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.
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.
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/
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.
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.
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/
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.
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
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.
(Fortunately) the physiology of lungs without a chest wall doesn’t happen very often, but you can see this in people undergoing sternotomy:
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.
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