out.

And as the publications of Dr. Schmid and others demonstrate there are effective tactics to counter not just the anti-vaccination movement but any anti-science campaign.

tellAs we move into the critical phase of rolling out vaccines to control the COVID-19 pandemic, physician voices on social media are not just nice to have – they are essential for making certain science-based approaches are applied.

An earlier version of this blog was posted on kevinmd.com

Illustration shows the cover of The Debunking Handbook 2020 written by Dr. Schmid, Dr. Gordon Pennycook from the Hill-Levine School of Business, University of Regina, and others which summarizes the current state of the science of misinformation and its debunking.

“I’ll meet you by the pixelated fountain”

By now most of you have probably had the experience of entering one of those crisp looking yet soulless virtual convention centre lobbies that serve as the homepages for the websites of most recent bigger medical conferences. Or possibly, you have just puzzled through one of the less visual homepages that eventually allow you to access the live presentations, chat rooms and other tabs that have become standard with virtual meetings.

If not, then just wait until the spring meeting of your society or association because the odds of any big medical or health care conference or symposium being anything less than just virtual before next summer, if not longer, are probably close to zero (those taking place in Australia and New Zealand excepted perhaps).

Virtual conferences are a reality since the COVID-19 pandemic struck and frankly conference organizers and conference committees have worked wonders to develop functional platforms that work.

Having attended several such virtual conferences in recent weeks I have made some observations shared earlier on Twitter that I thought might be worth collecting here. Just to emphasize, I made these observations strictly as a delegate and have not had the insights or frustrations that would come from being a conference organizer these days.

These are listed in the order in which the observations were made, with some minor edits:

1. It’s good if sessions begin on time otherwise attendees get nervous that they are not in the right place.

2. Test the software and platform. Then test it again. Then be prepared for a way to alert attendees if something still goes wrong the speaker’s audio, visual etc.

3. It’s best to have someone other than moderator check on questions posted during session and prioritize them.

4. I suspect getting delegates to visit the virtual exhibit hall and interact with exhibitors is even more challenging than in-person. This raises issues about value to sponsors.

5. Even the best virtual conference can come to a grinding halt when the speaker can’t get their slides to display.

6. The mix of live and taped sessions and hybrid versions of the two is changing what it means to be a “live” conference.

7. The more detailed and involved the virtual platform and the more features (more money spent?) the better the experience seems to be.

8. Fake backgrounds (à la Zoom or Microsoft Teams) don’t work unless you align your image perfectly. Otherwise it looks hokey and unprofessional.

9. Having the chair moderate questions eliminates “rambling irrelevant monologues” from the questioner (courtesy of @RichardPAConway)

10. It seems harder/more intrusive for moderator to cut off speaker who is running overtime during live virtual presentations

11. Technicians are even more important than for current in-person meetings to make sure things move smoothly

12. Always have soothing music ready if your conference loses the feed – and post a message letting people know what is going on

For those of you who are pining for real in-person conferences I suggest you read the latest editorial in the Canadian Urological Association Journal by editor-in-chief and Kingston urologist Dr. Micheal Leveridge (@_the_urologist).

In the piece titled “We’ll meet again, some sunny day” he reminisces on conferences long past and the changes wrought by the current pandemic. He notes that in future “maybe we will have less tolerance for crunching shoulder-to-shoulder in cavernous plenary rooms in favor of smaller, more curated settings with opportunities for deeper discourse. Maybe we will come to value investment  in presentation quality, and the democratization and diversity of presenters when our attention is at stake.”

Thoughts to ponder as you wait for the next session to go live on your laptop.

(Graphic courtesy of the Canadian Cardiovascular Congress)