The Blog is only as loud as the blogger

At LITFL and in the froth of #FOAMed we are constantly faced with a barrage of negative, cynical and disparaging comments on the role of the blog and social media in the provision of medical education and patient engagement.

I thought it would be worthwhile to post one of the more erudite commentaries on the subject, from a source that shall remain anonymous…

The Blog is only as loud as the blogger!

Information is powerful and power is dangerous in the hands of the illiterate!

If it is FREE it must be good! They are giving out free tickets to live in Broken Hill, would you take it!!!

How is a blog different to any research articles, just because it can be criticized online and is uncensored…?

Bloggers are confident people who are bold enough to put their views out there; but does that make it best practice???

Does a blog approach ensure that it rids the biases which plague the current medical society?

Just because old methods have fallacies, a new method need not be considered significantly better prima facie!

There is a clear difference between ideas and beliefs. There is then a clear step involved in making those beliefs turn into facts. Facts are then disseminated as knowledge when vindicated… that essentially I believe is the role of research. A thought, belief or idea is only born when a stimulated mind asks a question and then hypothesizes the answer. Thank god for Newton or was it the apple?

New ideas and concepts need to continually be raised and I believe, that is the role of educated minds. A mind that does not ask questions runs the risk of being run by someone else!

Blogs like all other forms of information transfer needs to be handled with utmost care. Opinions are different to educated outcomes and people reading and deriving knowledge from these blogs run the risk of plagiarising the thoughts of the bloggers and practicing a brand of medicine which is no better than today’s fashion! Bloggers and blogs need to be clearly classified – opinions, ideas and researched facts!

Minh Le Cong loves ketamine for agitated patients and published a case series of 23 patients with schizophrenia being air transported in WA. He runs multiple blogs for his love of ketamine and I believe in the same but would we adopt a strategy of same in [our hospital] without researching it? Whilst data/information on NNT.com and other sites which present researched data needs to be columned differently and these blogs can be influenced by the same biases as the researchers who run the NINDS trial! The bloggers looked at the data looking to debunk it whilst the researchers looked at the data to validate their beliefs. Numbers don’t lie but those of us who understand statistics realize that you can surely make your results look good on bases of the statistical methods you use.

Bloggers are smart people so are researchers. Both present self-proclaimed facts and we as doctors (presumably the top 2% of the nation’s intellectual knowledge base) need to have the basic skills to decipher, choose and differentiate facts from ideas, beliefs and hunches. Smart people also have the skills to distort and disseminate knowledge the way that suits their beliefs and though not all of us can be as smart as the bloggers and researchers, we need not be dumb followers to base all our knowledge on hearsay!

Like everything else I think the field of medicine has done a full circle… in the ages of the Sushruta and roman medics, the word of the elder physician was considered gospel. He was the blogger and the one with the loudest voice and longest trail of followers was the dean of the university!

Soon the medical fraternity was plagued by the curse of democratisation! Everyone could do medicine. There was dissent from the students and students who questioned the basis of this practice (history of anaesthesia).  Medicine like everything else would not have progressed from the blood-letting days but for some questioning minds. Soon the body of knowledge holders were writing books about their experiences and facts and findings. These formed the basis of single authored textbooks. Some were meticulous and factual and some weren’t. Soon these texts were replaced by the multi-authored, knowledge rather than belief driven single authored texts.

Over the years, the textbook and publishing cycle was unable to keep up with the ideas, beliefs and thoughts of the medical professionals. And the original blog i.e. medical journal was born! I refer the inquisitive to the first published article in NATURE journal.

It was but only a collection of thoughts, ideas and suggestions. The ideas formed the basis for research and without the pillars of research, medicine would not be where we now are.

Commercialization of research/journals and knowledge transfer plagues every facet of our life not just medical knowledge. But does that mean free press journal or open access research is not free of bias and simply a projection of the author’s idea?

There are 23000 peer-reviewed journals and over a million research articles published each year and only 50 which essentially change practice. This could be looked at as strength or deficiency of current day medicine. Whilst we let more and more researchers voice their opinions, we only let very few change our beliefs. I believe the same rigour needs to be applied to blogs since they are no more than a idea/suggestion/hunch/educated guess/researched fact.

A blog is just another journal and like all other data in this world, it is only as pure as its author. Interpretation of data and knowledge needs an inquisitive mind. I would hope the majority,  if not most of us  still bear a cortex that questions and inquisitively seeks out the answer for ourselves rather than believe every word that the professor told us at the lecture halls!

We owe it to our patients to be maintain high level of skills and knowledge. And as long as we continue to seek and find, we will continue to improve.  Knowledge is powerful and blogs carry significant amounts of information and so do journals… but are we smart enough to convert this information to knowledge? Now does information=knowledge… well that’s a discussion for another blog!

