Grand Rounds, Weill Cornell Medicine, Department of Medicine, November 2017

1. source unknown

2. News Without Gatekeepers:
Social Media and Medicine
- by Elaine Schattner, MD, MA
@ESchattner

3. How Did We Get Here?
1983 2017
Women’s health story, when I entered
medical school:
Woman speaking about health, via
Twitter:
Binghamton Press and Sun-Bulletin,
April 14, 1983. p.4
Schattner, Elaine (ESchattner). “Beth Caldwell's impact
on metastatic breast cancer, @fredhutch...” Nov 6,
2017, 9:30 am. Tweet.
@ESchattner

4. Pre-www (1993): support groups, telephone hotlines
1994-5: first patient list-serves
1997: weblogs (blogs), for health: ~ 2003
2004: Facebook
2005: Reddit, YouTube
2006: Twitter
2010
Future?
A Brief History of Social Media For Health
@ESchattner

5. Social Media For Health Is Not So New
Schlesinger Library, Harvard Univ.
(Our Bodies Ourselves) 1971
Yale Cancer Center image: launch of the
NCI Cancer Information Service (1976)
@ESchattner

6. Newspaper Readership Is Declining
0
10,000,000
20,000,000
30,000,000
40,000,000
50,000,000
60,000,000
70,000,000
1930 1940 1950 1960 1970 1980 1990 2000 2010 2020
Total estimated circulation for U.S. daily newspapers
(print and digital)
Weekday Sunday
data source: Editor & Publisher (through 2014); 2015-2016 estimation based on Pew analysis of
Alliance for Audited Media data, PEW RESEARCH CENTER, 2017.
estimated (2015 – 16)
@ESchattner

7. Where Do People “Go” On Social Media?
@ESchattner

8. • To advertise their practices and hospitals
• To promote their research
• To draw patients for care including clinical trials
• To connect with peers
• To educate and to learn
• To express themselves
• Curiosity, procrastination…
• Narcissism, psych issues & needs
Why Do Doctors Use Social Media?
#hcsm @ESchattner
(Adobe stock photo, licensed)

9. Doctors on Social Media
@ESchattner
(There’s a range.)

10. The Mayo Clinic on Social Media
@ESchattner

11. Tweeting at Medical
Conferences?
@ESchattner
Tweets can be measured. Not everyone thinks it’s a good idea.

12. “The Doctors” onYouTube
@ESchattner

13. The NCI is on Facebook
@ESchattner

14. Pathologists Use FacebookTo Share
and Discuss Clinical Results
@ESchattner

15. #Telepathology
@ESchattner

16. Pathologists UseTwitter to Discuss
Clinical Findings
@ESchattner

17. Doctors Use Social Media to Recruit
Patients for ClinicalTrials
@ESchattner

18. Dr. Nikhil Wagle Shares An Update on
the Metastatic Breast Cancer Project
@ESchattner

19. • Search for information about a health condition
• Learn about clinical trials and treatments not offered by local
physicians
• Want second (and third…) opinions
• Seek camaraderie and support among peer patients,
advocates and others
• Express viewpoints
• Curiosity, boredom, procrastination, etc.
• Narcissism, anger, joy, psych issues
& unknown needs
Why Do Patients Go Online?
(Adobe stock, licensed)
#hcsm@ESchattner

20. Why Do Patients & Caregivers Go
Online for Health Info?
@ESchattner
My answer (ES):
1. Doctors lack time
to answer Q’s
2. ↓ patient-doctor
relationship
3. ↑ information
access (web, etc.)

21. Tweeting for Platelets
@ESchattner

22. 2011
@ESchattner

23. Lisa Bonchek Adams (1969 – 2015)
@ESchattner

24. Sharing Health Stories Exposes Patients
to Journalists (among others)
January, 2014 – controversy overTweeting
@ESchattner

25. COLONTOWN is a Facebook Community for
CRC Patients, Survivors & Caregivers
@ESchattnerwww.colontown.org

26. Patients Use FacebookTo Discuss
Their Conditions
@ESchattner

27. My Online Profile (“Presence”)
@ESchattner
One profile, mix of personal and private posts
Many followers, loose ties – journalism, health
Strictly professional (including SlideShare)
Mainly for fun, filing of posts by topic

