The case against live tweeting

“Live tweeting” of conference presentations continues to be popular. The practice is defined as posting one or more tweets attempting to tell the Twitter audience what the presenter has to say. It is touted as a great way to convey information to those who are unable to attend the conference.

I’m not a fan of live tweeting, and here’s why.

The live tweets are also supposedly used as a substitute for notetaking. I have blogged about some of the studies showing retention of information is better when notes are taken on paper.

Many of the tweets are incomplete and/or incomprehensible because the description of them has to fit within 280 characters—at most two or maybe three sentences.

Good speakers will use short bullet points and verbally explain what they mean. This can be difficult to accomplish in a tweet.

Papers presented at meetings have not been peer-reviewed. [Okay, I understand that peer review is not perfect, but it is the current gold standard for evaluating published medical literature.] Some people may not know this, but program committees can only judge what is in an abstract—which can be misleading. The submitted abstract is usually worded to attract the attention of those deciding which papers will be accepted. When the paper is presented at the meeting, it sometimes only faintly resembles what was contained in the submitted abstract.

People who rely on live tweets for medical news assume the live tweeter understands what has been presented and is able to coherently communicate it. I worry that snippets of misinformation may be widely disseminated.

What about impressions. Some organizations brag about their combined meeting tweets having 240 million impressions. That doesn’t mean 75% of citizens in the US have seen a tweet. Impressions are simply an index of how many twitter accounts could possibly have seen a tweet. Most tweets are not at all. I have almost 18,000 Twitter followers. I average about 2000 impressions per tweet. Most of my tweets get fewer than 10% engagements—defined as as clicking on a link, expanding detail, likes, and retweets.

Photographs of PowerPoint slides tend to be from bad angles and are often blurry. Here are some examples. Identifying information has been removed to protect the guilty.

The prosecution rests.

The power of a photo in a tweet

Last week I did a little experiment on Twitter. No, I did not have IRB approval.

I wanted to see what the impact of attaching a photo to a tweet would be.

On August 30 at 10 a.m., I tweeted a link to a blog post I had just written about two new types of water—one that supposedly has “activated stabilized oxygen” in it and another that is “living crystal” water. Both are touted as having health benefits.

Here are the first tweet and its statistics.

Click on photo to enlarge it.

Of the 1299 impressions or unique Twitter accounts that could have been reached at 10 AM the time the tweet was posted, 11 (0.8%) people engaged with the tweet.

Three hours later I tweeted about the blog post again using similar wording but this time adding this photograph from the blog post.

Here are the tweet and its statistics. 

Social media solves a medical riddle

This foreign body was removed from a non-healing abdominal wall incision in an elderly lady with many comorbidities and previous operations. It was a rigid plastic tube which was 7 cm long and 2-3 mm in diameter. There were four transverse grooves at either end.

Physicians caring for her were unable to identify it. One of them emailed me the photos and asked for help. I didn't know what was, but I knew where to look for the answer.

I tried a Google image search, but the brownish discoloration of the object was interpreted as wood by the algorithm. None of the many images on Google resembled the foreign body.

Live tweeting from #ACSCC15

As many of you know, I have not been a fan of live tweeting conferences. I blogged about the issue last year (here and here) and received a lot of feedback about the posts, most of it strongly opposing my views.

Vigorous live tweeting from the American College of Surgeons Clinical Congress (#ACSCC15) in Chicago is underway. Here are a couple of examples of tweets from that meeting. Twitter handles are blocked to protect the innocent (or guilty).

First, the good. Here is a nice montage showing what surgical program directors are looking for in residency applicants.

The photos are in focus and well-positioned. Anyone not in the audience for the talk can get something useful from this tweet. My one complaint -- we do not know who the speaker is. That information may have been provided in an earlier tweet, but this retweet is the only one I saw.

Take lecture notes on a laptop computer or use old fashioned longhand?

A paper published last year in Psychological Science suggests that taking notes in longhand is the better choice.

The authors, from Princeton University and UCLA, performed three studies on college students. They found that even if multitasking and distractions were eliminated, “students who took notes on laptops performed worse on conceptual questions than students who took notes longhand.”

