Social Media: New Opportunities, New Ethical Concerns

The disclosure of potential conflicts is standard in the medical literature, in both print and electronic media, as well as in presentations such as Grand Rounds and continuing medical education (CME) conferences. While frequently pro forma, these disclosures help reassure the audience that even if bias cannot be eliminated, it can be managed—that is, mentally adjusted out, a bit like confounders in a regression. However, in the realm of social media, such disclosure is not yet the standard. Social media presents some unique challenges. The presenter is not necessarily known, and information about the presenter may be limited or absent. In lieu of a didactic lecture, information may flow bi-directionally. References to support statements may not be provided. The presentation style may be informal. The audience may include laypersons; for some platforms this is quite intentional. In these and many other ways, presentation of medical information and advice is still evolving; social media force us to rethink how we, our patients, and the lay public consume medical information. In this issue of JGIM, DeCamp presents an important perspective on addressing some concerns regarding disclosure of conflicts of interest in social media.1 He presents some examples of conflicts of interest, summarizes current guidelines, and provides a framework for managing disclosures in social media. In so doing, he highlights how consumers of social media are vulnerable to both overt and hidden conflicts of interest. This piece also heralds other concerns that may rise to prominence as social media continue to mature. For example, does the general public understand and interpret potential conflicts in the same way that medical professionals do? A blogger’s disclosure that he received a grant from a pharmaceutical company may not set off the right alarms if the reader is unaware that the new medication mentioned in the blog is in fact the pro-drug of a medication about to go off-patent—and that both drugs are produced by that same company. In this case, disclosure may have to involve more than a statement about funding. In 140 characters (or even 140 words), how much explanation to frame the disclosure is reasonable or feasible? The malleability of social media is both a curse and a blessing. It is a curse because content can change dramatically from day to day, making it difficult for readers to assess the provenance of scholarly material. On the other hand, authors and editors are empowered to post information on conflicts of interest as they arise, almost in real time. As both contributors to and consumers of the information shared in social media, we can demand more effective disclosure. We can post information regarding the role of conflicts in the presentation of medical information. And, perhaps ironically, we can use social media outlets themselves to promote the need for complete disclosure of conflicts of interest. Also in this issue, JGIM conducts an interview with executives from HelloHealth, a for-profit company working to transform (and reinvigorate) primary care.2 HelloHealth emphasizes use of health IT, clinical email, and telemedicine, and targets small-size and medium-size practices working in a fee-for-service environment. This approach appears to run at cross-purposes with the national movement to implement Accountable Care Organizations and other versions of “Capitation 2.0.” Nevertheless, the problems faced by primary care are unlikely to yield to a single strategy; as in diagnosis of a complex clinical case, it would be foolish to reach premature closure. Other research offerings this month include an evaluation of whether health information exchange can improve headache care in the emergency department;3 a study examining effects of an electronic health record system on providers’ patient safety perceptions;4 and an examination of the differential impact of academic culture on men and women,5 among many others. Plus, don’t miss the Editorial by J. Michael McWilliams and the Comment by Robert Brook. We hope you find this month’s content to be of interest, but either way, the Editors want to hear from you. We welcome letters-to-the-editor and email; we’re also on Twitter (@jgimeditor). Before you use social media, however, do be sure to think about (if not declare) your conflicts of interest.