Those who can, publish. Those who can’t, blog

What’s your view on social media and science? For example, the role of science blogs in critiquing published papers? "Those who can, publish. Those who can’t, blog," says Jingmai O'Connor.

According to Cell.com, Dr. O’Connor is a professor at the Institute of Vertebrate Paleontology and Paleoanthropology of the Chinese Academy of Sciences, and her comment was part of an interview published last month.

Dr. O'Connor says, "It often seems those who criticize or spend large amounts of time blogging are also those who don’t generate much [sic] publications themselves." She thinks comments should be peer-reviewed and published only in journals. She worries about the public who may not realize "a published paper passed rigorous review by experts, which carries more validity than the opinion of some disgruntled scientist or amateur on the internet." She adds, "criticism in social media is damaging to science, as it is to most aspects of our culture."

Apparently she isn't aware that peer review is under fire from a number of respectable sources.

"If peer review was a drug it would never be allowed onto the market," said Drummond Rennie, a contributing deputy editor of JAMA. Richard Smith, former editor of the BMJ agrees "because we have no convincing evidence of its benefits but a lot of evidence of its flaws."

In 2015, 107 scientific papers were retracted by several journals because their authors, nearly all of whom were Chinese academics, had performed fraudulent peer review by creating fictitious names and email addresses of suggested reviewers so they could write glowing reviews of their own work. Some of these charlatans are from Beijing, where Dr. O'Connor is based.

Australian bloggers found an error that had somehow been missed during "rigorous review by experts" regarding the number needed to treat in a New England Journal of Medicine paper on targeted vs. universal decolonization to prevent ICU infection. They contacted the paper's corresponding author who acknowledged the mistake within 11 days. It took five months for a correction to appear online in the journal.

Whether Dr. O'Connor likes it or not, the future will involve more immediate feedback about research papers. For example, PubMed and PubPeer already allow comments, and the BMJ also has a section for online rapid responses.

Blogger Marc Bellemare, an associate professor of economics at the University of Minnesota, cites David McKenzie, an economist/blogger at the World Bank who thinks that blogs play an important role in disseminating information to the public and "raise the profile of bloggers and their institution."

But Bellemare feels blogging might not be for every academic He quotes Tyler Cowen of George Mason University, who when asked why don't more economists blog replied, "I believe it is because they can’t, at least not without embarrassing themselves rather quickly, even if they are smart and very good economists. It’s simply a different set of skills."

Maybe Dr. O'Connor doesn't have the skill set to blog. I say, "Those who can, blog. Those who can't, insult those who can."

My blog cited in JAMA Surgery paper: Progress for bloggers

About a year and a half ago, I blogged that a medical student on Twitter used a blog post of mine as evidence. In January, the Canadian Journal of Anesthesia published an article I wrote under my pseudonym called “Why I blog and tweet.”

Last month, medical blogging took another step toward legitimacy. A JAMA Surgery Viewpoint formally cited my post critiquing the Finnish randomized trial of antibiotics versus surgery for the treatment of acute appendicitis.

Here is the first page with the portion of the piece discussing what I had written in the blog post.

Click on figure to enlarge.

Here is how citation appears in the JAMA Surgery article.

If you haven't read my entire post about the randomized trial, click here.

Last year I said this: “Journals may have to adapt and become more like blogs. In the future, medical information may be disseminated by blogs and comments rather than journal articles and letters to the editor.”

We have already seen prominent publications such as the New England Journal of Medicine starting online forums and the BMJ hosting blogs (at least 36 so far) and rapid responses to published papers.

The sea change in the way medical research is disseminated may be happening sooner than I thought.

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.

Dr. Topol's bad day

Dr. Eric Topol is a cardiologist, author, editor-in-chief of Medscape, and genomics professor. In 2009, he was named one of the 12 Rock Stars of Science by none other than GQ magazine.

But even rock stars occasionally have a bad day. After blogging for almost 5 years, I sometimes have trouble thinking of things to write about. This apparently happened to Dr. Topol the other day. He published a Medscape article with an accompanying video about how doctors are being squeezed by many outside forces that require them to do things they don't want to do.

It was kind of a rambling discourse in which he suggested that doctors should offload the responsibility to do these "more mundane aspects of care" to the patients. He thinks this would make medicine more exciting "the way it used to be."

Dr. Topol offered this cartoon to illustrate the outside forces that are squeezing doctors.

Genomics is a focus of Dr. Topol's research, but I don't think a lot of doctors are concerned that they lack knowledge about it.

His post created a lot of controversy prompting Medscape to take down all of the comments.

With great foresight, one physician, Dr. Kristin Held, preserved her comment with a screenshot which I have thoughtfully provided for you below.

What do you think she really wanted to say with the start of her second paragraph? Could it have been "How about growing a _ _ _ _ of _ _ _ _s?

