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SAMJ: South African Medical Journal

versão On-line ISSN 2078-5135
versão impressa ISSN 0256-9574

SAMJ, S. Afr. med. j. vol.101 no.10 Cape Town Out. 2011




Blogs and Twitter in medical publications - too unreliable to quote, or a change waiting to happen?



Pranab Chatterjee; Tamoghna Biswas




With the ubiquitous connectivity offered by the Internet, social media sites (like Twitter and Facebook) and personal publishing platforms (blogs) are proliferating rapidly. In this new, evolving scenario of social media, these tools become an important medium to disseminate information at a lightning speed. However, the conventional medical publication model is less than eager to regard them as equivalent to traditional modes of information dissemination. In this article we examine the role played by the social media as a critic of the medical publication system, and how it acts as a safeguard by building a platform for post-publication peer review.



The buzzword in the field of communication technology for some time has been Web 2.0. By engaging users in conversational exchange of information, Web 2.0 ushered in a new era of collaborative multi user interface systems. Science 2.0 followed. Sceptics frowned about taking research 'to the clouds', while advocates of the new way of doing things argued for openness, transparency and the use of harnessed collective intelligence to evaluate, dissect and implement science.

Some assert that blogs and other non-traditional modes of dissemination of information are soon going to become of paramount importance in determining the smooth flow of information from the bench to the bedside and vice versa. The main reason for this is that although journals and traditional routes of publication remain the primary source of information storage and retrieval, the real conversion of this information and knowledge into applicable ideas takes place after peer-to-peer discussion. This does not usually happen on the journal forum, no matter how open and involved members are. Twitter, blogs and e-mail discussion groups are superior in this regard. Discussions on the JISC mail Evidence Based Healthcare group or the HIFA2015 e-mail discussion group clearly show the power of peer-to- peer interaction in translating the published intelligence into applicable mechanics.

The BMJ and several other journals in its group encourage this user interaction. Although the BMJ has revolutionised reader feedback on their published articles via the Rapid Response system, and by establishing the medical professional networking site Doc2Doc, people are still reluctant to comment on journal sites. Richard Smith has the following to say in this regard in one of his illuminating posts on the BMJ Blogs:1

'What is perhaps surprising in all this is that researchers are happy to blog and use Twitter but are reluctant to comment on the websites of journals. Blogs in the Guardian or on attract hundreds and even thousands of comments, whereas articles in journals rarely attract any. Why are scientists Tweeting and blogging but not commenting on articles in journals? I can only speculate that it's something to do with the stuffiness, formality, and pomposity of journals compared with the happy go lucky, party atmosphere of the blogosphere.'

A similar reaction:2 "'Who in their right mind is going to log on to the PLoS One site solely to comment on a paper?' asks Jonathan Eisen, academic editor-in-chief of PLoS Biology, and a prolific blogger and tweeter. 'I guarantee that there are more comments on Twitter about a PLoS paper.'"

A second aspect of formalising academic discussion on social media, particularly on blogs and on Twitter, is using these as tools for post-publication review of papers. While post-publication peer review itself presents a paradigm shift in the form of research publication, combining it with blogs and social media seems too radical for the scientific community to handle.

However, one has to go back only a few months to the storm raised on Twitter regarding a Science article by Sebastiani et al.,3 which created a snowball phenomenon as the snipers on 23andMe and other science blogs took aim at the methodological fallacies of the paper, which had been ratified by the Science peer review. Although the popular media touted the study as the key to long life, it attracted a lot of flak immediately after publication from scientists who were active online on Twitter and on blogs. While this case exhibited the obvious and well-documented, much-criticised lacunae of the traditional peer review system, it also showed the strength of using social media as a filtering system for the review of articles, the so-called post-publication peer review. The Medical Journal of Australia Internet peer-review study4 concluded that while post-publication peer review is still not robust enough to replace the traditional system of pre-publication peer review, it can be a potential source of informational and critical inputs on an article. While blogs have been used as tools of education, 'peer-to-peer learning'5 and online collaboration,6 Twitter has accurately reflected disease activity trends during the H1N1 influenza, pandemic,7 earthquakes and even market trends. However, we have yet to see the impact of their entry into the (arguably) 'sanctum sanctorum' of rigorous peer-reviewed scientific communication.

