A tweet on “X” (formerly known as “Twitter”), dated Jan. 2, 2024, and attributed to Elon Musk stated:

“… heavy use of C-sections allows for a larger brain, as brain size has historically been limited by birth canal diameter.”

For some reason, this statement was recently circulating on social media, even though it is a year old. I first came across the statement in a Facebook group for physicians, where a colleague was thanking another physician for responding to the statement with his own comment about how the original statement was untrue.

Unfortunately, not everyone who sees the original tweet will see the physician’s corrective statement. There are people who are likely to believe anything they hear from a person like Elon Musk, simply because of his wealth and position. Musk was able to buy Twitter, rename it “X,” and now uses the platform to spread whatever type of information he wants to.

Given the amount of misinformation and disinformation on the internet these days, physicians need to be active on social media. With our level of education, it is imperative that we share accurate information with the public, especially when it comes to health-related matters. Lay members of the public should also be encouraged to think critically and ask questions before jumping to conclusions. Along those lines, let’s review the research study that Musk was responding to.

The Framingham Heart Study

The tweet in question was in response to another quote, copied below:

“More recent birth cohorts have greater cranial volumes, more gray matter, and larger hippocampuses. Newer generations have bigger brains!”

This was in reference to an article that was published as a preprint (prior to peer review), titled “Secular Trends in Head Size and Cerebral Volumes in the Framingham Heart Study for Birth Years 1902-1985.”

The authors concluded that their research showed an improvement in memory performance and brain health with advancing decades of birth, findings that were likely explained by improved environmental influences. The final paper, Trends in Intracranial and Cerebral Volumes of Framingham Heart Study Participants Born 1930 to 1970, was published in JAMA Neurology. The conclusion was that early-life environmental influences could explain the trends in larger brain volumes and lower rates of dementia in their study cohort (individuals born between 1930 and 1970).

There was no discussion of C-sections or the birth process, so one can’t help wondering where Elon Musk got his idea about C-sections and larger brains from.

The Framingham Heart Study spanned three generations, yet some of its conclusions were misrepresented in a single tweet.

Social media versus peer-reviewed literature

The last time I checked, Musk’s tweet had 592.9 thousand views, compared to the post he was responding to, which had 511 thousand views. The post I referenced earlier, in which a physician debunked Musk’s statement, had just over a thousand views. I would guess that very few of the people who saw any of those tweets—the original tweet or those debunking its claims—have read the articles that describe the research. Even though the preprint abstract was published prior to peer review and is open-access, that does not mean people will take the time to find and read it. The final, peer-reviewed article is likely to be accessed by even fewer people.

While I was in the process of writing this essay, I came across another Facebook post, once again posted by a physician in a physician group, to demonstrate the type of misinformation that was being circulated on social media. The original post in this case stated that tumors were “life savers,” and that they shouldn’t be operated on or “cured.” The post further stated that all cancers were linked to parasites and the solution was a combination of fasting, enemas, and herbal remedies. Unfortunately, there are people who will read this and very likely act on it, taking it as sound advice, with dire consequences, while the person responsible for spreading the misinformation gets away with it.

As physicians, we are held to very high standards when it comes to sharing information, yet people who are less informed and, in some cases, completely uninformed, are not held to the same standards.

We can’t assume that people will take their doctor’s advice over that of a social media influencer, but at the very least, we have an obligation to share our knowledge and expertise and counteract disinformation. We can no longer limit our focus to the medical and scientific literature—that isn’t where most people get their information from.

While it is prestigious to have publications in top peer-reviewed journals, at the end of the day, most people aren’t getting their information from these sources. They are on social media, which is the reason physicians like us need to be active on these sites, sharing our knowledge and correcting misinformation. We have an ethical and moral obligation to do so.

Olapeju Simoyan is an addiction medicine specialist.