Previous research has shown that note taking enhances learning by both providing external storage of information for later review and “encoding,” that is, processing information and reframing it in one’s own words.

Although significantly more notes were taken by laptop users, they tended to be more like transcriptionists instead of thinking about and summarizing what they heard.

That time Skeptical Scalpel wasn’t skeptical enough

Yesterday I retweeted a link to “Live Action News,” a website with a video claiming that Planned Parenthood was selling fetal organs.

I had watched the video and read the accompanying article but failed to engage my skeptical radar. It turns out that the video was maliciously edited to portray Dr. Deborah Nucatola, Senior Director of Medical Services for Planned Parenthood, in the worst possible way. The video showed her “having lunch with actors posing as buyers who are interested in purchasing the body parts of babies who have been aborted” and discussing prices.

The website Media Matters describes some of the edits and explains why they are deceptive. It turns out that of the 150 minutes of the original footage, only 8 minutes were used in the "Live Action News" clip.

If I had watched the video more closely, I wouldn’t have needed Media Matters or the 150 minutes of original footage to see the flaws.

First of all, it begins with an introduction by a former ABC News anchor Connie Chung promising something shocking. But as you can see in the screen shot below in the lower left corner, it clearly says “ABC News 20/20 March 8, 2000.”

Another obvious clue is that the date and time stamp in the lower left-hand corner of the edited video itself is “2014 07 25.” In retrospect, it does not seem plausible that an anti-abortion organization would have sat on this inflammatory story for almost a year before releasing it.

In addition, the times differ greatly as the video progresses which obviously should have told me that major editing had taken place.





The "Live Action News website looks pretty bogus too.


I am very disappointed in myself for having fallen for this dishonest garbage.

It won’t happen again.

Problem with my blog. I need your help

I have a big problem.

For the last 10 days, Twitter has been blocking me from tweeting any links to my blog.

This is the message I get whenever I try to send a tweet with "skepticalscalpel.blogspot.com" in it.

I have tried to contact Twitter through @twitter and @support four times and have received no reply, nor have they replied to numerous ticket requests through the Twitter Help Center.

I discovered a site called virustotal.com which compiles reports from 63 different programs that detect viruses, worms, trojans, and malware.

Originally a site called BitDefender claimed my site was malicious. The next day, BitDefender declared my site was clean, but AutoShun, which previously had no problem with my site, said it was malicious. The following day, AutoShun said my site was unrated and Clean MX said "malicious." But the day after, AutoShun went back to calling it malicious and Clean MX said my blog was clean. At no time, did more than one of the 63 detection programs identify my blogsite is being malicious.

You would think that if my blog contained any suspicious programs, more than one of the 63 virus detection organizations would have come up with a positive result on the same day.

None of the programs saying my blog was malicious gave me any clue as to what part of my site was supposedly creating the problem.

I attempted to get some help from Blogger, which hosts my blog. Although one person on a forum responded with some advice, it wasn't enough for me to solve the problem.

My blog is averaging 1600 page views per day. Not one person has contacted me to complain that I am harboring viruses or any other malicious software. That is because, to the best of my knowledge, no such malicious software exists on my blog.

Maybe it would help if you would go to the results section of the virustotal website and cast your vote in favor of my site as not being malicious. In the upper right-hand corner of the site you will see this cartoon.



 Please click on the green face to support my blog.

Meanwhile, I have discovered an interesting workaround which enables me to tweet links to my blog, but visitors to the site will still be blocked by Twitter from tweeting links.

If you consider yourself computer-savvy, maybe you can figure out how I did it. If you think you know the answer, please submit a comment.

I also would welcome any comments or suggestions that could help to resolve my problem. If anyone knows a way to contact a human at Twitter, please let me know.

Thanks.

Please stop this: "There are more ___ than Ebola victims in the US"

I get it. Can we please stop comparing the number of Ebola victims in the United States to all sorts of irrelevant things? PS: It's not that funny either.

The following are directly copied from recent tweets. Links have been removed for your protection.

There are more Saudi Princes than Ebola victims

Kim Kardashian has had more husbands than Ebola victims in the US

More Americans have been dumped by Taylor Swift than have died from Ebola

Fun Fact: More #kids die annually due to #faith healing than #Ebola.