 

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Comments

  1. Minh Le Cong says

    Interesting counterpoint here. thankyou.
    There is some irony here since the author proposes a Reader Beware approach to medical blogging and I suspect podcasting , yet remains anonymous. What biases does he /she have?

    One correction and I do find this very ironic that on the one hand the author suggests we take a very critical approach to medical blogging as information is sensitive and can be misrepresented. Yet he/she has not checked their facts.

    My study of aeromedical retrieval sedation with ketamine was conducted in Queensland, not WA.

    I agree with the authors main arguement though in that medical blogs and podcasts are an addition to our learning and professional development, not a total substitute and should be digested with as equal intelligence and due thought that we would apply to traditional methods of learning and advancement. I personally believe you need to be disciplined holistically as a medical learner.

  2. says

    Nice blog!

    And the points made are valid. I don’t read this as an argument against blogs or FOAMed. Rather a word of caution against accepting a novel strategy as flawless. Good medical practice needs knowledge and skill, making research, experimentation and discussion imperative. The journals will not disappear, though they may alter their format, and they will have a continued role. Will clinical and research conferences.

    Blogs and other FOAMed resources serve other functions -- the dissemination of information (which most good bloggers temper with advice to read the article for yourself and draw your own opinions) and raising questions about it, generating discussion and debate. Without discussion and debate, there is a risk of blind following of carefully worded research and the risk of not identifying deficits that can be subjected to further research and improved practice.

    So, blogs and FOAMed are not here to replace journals and universities and mentors. They are but another tool in a clinicians kit to assist with the process of keeping oneself informed.

  3. Toby says

    I think the above commentary needs a little background. The original was an email sent to me after I gave a talk / rant on medical blogs and the rise and rise of FOAM. With the permission of the author I forwarded the email to Mike (who had been incredibly helpful as I was putting the talk together.) Mike then asked for and was given perission to reprint the email. Minh’s comment about the author remaining anonymous is a bit unfair as I don’t think I gave Mike the authors name (or If I did, he has rightly decided not to print it)

    In the talk I argued that there are too many journals publishing too much crap (the so called Enid Blyton Effect where the number of publications has become more important than the quality.) I also critized peer review as being deeply flawed (though I offered no alternative). I then discussed blogs as a way of identifying and critiquing papers of significance (ie what ED Docs around the world are reading) as well as offering ticks of the trade, management pearls, discussions of cases etc. I may have given the impression that I was suggesting blogs as an alternative to medical journals rather than as an adjunct. The author of the email was particularly concerned that junior doctors had stopped reading journals and were only reading blogs. This is a concern that I share as I think we all need to be able to critically evaluate the literature. After talking to the author we both agreed that blogs have an ever increasing role in medical education. In particular they are an excellent way to identify “must read” papers. Junior doctors then still “must read” these paper for themselves as well as using the blogs to read the conlcusions of other people from all around the world. They can then email the bloggers or post long-winded comments such as this. A good example that this works is the response of the blogosphere to the publication of IST-3. Many of the responses raised valid concerns that I would never have thought of but alas their comments would never have been published in the letters to the editor section.

    Now I must check my inbox and see if the Lancet has finally published that retraction and apology.

  4. says

    A quick comment on:

    “If it is FREE it must be good! They are giving out free tickets to live in Broken Hill, would you take it!!!”

    Living in Broken Hill would probably be quite good. The irony is that when something is free, most people are naturally suspicious about it’s quality and the agenda behind it. This is certainly been an issue with LITFL, and now GMEP, in gaining acceptance. Some people just can’t believe that FOAM is really free -- there must be a catch.

    Such skepticism is to be welcomed, so long as it is rational and the mind that stands behind it remains open. If I have ‘faith’ in anything, it is that quality will rise to the top when thinking, open minded people are the judges.

    I see FOAM, and especially LITFL, as a way to give ideas a platform for efficient dissemination. I have little to offer that is my own, but I have been fortunate to have worked alongside, and been taught, by many great thinkers and teachers. FOAM helps level the playing field for those less lucky than I.

    Chris

  5. says

    There are some very valid points being made within this post, and I believe most are, in fact, entirely congruous with the underlying tenet of #FOAMed.

    The medical blogosphere encapsulates a vast array of tracts -- from straightforward evidence based compilations (Chris Nickson’s critical care compendium), to Scott Weingart’s discussion of his own publications, and others, David Newman’s unprecedented ‘deep dives’ trying to understand the historical influence of literature today, Cliff Reid’s uncanny ability to bring to the world’s notice articles before the ink is dry, to bamboozled puzzled opinion pieces, inviting a conversation where the literature is not clear. The vast majority, though, are based on medical literature, that which is published in peer reviewed journals.

