Nick Mark MD Profile picture
Nov 1 12 tweets 6 min read
What is #MedMastodon & why might we need it?

A short thread explaining what it is & why I think it’s time to consider moving to a free, self-moderated medical community as a #MedTwitter alternative.

med-mastodon.com/web/home

1/
Despite its flaws I think Twitter is a great platform for medicine/science.

It’s a fantastic way to follow breaking news & scientific pubs. It’s a great way to hear what brilliant people think. It can be an OK way to engage in debate.

I’m a better doc because of #MedTwitter
2/
Where else can you see the moment impactful research is published? Or hear the authors explain it & discuss with them?

Where else can you hear about the experience of colleagues around the world?

I’ve learned a lot and made some great friends IRL on here.
3/
But I worry about where this platform is headed.

In recent days, Hate speech has risen dramatically.

One researcher found an almost 100x increase in hate speech within days:

montclair.edu/school-of-comm…?

Docs, nurses, scientists, & others are often targets of this vitriol.
4/ Image
Health misinformation is also on the rise & @Twitter seems ill-equipped & unmotivated to address it.

washingtonpost.com/technology/202…

Many of those who oppose harmful medical misinformation have been threatened, doxxed, & harassed.

5/
In recent days some of the worst spreaders of misinformation have been welcomed back onto the platform.

These people weaponize their followers to harass critics of the pseudoscience they sell.

6/ Image
Is this a momentary blip in a self correcting system or the beginning of an inexorable decline? I don’t know 🤷

I do know that what makes #MedTwitter so effective is the people not the platform that hosts it.

7/
That’s why I think we should explore a backup option for #MedTwitter on another platform.

Mastodon is one open-source alternative. Unlike twitter which is one monolithic platform, mastodon is many independent nodes. Each can define its own standards.

en.wikipedia.org/wiki/Mastodon_…
8/
Think of #medmastodon as a small town & #MedTwitter as a neighborhood in a big city.

In a small town it’s easier to have laws that reflect the values of the community. For example prohibiting hate speech & blatant health misinformation. Self moderation may be more responsive.
9/
Another advantage of mastodon is that each separate “instance” can connect to others. You can be part of #medmastodon but follow people in another instance.

To use the small town analogy, it’s easy to visit other towns.

10/
Other than a community of peer medical professionals moderating our own content, there are a few clear advantages:
- you can edit
- up to 500 characters per “toot”
- it’s free
- no ads

11/
Will this be necessary? I hope not. But if Twitter becomes increasingly toxic I want an alternative.

Will it be perfect? Hell no. It’s buggy open source software! But it should provide most of what we need.

How to get started? Go to
med-mastodon.com/web/home
12/

• • •

Missing some Tweet in this thread? You can try to force a refresh
 

Keep Current with Nick Mark MD

Nick Mark MD Profile picture

Stay in touch and get notified when new unrolls are available from this author!

Read all threads

This Thread may be Removed Anytime!

PDF

Twitter may remove this content at anytime! Save it as PDF for later use!

Try unrolling a thread yourself!

how to unroll video
  1. Follow @ThreadReaderApp to mention us!

  2. From a Twitter thread mention us with a keyword "unroll"
@threadreaderapp unroll

Practice here first or read more on our help page!

More from @nickmmark

Nov 1
Here’s another pulmonary physiology question that *everyone* who gives O2 to patients ought to know:

What is the primary mechanism by which supplemental oxygen can increase PaCO2 in someone with severe COPD?

1/
This is a hard question! You probably learned that "its bad to give someone with COPD ‘too much’ O2 because they might stop breathing”

Turns out hypoxic respiratory drive causing apnea is a MYTH..but there is an important truth here:

A🧵on Oxygen induced hypercapnia!
2/ Image
Every myth has a little kernel of truth:

In the 80s it was shown that giving people with severe COPD (GOLD stage IV) high flow oxygen (15 lpm) made their minute ventilation (VE) drop then return (almost) to normal, but PaCO2 rose significantly.

