Social Media and Medicine: Relevance to Cancer Care
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Social media are becoming increasingly relevant to cancer care. They allow for interaction and sharing of content between users. While risks include misinformation and loss of privacy, opportunities exist for support, education, and research collaboration among patients, caregivers, and professionals. Effective use of social media in medicine requires further defining both risks and benefits to ensure safe and ethical practices in cancer care and research.
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Social Media and Medicine: Relevance to Cancer Care
- 1. SOCIAL MEDIA AND MEDICINE Relevance to Cancer Care
- 2. Conflict of Interest External advisor, Mayo Clinic Center for Social Media Previous consulting for Augmenix, Inc (2012- May 2013) No financial links, leadership position with any social media company
- 3. Overview Social Media Definition Types Role in Medicine Risks and Opportunities Clinical Research Why it matters in cancer care Ethical Practical Summary http://www.slideshare.net/subatomicdoc
- 4. Definition “Social media are web-based tools for interaction that, in addition to conversation, allow users to share content such as photos, videos, and links to resources” -- Meredith Gould, The Social Media Gospel
- 5. Brave New World Geography doesn’t matter as much as internet access Communities are defined by interest, not location New dynamics for previously isolated people
- 7. Social Networking Sites Nov 2013 data Source: Business Insider http://read.bi/1irEope
- 8. Rapid Adoption in U.S. In the US: 35% have searched for a medical condition online for diagnosis 80% start with a search engine N=3,014, Sept. 2012 Source: Pew Internet Source: Pew Internet http://bit.ly/1moDRZ4 http://bit.ly/1gXxHv7 N = 1,445, Sept. 2013 42% of adults are using social networks
- 11. Institute of Medicine report Grajales et al, IOM/PLM 2014 http://bit.ly/1deNg2g CR [1058] PLM [2125] Age 60+ 30% 23% Fair/poor health 15% 54% Specialist is main provider 3% 17% Feel medical care isn’t coordinated 30% 37% Want more health information sharing 95% 98% CR = Consumer Reports survey PLM = Patientslikeme
- 12. Data Sharing: PatientsLikeMe Willing to share de-identified data with: MDs 94% Researchers 92% Drug companies 84% Public Health officials 77% Perception of how likely PHI might be used 76% without my knowledge 72% to deny health benefits 66% to limit job opportunities 61% stolen by individuals or companies Grajales et al, IOM/PLM 2014 http://bit.ly/1deNg2g
- 13. Track and Interact Activity No Conditions 1 Condition 2+ Conditions Self-track health metrics 61% 70% 80% Trackers share notes w/others 30% 39% Trackers with chronic conditions 41% use pencil/paper 4% mobile phone app 1% use a website Source: Pew Internet http://bit.ly/1gXxHv7
- 17. Rapid growth of professionals on Twitter • Data analytics firms track us, including NPI numbers Creation Pinpoint, http://bit.ly/1hU6Kqd
- 18. Cancer on Twitter Organization Twitter Handle Followers World Health Organization @WHO 1.2 M Mayo Clinic @MayoClinic 754 K American Cancer Society @AmericanCancer 457 K Health Human Services @HHSGov 369 K Science Magazine @ScienceMagazine 249 K NEJM @NEJM 177 K Lancet @TheLancet 111 K National Cancer Institute @theNCI 51 K Institute of Medicine @theIOM 31 K MD Anderson @MDAndersonNews 26 K ASCO @ASCO 24 K AACR @AACR 18 K RSNA @RSNA 14 K American College of Surgeons @AmCollSurgeons 14 K Twitter data, March 29, 2014
- 19. Surgeons on Twitter Person Institution Twitter Handle Followers Sanjay Gupta Emory-CNN @drsanjaygupta 1.8 M Atul Gawande Brigham & Women’s @AtulGawande 85 K Diane Radford @dianeradfordmd 5985 Deanna Attai @DrAttai 5535 Susan Love @DrSusanLove 4480 David Gorski Karmanos/Wayne State @oracknows 4270 Aaron Cohen Gadol Indiana University @AaronCohenGadol 2415 Tom Varghese, Jr. UW/Seattle CCA @TomVargheseJr 2303 Brian Stork @StorkBrian 2249 Niraj Gusani Penn State @NirajGusani 2068 Stacy Loeb NYU @loebstacy 1619 Matthew Cooperberg UCSF @dr_coops 1576 Twitter data, March 29, 2014
