Making clear, concise and accessible—unbiased– information available to all represents the spirit and intent of knowledge democratization and this aligns well with the mission of TrialSite News. Recently, one of the country’s preeminent physicians used a traditionaleditorial to weigh in on the potential of Twitter and its ideal role in public discussion on medical research, and to outline his take on the influence some users acquire — deservedly or not — from engaging legions of “followers.”
Twitter and other forms of social media have the potential for “democratizing both dissemination and critique” of clinical trials, their results, and their lessons, “thereby bringing in the broad swath of the clinical practice and scientific community” to the public debate, Robert M. Califf, MD, Duke University, Durham, North Carolina (@Califf001), observes in the commentary. Of course Twitter does nothing to deal with the quality or accuracy of the information.
Twitter, Califf writes, “suffers from brevity and a dominance of Twitterati,” that is, “people with a gift for promotion of their ideas by using short phrases” who can potentially attract large numbers of followers.
In an ideal world, he argues, researchers with the most publications and citations, that is, those “with the most important contribution of original knowledge, would have the largest Twitter following” in proportion to their influence on Twitter.
But in reality, “pundits with few publications with impact and a large Twitter following either may be expert commentators and analysts or may represent ‘crackpots’ with little real knowledge of the topics on which they are commenting,” writes Califf in the editorial, published online February 5 in JACC: Case Reports.
The Kardashian Index
The editorial accompanied an analysis, which was framed as satire, that makes use of something called the Kardashian Index, or K Index, a metric for influence on Twitter as a function of influence in the scientific literature, and which was named for a pop-culture celebrity.
Medical discussion on Twitter seems to follow two distinct avenues, Califf told theheart.org | Medscape Cardiology. One, “I think it’s good for discourse and debate. It’s greatest value right now, I think, is for knowledge organization.”
He said that refers to when, for example, an accomplished and respected scientist uses Twitter to curate and comment on important research advances, perhaps even providing links to the pertinent publications.
To that end, Califf said, one goal of the editorial was to promote a sense of common purpose between the cardiology research community and cardiologists on the front lines of clinical practice who don’t participate in much research or contribute to the literature.
“We have an enormous gap of knowledge, and we need more people participating,” he said. “One marker of participation is either enrolling people in trials or participating in the writing of manuscripts that get published with peer review.”
He added, “The more knowledge people have about how trials get done, the better able they’ll be to discuss what they mean and how they can be done better.”
But the editorial, some observers say, argues that physicians with the greatest contribution to the medical literature are most qualified to critique medical research, especially clinical trials.
Moreover, they see the editorial as taking aim specifically at them and other physician users who are primarily in clinical practice and thus don’t have a lot of publications.
Indeed, Twitter “has some real advantages compared to waiting for the peer reviewed journal to come out, and then waiting to go to a meeting,” Califf acknowledged. “I mean, you can absorb and hear what different people think. It is democratizing. I think that part of it is good.”
On the other hand, a loud Twitter voice, as measured by number of followers, “does not necessarily equate with more impactful work,” concludes the primary article in JACC: Case Reports, for which Califf wrote the accompanying editorial.
The report’s authors, led by Muhammad Shahzeb Khan, MD, Stroger Hospital of Cook County, Chicago, Illinois, described their use of the previously defined K Index, the ratio of the number of Twitter followers a person has amassed to the number theoretically deserved based on their number of literature citations.
In their sample of 1500 leading cardiologists, only about 16% were on Twitter. Of those, about two thirds scored a K of 2 or less, signifying a low level of influence via the service.
Interpretation Vs. Commentary
In his editorial, Califf describes the K Index as “an oblique way of addressing an issue that is bothersome to researchers who have paid the hard price of designing, conducting, analyzing.”
When research is discussed on Twitter, Califf writes, “Another person who may have only casual knowledge of what is involved in the research may then make a comment that attracts enormous attention. People with a high K-Index may be those who thrive by commenting on the work of others rather than doing their own work.”
The medical community “will have to come to grips with the right balance of doing research versus interpreting and commenting on research. There is a need for both,” the editorial observes.
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