“Publish or perish” has been the mantra of academic medicine for as long as can be recalled as the reputations of professors, physicians, and academic centers have hinged on contributions to peer-reviewed literature for years.  Yet today’s information era is dominated by the rapid development of social media and online interactions, which have also resulted in some major advancements to print media as the majority of newspapers have now moved to an online format.  Despite these changes in media, academic medicine — and its reliance on peer-reviewed journals — has lagged behind.  Why has academic medicine not evolved to keep up with advances in social media?  What are the unique opportunities and dangers associated with the greater adoption of social media in medicine?

In contemporary academic medicine, a publication in a peer-reviewed journal remains the gold standard that defines success and influences grants, upward mobility and tenure.  The peer review process begins when the author submits a manuscript.  The manuscript is then reviewed by several experts in the same scholarly field (peers).  The peer reviewers assess for quality, accuracy, and validity.  In most cases, the reviewers are blinded from the identity of the author, so the article is judged based on its merit alone.  In academic publishing, this peer review process serves to protect the integrity and quality of the research.  However, there are many flaws with the system.

For one, the peer review process has created a “Glamour mag” culture with researchers largely focused on submitting articles to academic journals with a high “impact factor.”  The impact factor of a journal is a measure that reflects the average number of citations to recently published articles and is a means of determining the highest quality journals for publication.  It is largely believed that publication in a journal with a high impact factor is the most prestigious publication possible and reflects the highest quality of research of an individual or institution.  However, this ultimately creates a prolonged and arduous peer-review process.  For many of the top journals, the peer review process can take over a year before acceptance and even longer to reach print.  By this time, many statistics may already be outdated and/or potential advancements may be delayed from being rapidly instituted.

In addition to this the Glamour mag culture, the competitive atmosphere and the desire to stay relevant has further diluted the quality of research.  This sentiment is shared by Michael Eisen, a biologist at the University of California at Berkeley.  He states, “The thinking that ‘I have to get my paper into these [top] journals,’ just corrupts and poisons the way people do science itself.”  He goes on to say, “It leads to people making their work sound sexy at the expense of its veracity.”  Eisen speaks to a growing problem in the scientific community: “irreproducible” research.

The integration of social media and medicine is still in its infancy and, as a result, there is no impact factor for social media contributions, which may largely go unrecognized.  Nonetheless, social media might relieve the anxiety of publishing to stay relevant.  While the peer-review process is the cornerstone of scientific validation, social media offers professors, physicians and academic institutions the opportunity to publish from their own user handles in a way that is unconstrained from “pleasing” a top journal with sexy yet potentially mediocre research.

In fact, social media offers many distinct advantages.  By its very nature, social media can be used as a more effective tool to disseminate medical information to larger audiences than traditional methods.  While a top journal such as the New England Journal of Medicine reaches as many as 600,000 readers weekly, a social media publication may easily reach millions and is accessible anywhere in the world.  Moreover, unlike journals, social media is not shackled by membership fees, which narrows the subscriber audience.  Anyone who possesses a data-capable phone, computer or other tech device has the ability to connect and contribute to the social media web.  Lastly, publishing on social media may improve the public’s understanding of science.  While most journals are read by professionals of that particular field, social media publications have the potential of reaching a larger audience of laypeople who may not entirely understand the language within a professional manuscript but are nonetheless interested in the topic.

In addition, social media sites such as Facebook, Twitter and YouTube can connect with the general patient population to promote communication and overall public health more so than traditional methods of publication.  Social media authors often publish work that is intended for the general public and typically do so in a way that doesn’t compromise the integrity of scientific communication.  For example, at a time when the public desired to understand breaking epidemiologic news, Chiduzie Madubata, MD published a blog article entitled, “Ebola in the digital age: How doctors can confront it,” on KevinMD.com. Dr. Madubata shines a spotlight on social media as a medium for doctors to share information with their patients, colleagues, and the public and also for patients to share information with physicians.  The physician has the ability to interact and gauge the extent of public understanding as viewed in the comments section. He or she can clear up any misunderstandings and learn where the medical community should communicate more effectively.  Social media enhances the way medical information reaches a consumer.

Despite the great potential of social media in medicine, there are many concerns — so much so that professional organizations such as the American Medical Association (AMA) have published guidelines for the ethical use of social media.  In many aspects, traditional medicine has valued privacy and confidentiality, which sometimes seems to contradict the open and informal nature of social networking.  Recently, a number of institutions have implemented strict social media policies in response to privacy concerns, including a case in which a medical student posted pictures with cadavers online.  However, with advancements in social media, privacy settings have also evolved.  Many physician-to-physician websites such as VuMedi and Doximity are visible to only physicians who are members, while sites such as Facebook allow physicians to select who can see a specific post.

Another apprehension is that the rapid dissemination of knowledge through online articles in emerging “open access” journals has given rise to predatory journals with short and loose peer review processes as these publications are often willing to publish articles solely for profit.

It is clear that the future of medicine and publishing will have a large online/social component.  How should academic institutions view these contributions?  Should authors who publish on social media websites be recognized?  This question will linger for many years as medical education evolves to keep pace with the social norms of society.

Adam Bitterman and Brett Auerbach are orthopedic surgery fellows.  Jordan Fakhoury is a medical student.

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