Milton Packer wonders where physicians are getting trustworthy information Last week I wondered if physicians were reading journals in order to keep up with advances in their field. The overwhelming consensus was "No!" In fact, some wrote to me claiming that medical journals were a major source of misinformation. If medical journals are so unreliable, how are physicians keeping up with the development of new diagnostic tests or with improvements in treatment? According to one physician: There are no new advances in medicine. Every advance is simply hype on the part of industry. Another clinician said: I used to wait for guidelines, but they are very long and hard to understand, and different guidelines conflict with each other. The guidelines take years to develop, so they are all out-of-date. A third response: I try to listen to audiotapes by established authorities, but they don't necessarily cover areas of interest to me. And finally: I used to go to conferences, but most speakers are from my own institution, so there are no fresh ideas. In the past, there were many really good outside speakers, but not any more. Sadly, the four respondents just added to the list of sources that were not reliable. So I kept asking: How do you keep up with advances in medicine? Finally, for some, there seemed to be one answer. Twitter. According to some, Twitter represented the most reliable source of new information. Others claimed that Twitter was the only way of getting balanced views on any new innovation. For many, Twitter seemed to represent the cutting edge of medical practice. One exclaimed: Twitter was the new "evidence-based medicine," or EBM. REALLY? I do not have a Twitter account. I have never tweeted. I follow no one on Twitter, and no one follows me. And that is true for the majority of the leaders of medicine in my generation. But based on the recent feedback I received, I decided to wander onto Twitter, just to see if it would be a good source of cutting-edge information on advances in medicine. Here is what I found. Many of my good friends have Twitter accounts, and they use them primarily to cheer people on, provide some kind words, report on some gathering at a meeting or to highlight some major public health issue that none of us have the ability to solve. Some are fun to read but provide no evidence or guidance about the practice of medicine. Many people who are professional cynics (or perhaps are clinically depressed) send out messages of dark disparagements, typically based on uninformed stereotypes. Their message: "Don't believe what you read, but above all, you should believe in what I say." (If this makes sense to you, I would be grateful for any enlightenment.) Others revel in expressions of self-congratulations -- essentially, look what I have done! And many companies tweet about their successes. (Interestingly, I could not find any corporate tweets about failures.) But all in all, most tweets are simply emotional reactions or an opinion related to some another tweet or some non-tweet event. I tried really hard to find evidence of "evidence." I looked for reliable information about advances in clinical care. But how is that possible in 280 characters? Occasionally, someone might post an article, typically one behind a paywall. If I did not know about it already, it was best to go to the original source -- and read a number of related papers to make sure I got a complete story. Sadly, most of the time, I just found someone's opinion about something, but I had no idea whether the opinion was informed or biased. All too often, the post revealed that the self-proclaimed expert actually knew very little about clinical research methods. Some relied on "rules" that they did not understand. Many who rejoiced in criticizing the work of others had actually never done any original research themselves. But the lack of expertise did not keep them from posting strong opinions. All too often, those with the least experience showed the greatest expression of glee in their pretense to bring down someone else's work. Yet, they would never criticize shoddy papers that happen to agree with their biases or had been praised by friends. Some people are good at tweeting. But being good at tweeting does not mean that you know what you are talking about or that people should heed what you say. The U.S. president has more than 50 million followers. If Twitter is your primary source of reliable and up-to-date medical and scientific information and discourse, then you practice EBM -- emotion-based medicine. More precisely, you practice self-declared expert-based medicine. In reality, you practice opinion-based medicine. Here is the problem. The Twitter opinions that you rely on for the care of patients are someone else's opinions of the medical literature. They are not even yours. When I am a patient and want the best medical care, I am not going to find it by seeing a physician who is really good at compiling the opinions of others. I want practitioners who have examined the available evidence personally and thoughtfully, and have reached conclusions about medical practice based on their experience, expertise and insight. Do some people primarily practice Twitter-based medicine (TBM) and simply compile the opinions of others without reading the original source material? I don't know. That is why I am asking. So tell me: do you practice TBM? Source