FACT: Katie Price has claimed more victims than Ebola.

NYC traffic. another thing that's much more dangerous than #Ebola, courtesy of @bobkolker via @intelligencer

There are more people in this tram than ebola victims in America.

I've lost more followers than US Ebola victims [I didn't tweet this or any of these other tweets.]

@lbftaylor fewer #ebola victims in US than drunk Palins in a #PalinBrawl.

@pbolt @robertjbennett Also, there are more ex-wives of Larry King than there are ebola victims int he US.

Rush Limbaugh has more ex-wives than USA has Ebola victims!

@xeni Menudo has had more members than 3x the number of American Ebola victims...

Put #ebola in the context of vaccination preventable dz: 118,000 children < 5 yrs old die from measles per year

@Tiffuhkneexoxo @LeeTRBL more dc team quarterbacks have played this year than there are US ebola victims

Rest assured, there will always be more American guns in Africa than Ebola victims. Everything is fine. Relax

As #Enterovirus spreads faster x country & kills more than #Ebola, sure victims' parents must b sad congress isn't demanding an ED68 czar.

We are all far more likely 2 be victims of identity theft than #Ebola. Obama has a plan to fix that

Americans spend more money on Halloween costumes for their pets than the UN spends on helping Ebola victims and fighting ISIS combined.

@mikebarnicle 9900 gunshot victims since Newtown, much scarier than Ebola.

So FYI... More people die from the #flu than #ebola .

Fear hospital infections not Ebola. 1 in 25 patients are infected. 75,000 die yearly.

Every day in America around 100 people lose their lives to mostly preventable car crashes. #Ebola

There are more experts on CNN right now talking about Ebola in America than people with ebola in America.

Reaction to post on academia and social media

"Should social media accomplishments be recognized by academia?" a post of mine from October 4th, generated some lively discussion on Twitter.

Here are a few of the more interesting responses:

@ashishkjha Important question from @Skepticscalpel Should academia value impact on social media? Yes. And it's coming. Slowly.

@MartinSGaynor Science comes 1st, 2nd, 3rd.. MT @ashishkjha Important Q: @Skepticscalpel Shld academia value impact on social media?

@ashishkjha agree how to measure impact a key question. Eye balls can't be enough. But too important a question to ignore.

‏@DoctorTennyson Yes-I think social media has a role for #publichealth, #education, and fosters collaboration. More than obscure journals

@NirajGusani still you add value to your dept -how do/should they measure it?

‏@gorskon Heck, at @ScienceBasedMed, we get 1M page views a month, but I get no credit.

@gorskon I agree though. For the most part, social media harms, not helps, academic career.

Tsundoku

Back in May, I posed this question, "Does anyone really read anything online?" Based on some data from various sources, I concluded that not many do. I also noted that many links I tweeted were passed along by others who could not possibly have read them in the elapsed time between my tweet and their tweet.

The problem may not be limited to online readers.

Have you ever heard of "tsundoku"? It's an informal Japanese word defined as "the act of leaving a book unread after buying it, typically piled up together with other such unread books."

This reminds me of a phenomenon which I observed among medical students and surgical residents over the course of many years.

Whenever a subject arose that they were not too familiar with, they would go off to the library and copy some articles about it and carry the articles around in their pockets for weeks. The papers would curl up at the edges and become as soiled as their white coats. But most of the time they were never read.

I would point out to them that photocopying an article, even though it can take a few minutes, was not a substitute for actually reading it.

I thought I might have been the only one to have noticed this, but recently a Twitter follower of mine, Terry Murray [‏@terromur], tweeted, "In the 1980s, the librarian at Hosp for Sick Children in Toronto urged 'neuroxing' (i.e., reading) instead of photocopying."

The Internet version of this phenomenon is facilitated by programs like Evernote, which make it easy to save links or PDFs for reading later. And you don't even have to go to the library.

I suppose some people eventually do read them. But I'll bet the majority don't.

Maybe the definition of tsundoku should be expanded to include the act of leaving a link unread after tweeting it, typically piled up together with other such unread links.

More about why live tweeting conferences is bad

Yesterday, I blogged about why live tweeting from conferences is not worth it. (Link here.)

