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Healthcare Social Media (#HCSM) Series: Public Health Impact

Twitter Birds Connected- Shared from Paul Sonnier

Shared from @Paul_Sonnier

This article originally appeared on the blog of Austin Chiang, MD, internal medicine resident at New York-Presbyterian Hospital/Columbia University Medical Center in New York City. We’re so excited he’ll be moving to Boston this summer to start his Gastroenterology training at Brigham and Women’s Hospital, a Harvard Medical School-affiliated teaching hospital.

Connect with Dr. Chiang on Medstro, Twitter (@AustinChiangMD), Instagram (@AustinChiangMD), Facebook (AustinChiangMD), or his website!

This is the third entry of this 6-part blog series on Healthcare and Social Media!

  1. #HCSM Series: Listen Up Medical Providers
  2. #HCSM Series: Keeping It Professional
  3. #HCSM Series: For The Patients
  4. #HCSM Series: Impacting Public Health
  5. #HCSM Series: Industry and the FDA
  6. #HCSM Series: Shaping Medical Education


Given how social media is so widely used nowadays, it’s not surprising that some have used it for public health purposes. As explored in previous sections, medical professionals use social media to educate, medical journals use it to share their content, pharmaceutical companies introduce their products through social media, and patients share their experiences and concerns. However, the capabilities reach far beyond raising awareness about health issues. Novel applications of social media that have impacted public health include emergency response and epidemic tracking. However, as easy as it might be to disseminate good information, there is little that can be done to screen for inaccuracies. Unfortunately, some of these inaccuracies can lead to adverse health and financial outcomes.


1. Flu tracking through social media

Studies have shown that social media can be used to accurately estimate flu prevalence when compared to CDC-ILINet (Influenza-like Illness Network) tracking system. University of Pennsylvania researchers also detailed in a New England Journal of Medicine (NEJM) article that after tweeting the location where flu vaccines were offered, the VA Health Department noted a surge in vaccinations. Similarly, when public figures like Barbadian singer Rihanna tweet about the flu, spike in searches for “flu” were noted. The researchers also looked into sentiment toward the 2009 H1N1/09 vaccine. Of 470,000 tweets collected, 318,000 were relevant, 256,000 were of neutral opinion, 35,000 were positive, and 26,000 were negative. They demonstrated that for those who had positive or negative sentiments, information spread in a manner that geographically clustered. As a result, some communities were at risk for diminished herd immunity, but by being able to identify these pockets, resources can be targeted to these areas.

One study looked at misconceptions about the flu and antibiotics by searching keywords. 345 status updates reaching 175,000 followers used “flu” and “antibiotics” incorrectly together and 305 status updates reaching 850,000 followers used “cold” and “antibiotics” incorrectly together. Misuse of “leftover” or “shared” antibiotics were also examined.

2. Promoting behavior through social media

Patients, advocacy groups, and companies alike have used social media to deliver certain messages to the public. The Dove “Evolution” campaign went viral and helped bring to light how magazine covers and advertisements place an unrealistic standard on beauty. As expected other groups have used social media to educate and raise awareness about a wide variety of health issues from breast cancer and healthcare policy to safer sex and smoking cessation.

When people voice their opinions on a public forum there can be potentially hazardous public health effects as well. More recently, the anti-vaccination movement promoted by several high-profile public figures has caused alarm among public health experts. What’s even more worrisome is how these views spread across country borders. One study attributes 26,000 cases of measles in the past year in Europe to social media influence.

Image credit: Wikimedia Commons


3. Emergency response and Ushahidi

Ushahidi, meaning “witness” in Swahili was a social media platform that originated in Mogadishu but was key to emergency response in the 2010 Haiti earthquake. Mobile providers in Haiti opened access to the platform, which allowed those reporting emergencies (fires, missing people, contaminated water, infectious diseases, food shortages, theft, roadblocks, floods, etc.) to be linked to help.  Further upstream, resource providers were also linked the resource suppliers. GPS location also made it easier for relief organizations to reach areas in need. The technology reportedly also helped crowdsource the most detailed roadmap in Haiti to date with 1.4 million edits at the time. The mobile provider Digicel also noted how 630,000 people were displaced out of Haitian capital Port-au-Prince, which helped track a cholera outbreak.

4. Medical Journals on Twitter

Several studies have looked at how medical and scientific journals share their content on Twitter. 3725 out of 3812 Journals have Twitter accounts, including high-impact journals such as Nature, Science, NEJM, and The Lancet. Between 2010 and 2012, 9.4% (or 135,000) of 1.4 million journal articles were posted on Twitter. NEJM for instance tweeted nearly half (48.1%, but clearly not all) of their 1580 papers in that period.

However, popularity on Twitter doesn’t seem to necessarily translate to how frequently cited or how scientifically robust the paper is. In fact, popular papers may be more pertinent to current events. The #1 and #2 most highly-tweeted papers were papers from PNAS related to the Fukushima disaster and nuclear contamination. Similarly, Journals that tweet more aren’t necessarily the most cited either.

5. Social media as a research tool

As mentioned earlier, social media content has been used to track flu epidemics and highlight misconceptions about antibiotics.  Various researchers are looking into both “primary data” (directly asking the public a question on social media and gathering responses) and “secondary data” (analyzing the content of tweets). As social media becomes more recognized as a source of data, metrics are being developed to more efficiently and accurately measure its content. Beyond the scientific focus of medicine, linguistic studies are also being conducted to examine how storytelling can be used as a coping mechanism for cancer survivors on social media sites.

Austin Chiang, MD

Austin Chiang, MD

    Dr. Chiang completed his medical education in 2011 at the Columbia University College of Physicians and Surgeons in New York, NY. He continued his training at New York-Presbyterian Hospital, Columbia University Medical Center in New York City where he is currently finishing a residency in Internal Medicine. Under the mentorship of Chief Health and Medical Editor Dr. Richard Besser and managing editor Dan Childs, he contributed briefly to medical stories as a resident member of the ABC News Medical Unit at the ABC News national headquarters in NYC. In the summer of 2014, he will begin his fellowship training in Gastroenterology at Brigham & Women's Hospital, a Harvard Medical School-affiliated teaching hospital in Boston, MA. He hopes to explore his role as a physician not only in the clinical and research settings but also in social media, mass media, and medical innovation.

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