Last summer, Professor Louis Appleby contributed this opinion to the BMJ as a guest writer:

“It’s common to see academics dropping off social media to escape abuse. It starts with a tweet or media comment on their field of study. Someone takes exception to their message, outrage spreads. Their timeline becomes a torrent of hostility.

This is hardly unique to researchers: twitter is a bear pit. But talking to the public is part of the academic job. Funders expect it. A public health crisis demands it. Yet, we have calls for covid scientists to resign. One expert’s bio says simply: “I block.” How did it come to this?

I should mention my own brush with the Twitter pile-on, though it was comparatively minor. In November 2020, my research group released the first pandemic suicide rates for England. Against expectations, we found no rise. Over the next week I received hundreds of angry tweets: insults, abuse, a few implied threats. Suicide had become a political issue in the pandemic. Claims of a huge rise were everywhere, blamed on lockdown. Our findings were inconvenient.

Attacks came from covid-deniers, libertarians, anti-vaxxers. We were wrong, they said, and what’s more, we knew we were wrong. We were up to something. Some alleged fatal flaws in the study.

It’s tempting to shrug and move on. But to treat abuse lightly is to normalise it, and harassment of researchers on whom we rely in a crisis should never be normal. And if researchers give up on public dialogue, the stage is clear for charlatans. We all lose. Equally, seeing it simply as the product of ignorance—the pitchfork mob at midnight—is simplistic and gets us nowhere. Public outrage at scientists is a social phenomenon powerful enough to have shaped the course of a pandemic. It needs to be understood.

It starts from the dominant political force of our time, a sense of being excluded, a belief that decisions affecting us all are the preserve of people who know nothing of real lives. Hostility to “the elite” isn’t new. It has been a tool of populist leaders for centuries. Add to that something more recent, the cynical denigration of experts, a word that now carries a pejorative sense: out of touch. Or worse: hiding the truth, in the pay of the powerful.

Twitter imposes a new element: an egalitarian format that creates equivalence, real or not. I’m entitled to my opinion, say the keyboard warriors. And so they are. My opinion is based on 30 years of study, says the expert. Exactly what you’d expect from the elite. Twitter also brings aggression to every debate, stoked by anonymity, like road rage. Resign, sack, arrest, imprison—these words reverberate across social media. No disagreement is too trivial to end with insults and accusations.

And Twitter runs on confirmation bias. People follow, like, retweet, sure of what they believe. It’s unsettling if an expert says otherwise. But aren’t experts in a bubble of their own? Do I know what the public believe on suicide? I look at who I follow: they are all like me.

Underlying this is the cultural rise of subjective truth. People talk of “my truth” when they mean “my experience.” On Twitter, they may see a new treatment successfully trialled and say: it didn’t help me. Who can blame them for putting their experience first?

There was in fact another group who criticised the suicide data we published, whose motive was not political. They were people whose mental health had suffered during the pandemic. They saw in our findings a denial of their experience.

In health research, subjective experience has gone from dismissal as anecdote to vital evidence, a driver of “personalised” care. It sits alongside population data, enriching large-scale studies. They are not in opposition. Both are needed. Both come with uncertainty. Experience can vary. Data can change. Uncertainty is the stuff of academic life. No research is perfect.

On Twitter, academic uncertainty meets subjective truth. We become defensive. Can Twitter ever be mature enough to discuss uncertainty? To see the difference between belief, opinion, and evidence? Between subjective experience and subjective truth? It’s not there yet.

What can academics do to improve the dialogue on social media? Zero tolerance of abuse is essential. So too is engaging with the public on their terms, valuing their experience. We need to reassure them of our independence. We need to explain uncertainty. We must also convince the public that when we speak about a research field, we have the expertise to do so, that we are not using academic titles as a smokescreen for private opinion no more valuable than anyone else’s. We’ve seen this in the pandemic, it diminishes us all.

The public too has a responsibility to make this dialogue work. Challenging commonly held beliefs, their own and other people’s, is what academics do. It’s how knowledge advances, for public benefit. It should be encouraged, not cancelled.

And in an age when information is power, is it too much to expect that interpreting evidence should be something everyone can do, as important as numeracy or grammar? That sampling, bias, and small numbers could be taught in school—skills for life.”

Louis Appleby, professor of Psychiatry, University of Manchester.
Competing interests: none declared.

This week I was reminded of this BMJ blog when I tried to introduce myself to Professor Appleby outside the International Congress of the Royal College of Psychiatrists. I had never met Professor Appleby before. Professor Appleby did not go out of his way to make our brief meeting congenial.

This was my response To Professor Appleby’s  BMJ opinion of August 2021:

In 2017, when BMJ Opinion was launched, this was promised: “As ever, we welcome debate on topical issues” providing “a new space for informed debate” [1]

It was interesting to read this BMJ Blog about social media and academia which rightly states that “to treat abuse lightly is to normalise it” [2]. This Blog also makes clear that academics and doctors should “engage with the public on their terms, valuing their experience” and be able to “reassure” the public of the independence of scientific research and medical education.

I worked as an NHS doctor for over 25 years and have always been of the view that openly asking questions of prevailing approaches is vital to science. If barriers come in the way of such approaches then learning will be limited and harm will result. This is why this BMJ Blog is so important but also why the reflections it makes on social media need to be considered not just in one direction but in all directions.

My understanding is that the GMC regularly have concerns raised with them about professionals’ use of social media though I am not sure what research has been done on this subject. As a retired doctor it is my view that if the medical profession [including academia] wishes to aspire to being the paradigm of professionalism, and to assume the position of power that comes with this role, then the medical profession and its representatives must be willing to be held publicly accountable when they are perceived to depart from the values they collectively espouse. This should apply to professionals’ use of social media.

This aspect was less clearly spelled out in the BMJ Blog and I am grateful to have the opportunity to raise it even though I have not found it easy to articulate this given my shared concern of contributing to unhelpful social media discourse.

Dr Peter J Gordon [retired NHS doctor]
Bridge of Allan.

[1] Editorial: Welcome to BMJ Opinion: BMJ 2017; 356 (Published 07 February 2017)
[2] Academics and social media hostility: should we give up or do more? August 23, 2021

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