Such tweets are difficult to comprehend, lack context without a detailed explanation, and might be detrimental to the persons who are tweeting because they aren't paying attention to the lecture.

I have never had such a response to a blog post before. Live tweeters were highly indignant that I should question what they are certain is the greatest marvel in medical education since the invention of PowerPoint.

I said it took a minute to compose and type a tweet, and many claimed they can do it much faster. Others also said that they use their tweets as notes for later reference.

A twitter colleague, Dr. John Mandrola (@drjohnm), unknowingly stepped into the conversation by posting a link to an article [link fixed 6/8/14] in The New Yorker about college teachers proposing to ban laptops in their classrooms.

It referenced a 2003 study from Cornell "wherein half of a class was allowed unfettered access to their computers during a lecture while the other half was asked to keep their laptops closed."

"The experiment showed that, regardless of the kind or duration of the computer use, the disconnected students performed better on a post-lecture quiz. The message of the study aligns pretty well with the evidence that multitasking degrades task performance across the board."

A New York Times piece about handwriting said, "For adults, typing may be a fast and efficient alternative to longhand, but that very efficiency may diminish our ability to process new information."

It cited a study showing "that in both laboratory settings and real-world classrooms, students learn better when they take notes by hand than when they type on a keyboard. Contrary to earlier studies attributing the difference to the distracting effects of computers, the new research suggests that writing by hand allows the student to process a lecture’s contents and reframe it—a process of reflection and manipulation that can lead to better understanding and memory encoding."

The New Yorker article concluded, "Institutions should certainly enable faculty to experiment with new technology, but should also approach all potential classroom intruders with a healthy dose of skepticism, and resist the impulse to always implement the new, trendy thing out of our fear of being left behind." [Emphasis mine.]

The elephant in the room—Live tweeting conferences

Live tweeting from conferences has become very popular, but I'm not sure why. The biggest problem is this—lucid communication of a point made by a speaker using more than 140 characters at a time is difficult to capture in a tweet.

The tweets tend to be filled with obscure abbreviations and references to previous tweets that may seem quite clear to the tweeter but not the tweetee. Some also post out-of-focus photos of the dreaded PowerPoint bullet slides taken from acute angles. Lacking context or explanation, they tend to be useless.

What about the one doing the live tweeting? How can you fire off 15 or 20 tweets in an hour and continue to pay attention to what the speaker is saying?

Please don't tell me what Symplur or some other data disgorging company says a meeting's impressions were. Here's an example from the recently concluded meeting of the American Society of Clinical Oncology. (#ASCO14) for May 30 through June 4.

There were 38,896 tweets generated by 7,284 participants. Let's very conservatively estimate that it took each tweeter 1 minute to compose a tweet, type it into a mobile device, and send it. That is 648 hours worth of tweets. The leading tweeter at ASCO produced 975 tweets or 16 hours worth of tweets.

You might say, "Hey, there were 134,569,479 impressions. That number represents over 40% of the population of the US." But hold on. Impressions are the number of tweets delivered to a follower's Twitter feed and potentially available to be viewed. There is no way to determine if anyone has actually read a specific tweet.

Other than counting retweets or replies, which apparently is not done by Symplur, there is no way to measure engagement. And even a retweet does not guarantee that a tweet was read. [See my previous post on this subject.] Favoriting (yes, that's a Twitter verb) is not a countable Twitter metric and even if it was, it's not a surrogate for reading.

Most of the time, I solve the problem by temporarily unfollowing someone who is live tweeting a conference.

What do you think about live tweeting of conferences?

6/7/14 ADDENDUM: 


More about why live tweeting conferences is bad. Link here.

Does anyone really read anything online?

Not long ago, I tweeted a link to a very long story. Within 60 seconds, it received three retweets. Since the article would have taken at least 10 minutes to read, it is highly likely that those who retweeted it did not read it.

This phenomenon is not limited to Twitter. A couple of recent articles revealed some interesting data about what people really do online.

From Time magazine in early March: "A stunning 55% [of those who clicked into an article] spent fewer than 15 seconds actively on a page. [emphasis theirs] The stats get a little better if you filter purely for article pages, but even then one in every three visitors spend [sic] less than 15 seconds reading articles they land on."