28. ES onTwitter
@ESchattner

29. ES on Pinterest
@ESchattner

30. •Treating people with respect goes far.
•Twitter’s not a place for dispensing medical advice.
•Be informal, but keep it professional!
•Consider the old rules for physician behavior in hospital
cafeterias and elevators:
Patient-Doctor Engagement on
Social Media GetsTricky
chatting in a hospital cafeteria
(Adobe stock, licensed image)
• Patients and caregivers on Twitter
are often watching, listening and
reading;
• A careless remark can be hurtful.
@ESchattner

31. A Good Example of Not Answering a
Clinical Question onTwitter
@ESchattner

32. Informational Chaos
Schattner, E. “Can Cancer Truths Be Told? Challenges for Medical Journalism” ASCO Educ Book 2017;37:3-11
“
@ESchattner

33. “Old” News is Imperfect,Too
Scott Pelley CBS Evening News May 12, 2016 (screenshot)
Schattner, E. Am Soc Clin Oncol Educ Book 2017;37:3-11 @ESchattner

34. WhoTurnsTo Social Media for News?
@ESchattner

35. Fake News is Real (and Contagious)
@ESchattner

36. @ESchattner
Social Media Spreads Fake Health News

37. @ESchattner
Is Fake Health News Easy to Spot?

38. 1. Newsrooms reduce staff for reporting and editing.
2. Many outlets lack fact-checkers.
3. To keep their jobs, reporters need file articles
quickly.
4. Most journalists lack time or knowledge to critically
evaluate reports about medicine, science,
technology and drug development.
5. Income depends on web traffic (clicks)
6. Editors may favor sensational stories to drive traffic.
Pressures on the Quality of
Medical Journalism
Adapted from: Schattner, E. “Can Cancer Truths Be Told? Challenges for Medical
Journalism” ASCO Educ Book 2017;37:3-11 @ESchattner

39. Sensational Stories Sell More
USA Today (screenshot, Nov 2017)
@ESchattner

40. News Has the PowerTo Influence
Public Health
@ESchattner
Angelina Jolie’s op-ed on BRCA testing and
her decision for bilateral mastectomy

41. 1. Seek input from varied sources.
2. Transparency about COIs at all levels of reporting:
doctors & scientists, patients, reporters, publishers
3. Better education
4. Foundations to support in-depth medical coverage
5. Patient-driven “advocacy journalism” to distribute
critical information.
6. Open access to real-time and anonymized clinical data
7. Innovative systems of weighted commentary culled
from social media and elsewhere
Health News Fixes?
Adapted from: Schattner, E. “Can Cancer Truths Be Told? Challenges for Medical
Journalism” ASCO Educ Book 2017;37:3-11 @ESchattner

42. Digital Data Might Boost Health
@ESchattner

43. Search is Social!
J Oncology Practice 2016 12:8, 737-744 @ESchattner

44. Search Data Reveal HealthTrends
@ESchattner

45. Date of download: 11/27/2017
Copyright 2017 American Medical Association.
All Rights Reserved.
From: Internet Searches for Suicide Following the Release of 13 Reasons Why
JAMA Intern Med. 2017;177(10):1527-1529. doi:10.1001/jamainternmed.2017.3333
Internet Searches Following the Release of 13 Reasons
Figure Legend:
@ESchattner

46. Security Issues:
• Stalkers exist and may be following you.
• Think before sharing details:
family, location, vacation, events
• Block pornographers, spammers, and individuals
displaying hateful language or violent images.
• Boringness can kill a social media feed; consider
divulging safe-yet-interesting aspects of your life.
• Know yourself. Establish limits about what you’re
comfortable sharing, and stick to those limits.
Yes, you are being watched.
Flickr, CC attribution:
Kristina Alexanderson
@ESchattner

47. • Doctors no longer control
conversations about health.
• Traditional journalism is fading.
• Social media is not going away.
• Information about health will emerge
from new sources, more from patients
• Public access to data and patients’ engagement
in decisions will grow.
• Artificial Intelligence
What Does the Future Hold?
@ESchattner

48. The Future of Medical Media
Will Be Amazing
Thank you!