    Prior to the emergence of #FOAMed, when papers came out, the only way that most of us mortals would figure out that perhaps the author’s conclusions were not necessarily relevant/accurate/statistically valid were through insulated journal clubs. Often it was only the people that were the equivalent of the stick on the cherry on the icing on the cake who were well statistically versed to be able to really question what was put into journals, editorials and, gods forbid, the Cochrane collection. That person is not me (perhaps I should stick to jumping out of a cake ) (just kidding, had to carry on the metaphor just that one step too far).

    I see the blogosphere as an extraordinary conversation. Yes, it needs a filter, yes it needs some temperance of mind, and it needs leaders to help more impressionable juniors to navigate.
    So, I essentially agree. This is a very important piece. Balance is required. The onus continues to remain with the reader, the great consumer of knowledge, to read with tempered evaluation.

  6. Minh Le Cong says

    This is very useful commentary so thankyou all.
    I think we will hash this out more at SMACC, wont we? Just another example of how FOAMEd community is willing to blend traditional methods of academic discourse with newer ones.

    but I get a sense there is some concern, anxiety, indeed fear that somehow FOAMEd is perverting the next generation of doctors/health care providers into some kind of substandard learner?

    now I get that some are suspiscious as it is free and might be a con job. I even get it that some are worried that junior doctors and trainees are not doing what is expected of them and spending their free time pouring over the journals and textbooks so they can all be like their consultants and seniors.
    But lets be honest..as junior doctors/trainees I suspect many of us did not read a single journal in preparing for exams and Fellowship. Why? because it is a time poor/inefficient way of learning.
    So are we expecting the next generation to do something that we never did…why do I ask?
    Where is the evidence this is occuring anyway?
    Where is the evidence junior doctors are inadequately preparing for exams because they are wasting their time reading blogs and listenining to podcasts?

    What evidence I am aware of are anecdotes on forums and twitter that junior doctors are derided and criticised for questioning concepts that they have read about on FOAMEd.

    Would we not want the next generation to learn better than what we did? Dont we want them to be better than us? Maybe some fear this.
    I do not.
    Portable asynchronous learning and real time online interaction is an affordable reality to the individual now, even in countries where doctors might not get paid well enough to afford expensive journal subscriptions and paid conference leave.
    Are we telling them and our junior staff that we want them to ignore this modality of learning because we did not have it when we were training?
    And is it really fair that we use the arguement that you cant trust free information sources to discourage such learning method?
    I do not regard this as fair.
    I have faith in the next generation in deciding their learning as my teachers had in me

    Medical education like any human endeavour is subject to evolution and sometimes revolution. Time will tell but I do not believe we have anything to fear.
    Except ourselves.

  7. Ben D says

    “How is a blog different to any research articles, just because it can be criticized online and is uncensored…?” Lets move that comma and question mark and take out “just”…

    How is a blog different to any research articles? Because it can be criticized online and is uncensored.

    And then the article beautifully demonstrates this by being available to everyone for free, and generating thoughtful discussion. It raised several points for me:

    I had Mihn’s guidelines for ketamine in agitated patients before I knew about FOAM. And I think many standard practices in hospitals are based on an anecdote that has no better support than being published in a journal. My instinct is that blogs/FOAM are held more accountable than journals, not less.

    To say that theNNT (or others) has the same biases as the NINDS group is unfair. Although not perfect, the whole point of SMARTEM and theNNT is to try and deal with the various biases that corrupt medicine. To compare them is akin to when science is accused of being another kind of faith, when it asks no faith at all.

    I think we need to protect the ability to be anonymous in FOAM and online. Unfortunately the medical hierarchy has a dark side full of fear and intimidation and threats. Anonymity allows an outlet; and the online medium allows the trolls and spammers to be ignored and deleted. Clearly context is important, but sometimes the words matter much more than the author.

    My personal experience is that compared to journals alone, FOAM is more engaging, stimulating, and accountable. It allows fast access to good information, and the FOAM community becomes a powerful group of editors and critics. I trained before FOAM, and now I’ve moved countries and I’m retraining with FOAM. It is so much better, I’m delighted to be part of it.

  8. DocXology says

    I don’t think many junior clinicians have the ability or skills to perform a sophisticated review of a study and interpret their results. Firstly, they don’t possess a strong enough foundation of current biomedical and clinical understanding and reconcile the reults (sometimes contradictory) of clinical trials. Secondly, it takes a degree of clinical experience to discern the context and confounders inherent in any study population and then translate to a local setting.

    I would like to see more robust on-line journal clubs where experienced clinicians can debate the merits of a particular study and demonstrate their ‘line of thinking’ to illustrate the process of erudite peer review.

Comments