Why?

ncbi.nlm.nih.gov/pmc/articles/P…
3/ Image
Read 15 tweets
Oct 31
Hi #MedTwitter friends -

Hoped it wouldn’t come to this but I just setup med-mastodon.com as a #MedTwitter alternative.

Trying to create a free, open community for sharing & discussing medical topics. Join & create your own free verified account.
Some advantages of mastodon:
- open source, decentralized platform
- a small community that can moderate itself (that means no hate speech, no misinformation)
- 500 characters per "toot"
- built in content warnings & enhanced privacy settings
- cross platform compatible
- free
Read 5 tweets
Oct 30
A case everyone needs to know:

A man admitted for CHF exacerbation is normoxic on ambient air. POCUS shows bilateral pleural effusions.

He develops Afib w/ RVR (HR 150s). A med is given. Suddenly he develops hypoxemia (SpO2 84% on NC, 94% on NRB).

What med & what happened?
1/
Which medication was most likely given for Afib with RVR that could have *caused* this person to become hypoxemic?

2/
This is a textbook example of *loss of hypoxic pulmonary vasoconstriction* due to administration of a calcium channel blocker (diltiazem).

This is a surprisingly common cause of iatrogenic hypoxemia!

A 🧵 about hypoxic pulmonary vasoconstriction & why it really matters!
3/
Read 11 tweets
Oct 11
Want to see how PEEP recruits atelectatic lung?

Here’s a video I shot of pig lungs 🫁 connected to a ventilator. Watch as we increase the PEEP from 0 to 5 to 10 cmH2O.👇
Caveat: Normally the inward elastic recoil of the lungs (causing collapse) is balanced by the outward elastic recoil of the chest wall (causing expansion). At FRC these forces are at equilibrium.

When you have lungs without a chest wall👆, PEEP is essential to prevent collapse. Image
(Fortunately) the physiology of lungs without a chest wall doesn’t happen very often, but you can see this in people undergoing sternotomy:

pubmed.ncbi.nlm.nih.gov/8865383/ ImageImageImage
Read 4 tweets
Oct 2
In his latest effort to win the Dunning-Kruger award, VP is now opposed to lung cancer screening.

In order for VP to consider cancer screening “worthwhile” its not enough to prevent lung cancer mortality it must prevent death from literally anything (all cause mortality)
1/
For context, large RCTs have demonstrated the value of lung cancer cancer screening in high risk people: those who are older & with greater 🚬 exposure.

In particular, the NLST (2011) & NELSON (2020) trials found reduced lung cancer mortality with low dose CT screening.
2/
A recent meta-analysis of 9 lung cancer screening RCTs (that included almost 100,000 people) confirmed this finding: low dose CT scans reduce lung cancer mortality.

For every 265 people screened, 1 death from lung cancer is prevented.
pubmed.ncbi.nlm.nih.gov/32583338/

3/
Read 14 tweets
Oct 1
Lots of misunderstanding about what constitutes harmful misinformation.

We’re not talking about evolving evidence (eg. Vaccine efficacy was 89% vs Delta infection but only 65% vs omicron).

We’re talking about people who literally say vaccines contain microchips & cause AIDS…
If you read the bill (or Gov Newsom’s statement) you can see how narrow it AB2098 is:
- it only applies to Drs who actually practice medicine
- it only covers misinformation directly conveyed to patients
- misinformation must be “malicious” or outside the standard of care
Who won’t be affected by AB2098:
- people who don’t have a medical license
- licensed doctors who share misinformation online
Read 5 tweets

Did Thread Reader help you today?

Support us! We are indie developers!


This site is made by just two indie developers on a laptop doing marketing, support and development! Read more about the story.

Become a Premium Member ($3/month or $30/year) and get exclusive features!

Become Premium

Don't want to be a Premium member but still want to support us?

Make a small donation by buying us coffee ($5) or help with server cost ($10)

Donate via Paypal

Or Donate anonymously using crypto!

Ethereum

0xfe58350B80634f60Fa6Dc149a72b4DFbc17D341E copy

Bitcoin

3ATGMxNzCUFzxpMCHL5sWSt4DVtS8UqXpi copy

Thank you for your support!

Follow Us on Twitter!

:(