- 20. Medical Oncology on Twitter Oncologist Institution Twitter Handle Followers Steven Eisenberg @drseisenberg 21.9 K Anas Younes MKSCC @DrAnasYounes 10.1 K Steven Tucker @drsteventucker 8096 Naoto Ueno MDACC @teamoncology 7708 Michael Fisch MDACC @fischmd 7707 Elaine Schattner Columbia @ElaineSchattner 6764 H. Jack West Swedish Hospital @JackWestMD 5689 Robert Miller JHMI @rsm2800 5483 Mike Thompson Aurora Health @mtmdphd 4849 Robert Orlowski MDACC @Myeloma_Doc 2818 Pervez Dara @JediPD 2351 Wafik El-Deiry Penn State @weldeiry 2178 Don Dizon MGH @drdonsdizon 2232 Julie Gralow U Wash/Seattle CCA @jrgralow 1818 Source: Twitter, 3/29/2014
- 21. Radiation Oncology on Twitter Radiation Oncologist Institution Twitter Handle Followers Shalin Shah MDACC Sugarland @ShalinJShahMD 8416 Matthew Katz @subatomicdoc 7218 Krupali Tejura @krupali 4872 Colin Champ UPMC @CavemanDoctor 2859 Ian Pereira* Kingston (Canada) @IanJohnPereira 1273 Mary Gospodarowicz PMH @marykge 691 Jonathan Livergant* U Toronto @jpil 680 Cary Gross Yale @cpgYALE 580 Leah Minnie Katz NYU @leah_minnie 516 C. Dave Fuller MDACC @cd_fuller 383 Miriam Knoll* Mount Sinai @Mknoll_MD 250 Wally Curran Emory @wallyjc 244 Brandon Mancini* Yale @brandonmancini 200 Source: Twitter, 3/30/2014* Resident
- 22. Cancer Hashtags on Twitter Hashtag Tweets 2013 Impressions 2013 #oncology 36821 108162977 #breastcancer 374176 1482780746 #bcsm 49077 359715942 #lungcancer 53609 173792419 #lcsm 32339 59175200 #coloncancer 23520 109520148 #crcsm 1278 3829527 #prostatecancer 33182 133968946 #pcsm 2333 6671329 #gyncsm 4374 4185558 Source: Symplur.com
- 23. What is Stopping Us? QuantiaMD.com, 2011 http://bit.ly/OKR00w
- 24. Risks of Social Media Patients/Caregivers Misinformation Information bias Omission Loss of privacy Job/insurance discrimination Marketing manipulation Psychologic amplification Professionals Professional harm Reputation Malpractice Patient harm Loss of boundaries Misinterpreted/bad communication Psychological harm Split personality Burnout
- 25. Benefits of Social Media Patients/Caregivers Support Education Collaboration Advocacy Professionals Coordinate Care Collaboration Networking Education Career Opportunity Reputation Management
- 28. Learning – Patient Education http://bit.ly/1bYlAdQ
- 31. Advocacy On Facebook, Twitter Assists with building radiation facilities and raising cancer funding globally www.radiatinghope.org
- 33. Online Search = Privacy Risk Web surfing may give your search information 65% of sites have at least 1 tracker 35% leaked information to 3rd parties Martin Huesch, JAMA Int Med 2013
- 34. Google Glass Katz M, KevinMD.com, http://bit.ly/OPUY7M
- 35. Who represents doctors? Silent since 10/2013
- 36. Date of download: 2/9/2014 Copyright © 2014 American Medical Association. All rights reserved. From: Physician Violations of Online Professionalism and Disciplinary Actions: A National Survey of State Medical Boards JAMA. 2012;307(11):1141-1142. doi:10.1001/jama.2012.330 Bar length indicates total frequency for each violation type. Figure Legend:
- 37. Doctors are public figures UK survey of 953 respondents in general public Professionalism based upon clinician workmanship citizenship Respondents expect doctors to be: confident reliable composed accountable dedicated Chandratilake et al, Clin Med 2010
- 38. @Doctor_V @Berci @SeattleMamaDoc @DrJenGunter @KevinMD @hjluks @doctorwes @oracknows @KentBottles @amcunningham @RyanMadanickMD @drmikesevilla
- 42. Gamification of Science Playstation3 >130,000 players Geek.com, http://bit.ly/1gZNOs3
