‘Twitter doesn’t require peer review’: The benefits, risks of cardiology chatter on social media

The immediacy and accessibility of social media provides a fertile ground for cardiology practitioners to quickly share feedback, insight or criticism of the latest medical research, case studies and practical techniques.

But those same characteristics can lead to the spread of misinformation or uninformed opinions from users who haven’t bothered to read past headlines or the maximum 280 characters from another #CardioTwitter poster—common problems in the “Fake News” era that take on whole new implications when important clinical matters are being discussed.

“Things have changed and we all need to get used to it,” said David J. Maron, MD, with Stanford University School of Medicine. “The trials are being reviewed before they’re published and there are bits of information that may or may not be accurate that are floating around. Twitter does not require peer review.”

Maron is a co-chair of the ISCHEMIA trial, whose investigators touched off a back-and-forth of journal editorials and social media posts when they changed their primary endpoint late in the trial recruitment period.

Another example of a cardiology “Twitterstorm” that may have gotten out of hand was the reaction to the ORBITA trial that was released during the 2017 Transcatheter Cardiovascular Therapeutics conference. Some applauded the bold, sham-controlled trial of percutaneous coronary intervention while others dismissed it, rebuked it or even personally attacked the researchers.

“In medical discussion … it’s partly the platform and the channel and it’s partly the environment you create,” Asif Qasim, PhD, said during a presentation at TCT 2018. “If you create a professional environment people will behave in a professional way. On Twitter, people unfortunately—even though you know who they are—they feel like they might be in the bar having a chat and sometimes that spills as their professional conversations and that can introduce risks.”

Qasim has a vested interest in moving medical conversations away from public arenas. He’s the founder and CEO of MedShr, a platform clinicians can visit to discuss challenging cases, learn from colleagues and keep these conversations restricted to the medical community.

But that doesn’t invalidate Qasim’s point, and other cardiologists considered the question of whether negative trial backlash on social media could affect patient enrollment and recruitment—especially because a patient can withdraw consent to participate at any time.

“Let’s say you’re a patient who is considering going into a trial and you’re aware of this buzz going on in the Twittersphere, you might have second thoughts about participating,” Maron said. “Or, if you’re a referring physician, you might have second thoughts about allowing your patients to participate. Twitter needs to be responsible; it can affect the integrity of a trial.”

Chuck Simonton, MD, the chief medical officer of Abbott Vascular, said he isn’t aware of trial enrollment being affected in this way so far, but added it’s a “valid concern.”

“Someone might say, ‘Well I would never volunteer to be in a sham-controlled, randomized trial,’ and start a whole bad run of commentary on that when there’s an active trial like ORBITA 2 about to start soon,” he said. “I think … it’s a real risk and I don’t know how to control that. I think it’s more the community controlling itself and realizing that the opinions you post can be read by the lay public and people who may even be approached for a clinical trial.”

Robert W. Yeh, MD, MBA—one of the more active cardiologists on Twitter with upwards of 7,000 followers—agreed with that self-policing approach within the medical community.

“I think you’d be playing a game of whack-a-mole by trying to censor information from one medium as opposed to the other,” said Yeh, director of the center for outcomes research in cardiology at the Beth Israel Deaconess Medical Center in Boston. “As a society we’re getting misinformation in more spaces than just trial data, but I do think where those misinformation are published, I think the rapid correction via the wisdom of the crowd can help things. That’s why I actually think we need greater participation (on social media).”

The authors of an editorial published in Circulation last month highlighted additional benefits of sharing cardiology-related information on Twitter.

“Medical Twitter gives access to the some of the world’s best clinicians and academics who can be potential virtual mentors for aspiring clinicians and surgeons or provide medical knowledge to those patients who feel that they are underinformed on their own medical condition and treatment,” noted Damian Gimpel, MBBS, and Max Ray.

With multiple social media-themed sessions at TCT 2018 and medical journals now devoting space to the topic, it’s clear #CardioTwitter is here to stay. As Gimpel and Ray suggested in their editorial: “For those who are concerned that the next generation of patients are being misled, join the conversation.”