Like Dr. Held, I have no idea which of the "mundane aspects of this new world" Dr. Topol had in mind to offload on the patients. Of the 16 forces squeezing doctors that he illustrated, I don't see many of them being taken over by patients. They already control patient satisfaction and what's written on Yelp. Maybe they can cover the lack of genomic knowledge too.

It's sad that an influential doctor like Topol is so lost in the woods. However, the bright side is that gave me something to write about.

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?

My blog is now being cited as evidence

That is a scary thought.

Some people on Twitter were questioning the rationale for the UK's "Bare below the Elbows" infection control policy which says that all hospital personnel who are in contact with patients must wear short sleeve shirts, no lab coats, no watches, and no ties.

A medical student from the UK who follows me posted this tweet:

In a recent post on anonymity, I tried to justify my existence by referring to a post that I wrote about CT scans and appendicitis noting that I have received many questions from patients asking for advice. This suggested I had credibility despite using a pseudonym.

But I think being cited as evidence tops any previous attempts to claim that my writings can be trusted.

Here's the med student on how the Brits feel about "Bare below the Elbows:" He said they are ambivalent and in his experience the policy results in "infection control people chasing people round for long sleeves/watches and missing the real problems!"

I told him that we have legions of clipboard carriers in our hospitals too.

He added, "Antibiotic stewardship is a far more pressing issue than length of my sleeves."

That's a pretty astute observation for a medical student to have made.

I thank him for considering my blog post as evidence. If you too want to find evidence, here's a link to that post.

Can I apply to be listed in PubMed?

Who would ask an anonymous blogger for medical advice?

I'm often asked why I use a pseudonym. When I first started blogging almost 4 years ago, I was still in practice. Some of my posts are a little edgy and my sense of humor is not for everyone. I didn't want patients to google me and have my blog come up on the first page of hits.

Now that I've been retired for over a year, I still have not revealed my true identity. You may ask, "Why not?"

I like being anonymous. I feel that I can be more honest because I am not worrying about what someone is going to think. A quote from Oscar Wilde says it all: "Man is least himself when he talks in his own person. Give him a mask, and he will tell you the truth."

Some people have questioned my credibility. They say how can anyone believe what you write when they don't know who you are? I've been referred to the UK General Medical Council's rule #17, which states "If you identify yourself as a doctor in publicly accessible social media, you should also identify yourself by name. Any material written by authors who represent themselves as doctors is likely to be taken on trust and may reasonably be taken to represent the views of the profession more widely."

Regarding the previous sentence, I agree with the first part about trust and strongly disagree with the second part. How could anyone think that what a single doctor writes is representative of the profession more widely? I am reasonably certain that is not the case in my situation.

You want credibility?

A single post of mine called "Appendicitis: Diagnosis,CT Scans and Reality," which I wrote about three weeks into my blogging career, has received almost 14,000 page views.

In the comments section of that post or via email, more than 50 people have asked me questions about their own or a family member's abdominal pain. I've had to add numerous disclaimers over the years reminding readers that I could not give medical advice without examining the patient.

Despite the disclaimers, the questions keep coming with the most recent one submitted two days ago. I can only guess that they are either reluctant to ask questions in person or not getting satisfactory answers from the doctors they are seeing.

Premed and medical students and residents frequently look to me for career counseling. Last week I even got a question from a high school student who was thinking about becoming a doctor. The students and residents occasionally preface their questions by saying that they didn't want to ask someone from their school or residency program for fear it would reflect poorly on them.

I have been amazed at how many readers seem to trust me enough to ask personal questions about their health or their career. To be able to connect with so many people despite my use of a pseudonym is rewarding.

Patients and aspiring doctors—that's who would ask an anonymous blogger for advice.

Keep staying ahead of the news: Why you should follow Skeptical Scalpel

Last March, I blogged about some stories that national news organizations covered, but I had written about weeks or months before.

In the last few weeks, four more such episodes have occurred.

On December 10, 2013, a CBS article noted that patients who used proton pump inhibitors to control acid reflux were at risk for vitamin B12 deficiency. I wrote about the many side effects, including B12 deficiency, of these drugs back in June of 2012. Links are here: CBS/me

The New York Times ran a piece on December 12, 2013 asking if today's new surgeons were unprepared for practice. I have been writing about this for over three years. My most recent post about this topic was on April 18, 2013. Links are here: NY Times/me

On January 26, 2014, an op-ed piece in the New York Times by Nicholas Kristof discussed the ethical issues of doctors conducting body cavity searches at the request of police. My post on this same topic, which included all of the same cases, ran on Physician's Weekly on January 6 of this year. Links are here: NY Times/me

Also on 26th of January, the Washington Post published an article on high-ranking military officers who had significant behavior issues. I had written about three of these cases back in November of 2012. Links are here: WashingtonPost/me