Saturday, October 4, 2014

Should social media accomplishments be recognized by academia?

In August, I posted this: "A paper of mine was published. Did anyone read it?"

A recent comment on it raised an interesting point. Dr. Christian Sinclair [@ctsinclair] said that a website he is helping to run called "Pallimed" has received almost 2 million views since 2005.

He then made the following calculation:

Two million views with an average of 1:30 minutes on a page = 3 million minutes = 50,000 hours = 2,083 days = 5.7 years of 24/7/365 informal learning on hospice and palliative care topics.

He said that this type of communication counts for nothing regarding academic advancement and added that writing another paper and having it published in a journal no one reads or a chapter in an expensive book no one will buy is considered worthwhile.

This reminded me of something I have talked about in recent presentations. The first laparoscopic cholecystectomy done in the United States took place in 1988. The procedure rapidly became popular due to its obvious benefits over traditional open surgery—smaller scars, shorter hospitalizations, quicker returns to normal activity.

Many academic surgeons considered the procedure radical and heretical. Opinion pieces appeared with titles like "Laparoscopic cholecystectomy: Passing fancy or legitimate treatment option?" and "Laparoscopic cholecystectomy: A new milestone or a dangerous innovation?"

Nearly all of the early adopters were community hospital surgeons who also became instructors, ran courses, and proctored others learning the procedure.

Academic surgeons were slow to take up the procedure because even back in those days they steadfastly demanded to see the results of a randomized prospective trial. The problem was that an adequately powered trial never occurred. Patients did so well after laparoscopy surgery that it became difficult to recruit anyone who would agree to be randomized.

Will most academic surgeons, who have not embraced social media, miss the boat again?

Last year, some Australians, blogging at the Intensive Care Network, found that the number needed to treat stated in a New England Journal paper on targeted vs. universal decolonization to prevent ICU infection was wrong. They blogged about it and contacted the lead author who acknowledged the error within 11 days. It took the journal 5 months to make the correction online.

Post-publication peer review is already happening on PubMed and PubPeer, a new site that allows anyone to comment on any paper.

Three years ago, I wrote "Statistical vs. Clinical Significance: They Are Not the Same," which reviewed a paper on sleep apnea. The use of compression stockings at night significantly lowered the number of apnea episodes but not enough to enable them to stop using CPAP.

That post has received over 13,400 page views, certainly far exceeding the number of people who have read my 97 peer-reviewed papers, case reports, review articles, book chapters, editorials, and letters to journal editors.

How many scientific papers published in journals have been viewed by that many people?

Since I started 4 years ago, the 565 posts on my blog have amassed 1.1 million page views, but if I still held a teaching appointment at a medical school, I would get no academic credit for that level of exposure.

Is it time to reconsider how academic promotions are determined?


Justin Hensley said...

Since print media is going to go the way of the dinosaur (within my lifetime), I agree that the new paradigm is the future. Nearly instant peer review occurs online. Instead of the ivory tower viewpoint (I'm better than you people simply reading my paper), it's more of a collaboration of everyone. Also, the concept of forcing people to pay for information goes completely against the concept of improving patient care.
#FOAMed and podcasts are how the majority of my residents learn new topics. Books are out of date the instant they're printed, and contain horribly inaccurate dogma, sometimes for decades. All because nobody wants to correct the grey-hairs that wrote them.
It needs to change, and obviously is. Sadly, academic faculty are again behind the 8 ball with regards to the social media, and the community people are way ahead just as they were 30 years ago.
This is why historically it took 10 years or more for practices to change, because the ones teaching are usually the slowest to adopt new practices.

Skeptical Scalpel said...

Thank you for affirming what I have thought for a while now. I didn't have room to include #FOAMed in the post but it is a valuable tool which I do mention in my talks.

Josh said...

These are really great points. The 5 mo. delay on the part of the NEJM is especially representative of the problem. To that I would add that among the great things about the proliferation of medical blogs and forums (even the new one established by the ACS) is how easy, quick, and FREE it is to exchange ideas and get a sense of best practices. It is really reprehensible in the age of open information on the internet for so many professional journals to continue to be behind pay walls. Its astonishingly expensive to subscribe to a journal, and even more so to buy individual articles. Information that might help guide patient care should be available without hinderance for all healthcare professionals. There is an interesting corollary in the story of Reddit founder Aaron Schwartz, who committed an act of civil disobedience by freely publishing academic legal journals otherwise behind an expensive paywall. Sadly while he was facing federal prosecution he committed suicide, but it raised some debate in the media about free access to information that never quite made it to the medical community.

Skeptical Scalpel said...

Josh, I hadn't heard about the Aaron Schwartz issue. Thanks for bringing it up. Change is occurring. I don't know how much longer journals will be able to charge $31.50 (interesting figure and they all charge the same amount) for 24 hours of access to a paper.

Christian Sinclair said...

Thanks for expanding on the comment from your previous post. I think there is a big opportunity for defining impact in this new media world.

And I want to emphasize thecredit to the many (20+) writers who contribute to Pallimed.

Mahesh Devnani said...

Excellent piece @Skepticscalpel and a very important question. No one denies the role, reach and speed of social media including academia as we see more and more schools and journals now have twitter handles, Facebook pages etc. But I was wondering how would academia quantify and standardize the impact in an era of ‘fake likes’, ‘fake followers’ and paid manipulated page visits.
Couple of months ago I did a small 'Comparative analysis of Twitter handles of Cabinet Ministers of India' ( and found that one person @devoted2nation who himself has only 2 followers on twitter was the 2nd top contributors to 'Total Audience Activity' of Twitter handle of Prime Minister of India in the month of August 2014. The top contributor @Suryavam_Ganesh has since then closed its twitter account.

Mahesh Devnani said...

@SkepticScalpel, I run the fake follower test on According to this around 1002 (10%) followers out of total 10435 followers of @SkepticScalpel are fake.

This is what they say about their testing method:-
"Each audit takes a random sample of 5000 Twitter followers for a user and calculates a score for each follower. This score is based on number of tweets, date of the last tweet, and ratio of followers to friends. We use these scores to determine whether any given user is real or fake. Of course, this scoring method is not perfect but it is a good way to tell if someone with lots of followers is likely to have increased their follower count by inorganic, fraudulent, or dishonest means."

urther here are some recent news items related to fake likes and fake followers etc.:-

Thank you again for raising this important issue. I am hopeful that academia will recognize and find a way to incorporate social media impact.

Skeptical Scalpel said...

Christian, thanks for giving me the idea to write about this.

Mahesh, I appreciate the comments and the links. You have done a lot of work to compile all these data.

That's an interesting site. It looks like having only 10% of one's followers as fake is actually pretty good. Everyone who is on Twitter should take a look at their own numbers.

Chris Porter MD said...


I think academia has a moral obligation to move away for the traditional publishing model, which now impedes the diffusion of science. In clinical medicine, that adds up to a delay in raising the standard of care.

Also, it's anachronistic, narrow, and boring for academia to persist using the published article as the primary unit of productivity. Time would be far better spent, from my consumer's perspective, creating content (lessons, videos, discussions, best practice guidelines) from the existing body of knowledge.

Go open access! Presented on the topic here:

[Darn that sign-in! I've written this comment thrice, and lost it twice.]

Skeptical Scalpel said...

If it makes you feel any better, it happens to me too. The secret is to copy your comment before posting it. Then if it crashes, you can easily redo it.

I agree that scientific research can be wonderful, but other types of publications, like the ones you mentioned and more, should count for something too.

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