Analysis of 10,000 articles shared on social media "found that there is no relationship whatsoever between the amount a piece of content is shared and the amount of attention an average reader will give that content."

A Slate article noted that about 5% to 10% of those who open an article leave it immediately and 38% of people who click on it "bounce" [leave it] before the end of the first paragraph.

At a few hundred words into the article, about half of the remaining readers have left, and very few of the rest make it through to the end.

The amount of scrolling can also be tracked. "There’s a very weak relationship between scroll depth and sharing. Both at Slate and across the Web, articles that get a lot of tweets don’t necessarily get read very deeply. Articles that get read deeply aren’t necessarily generating a lot of tweets."

On April Fools' Day, NPR published a story called "Why Doesn't America Read Anymore?" There was no article [emphasis mine]—only the headline and an explanation of the fact that they wanted to see if people would comment anyway. They were not disappointed as many brainless comments rolled in. This Gawker post has the best of them.  

The Washington Post noted that in addition to diminishing attention spans, we are developing into a nation of superficial readers. “It’s like your eyes are passing over the words but you’re not taking in what they say,” said a graduate student in creative writing.

Attempting to stay with the trend, last week both the Associated Press and Reuters directed their reporters to limit stories to fewer than 500 words.

If anyone is still reading this, what it means is that I should not feel slighted that people are retweeting me without necessarily reading what I so carefully and lovingly select for dissemination. 

It's not me. It's you.

PS: I am aware that some people retweet things and plan to read them later. But how do they know that what they have retweeted is worthy? Or does it matter?

The ultimate first-world problem: Twitter is slightly different on the computer, iPad & iPhone

Each platform has some advantages and disadvantages.

The standard computers, both PC and Apple, offer the full keyboard and obviously larger screen. It is easier to grab URLs and shorten links. Computers also include all interactions, not just mentions. But retweeting by copying someone else’s tweet and commenting on it is very cumbersome. The URLs do not copy with the “http://” and even the rest of the URL is omitted unless you copy the entire tweet including name and twitter handle of the tweeter.

The iPad lets you “Retweet” and “Quote Tweet.” Quote tweet reproduces the entire tweet with the full URL. You must delete the quotation marks after the tweet if they are directly next to the URL. But on the iPad, your “Mentions” are just that, mentions in tweets. Retweets of your stuff and other interactions like new followers are not listed. The iPad allows you to write a tweet and save it for later, a feature not available on a PC. But shortening a URL is a project that takes several steps because of the clunky way the iPad copies and pastes.

The iPhone lists all interactions, just like the PC and has “Quote Tweet” just like the iPad. It also permits writing a tweet and saving it for later. This feature is in a menu displayed by clicking “Cancel” instead of “Close” as is the case on the iPad. However like the iPad, the iPhone also makes shortening a URL a big deal.

There are other differences like the way profiles are displayed and direct messages are handled.

Is there some reason why there can’t be uniformity across all the devices?

Online etiquette. Stop telling me what to do.

Don't blog/tweet anonymously. Tweet before you blog. Bloggers should meditate [of course]. Don't use emoticons. Don't “dis” patients. Mind your HIPAA (often misspelled "HIPPA"). You have to have a social media presence. I could go on.

I blog anonymously because I want to. I started blogging and tweeting at the same time and I'm doing fine. I use emoticons because sarcasm and satire are difficult to convey in a tweet or email. I find they help me express myself and avoid misunderstandings.

Occasionally, patients who do silly things should be dissed. I rarely do it myself but if others do, it's their business. Also, this can be funny.

Digression: HIPAA is a major nuisance. It's one of the most annoying and misunderstood federal laws ever enacted. Really, are there large numbers of people trying to look at my patients' x-rays so I need to go through logins to get into the PACS? It's not a HIPAA violation to exchange patient information in the process of caring for said patient. But many times doctors and hospital medical records people stubbornly refuse to tell you vital information needed in emergency situations.

I don't want to have a social media presence for my practice. I don't need it. I don't have the type of practice that would benefit by it.

So do me a favor; don’t tell me what I should or should not do online.