The problem with using social media as a part of this system is that it tends to be unstructured and chaotic. Especially when something goes viral, the torrential flow of information can be too much to process and handle. And scientists are traditionally trained to abhor the absence of a systematic layering of intelligence. These 'frivolous' entities are therefore considered to be poor sources of information. We have seen that even medical news stories written by specialist health journalists are of better quality than those written by nonspecialists or inexperienced writers.8 Add to that the ephemerality of the interwebs, and there is a problem. A recent study9 highlighted this potential threat where medical misinformation was found to spread through tweets to hundreds of 'followers'.

In an ideal world, in addition to its parent journal's impact factor a paper would also be measured in terms of metrics defined by the offline/online chatter it raised. The feedback loop generated could prompt further insights in the topic of discussion and enhance the 'knowledge impact' of the research. Some formal platforms for post-publication peer review have already been launched, like JournalWatch or Faculty of 1000, which pick out what is important and relevant, and also analyse the quality of the evidence.

Constraint through formalising and putting up communication barriers may well amount to crippling these powerful tools, or may well be seen as necessary means to keep a check on miscommunicated science, pseudoscience or plain irrelevant chatter. The ideal form is certainly not yet at hand, and the social media is still in its infancy when it comes to medical publications. However, the day is not far off when, in addition to formal outlets of publications, more informal forums and blogs will also be recognised as valid, quotable information sources.

As Richard Smith says in yet another blog:10

'Scientific blogs are becoming more important, and molecular biologists have for some time been leading the way by sharing their results immediately with each other through the internet ... It's back to our roots.'



1. Smith R. Twitter to replace peer review? BMJ Blogs, January 26, 2011. (accessed 6 August 2011).         [ Links ]

2. Mandavilli A. Peer review: Trial by Twitter. Nature 2011;469:286-287.         [ Links ]

3. Sebastiani P, Solovieff N, Puca A, et al. Genetic signatures of exceptional longevity in humans. Science 2011:333;404. Retraction in Science DOI: 10.1126/science.333.6041.404-a        [ Links ]

4. Bingman CM, Higgins G, Colleman R, Weyden MB. The Medical Journal of Australia internet peerreview study. Lancet 1998;352:441-445.         [ Links ]

5. Hanson K. Blog enabled peer-to-peer learning. J Dent Hyg 2011;85(1):6-12.         [ Links ]

6. Grassley JS, Bartoletti R. Wikis and blogs: tools for online interaction. Nurse Educ 2009;34(5):209-213.         [ Links ]

7. Signorini A, Segre AM, Polgreen PM. The use of twitter to track levels of disease activity and public concern in the US during the influenza A H1N1 Pandemic. PLoS One 2011;6(5):e19467.         [ Links ]

8. Wilson A, Robertson J, McElduff P, Jones A, Henry D. does it matter who writes medical news stories? PLoS Med 2010;7(9). doi:10.1371/journal.pmed.1000323        [ Links ]

9. Scanfeld D, Scanfeld V, Larson EL. Dissemination of health information through social networks: Twitter and antibiotics. Am J Infect Control 2010;38:182-188.         [ Links ]

10. Smith R. Scientific communication is returning to its roots. BMJ Blogs, July 26, 2011. (accessed 6 August 2011).         [ Links ]


Conflict of interests: None to report.



Pranab Chatterjee, MB BS, is an independent researcher and general practitioner and Tamoghna Biswas an 8th-semester student at Medical College, Kolkata, India.



Corresponding author: P Chatterjee (
Research ethics committee approval: Not required.

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