- 43. DNA Analysis by Smartphone 1.5 M chromosomes analyzed in 1 month Available for iOS, Android Cancer Research UK, http://bit.ly/1hduzYD
- 44. Parkinson’s on PatientsLikeMe Accessed 4/6/2014, http://bit.ly/1lJ2cbX
- 45. Community or research cohort? PLM has two peer-reviewed publications on Parkinsons Up to 50% of patients develop psychosis Large cohort had 28% incidence of dementia by DSM-IV criteria Does terms of service count as consent? Fenelon and Alves, J Neurol Sci 2010 http://1.usa.gov/1hiYXG9 Riedel et al, J Neurol 2008 http://1.usa.gov/1jROYqR
- 46. Wall Street Journal Published 10/12/2011 http://on.wsj.com/1hU8zDA • AC Nielsen removes data from website directly • “I felt totally violated” •"We're a business, and the reality is that someone came in and stole from us," says PatientsLikeMe's chairman, Jamie Heywood.
- 47. Personal genomics services Saliva SNPs for detecting risk of disease Test for $99 Direct to consumer, no genetic counseling Shut down by FDA 11/2013 for not complying with required testing Interference with empowered patient/consumer rights Direct to Consumer Research Source: FDA, http://1.usa.gov/1nVOyUt
- 48. DTC Personal Genomics No corporate transparency No evidence test works Privacy risks Vague whether genome used for research Allows children/vulnerable populations to be tested No discussion or review with a genetic counselor http://bit.ly/18jOCku
- 50. What about academic medicine?
- 51. Ethics in Flux Newer research models conflict directly with more traditional interpretation of Belmont Report, bioethics HIPAA an issue as well Do we need to adapt current ethical frameworks, or how these technologies are used?
- 52. Research in an Apomediated World Subjects can play a more active role in research How do you regulate “when it is not clear who the researcher is and who the subject is” What role for IRBs if done online only? How can you separate trial recruitment from solicitation? Dan O’Connor, J Law Med Ethics 2013
- 53. Does Autonomy Trump All? Autonomy favors empowered patient/consumer rights Survey of 51, 946 show that patients with highest satisfaction scores had worse outcomes than least satisfied Inpatient hospitalization OR 1.12 Total health expenditures 8.8% higher All-cause mortality OR 1.26 Fenton et al, Arch Int Med 2012
- 55. WHO Definition of Health
- 56. Oath of Maimonides “Grant me the strength, time and opportunity always to correct what I have acquired, always to extend its domain; for knowledge is immense and the spirit of man can extend indefinitely to enrich itself daily with new requirements.”
- 57. Extend Your Domain Online Bik & Goldstein, PLOS One 2013
- 58. Relevance to Research Only 0.04% of published medical research gets mainstream attention Social media provides a way to share your research with patients, caregivers who may directly benefit
- 59. Twitter and Academic Citations Eysenbach, JMIR 2011
- 60. Altmetrics correlates with impact factor 11 Components: Tweets Facebook posts Blog posts Google+ Nature Publishing Group highlights Reddit Forum threads Q&A Pinterest LinkedIn Thelwall et al, PLOS ONE 2013
- 61. Annual Meeting Twitter Activity Katz M, ASCO Connection 2013 http://bit.ly/Q9LfdJ
- 62. Followers Magnify the Message Katz M, ASCO Connection 2013 http://bit.ly/Q9LfdJ
- 63. Practical Cancer patients and caregivers are increasingly online, seeking help and support If clinicians and researchers don’t engage, expect more influence on health decisions by Peers and family Fearmongerers, opportunists Industry
- 64. Participation is not optional
- 65. Summary Social media are pervasive, powerful communications tools Rapid adoption in healthcare despite poorly defined risks and benefits More connected = more reward and risk Research is critical to develop safe effective use in cancer care
- 66. Thank you