The Battle for the Truth: Social Media Versus Critical Appraisal

Your article is finally accepted after the reviewers have been satisfied with the revisions of your manuscript. The journal Editor congratulates you and your co-authors on your achievement and highly recommends that you promote your article via social media. I am not sure which journal thought of this first, but it seems that all of them make this recommendation nowadays.

Politicians in the last decade have adopted social media as an innovative way to disseminate their message; some very successfully. Two specific examples are the electoral successes of American presidents Barack Obama and Donald Trump (for the latter, at least in his first attempt), with contrasting political ideologies. Social media was then a new technological revolution in communication and they both used it to its hilt to further their political agendas. I guess the thinking went like this; if it worked for the politicians it must work for the journals as well.

Social media is pervasive. I am distraught when at family get-togethers I see my nephews, nieces, and their children not partaking in verbal communication but instead they are hunched over their digital devices to reading about the gossip of the world. I am afraid that at some point all these young people will develop an arthritic neck from hunching over their digital devices, just like us, the senior surgeons, who are now suffering from the abuse we inflicted on our cervical spine hunched over the microscope or loupes over decades in surgical practice. The new generation of plastic surgeons may even have to deal with an epidemic of thumb osteoarthritis from the constant abuse of the thumb CMC joint.

Many colleagues, residents, medical students, and research assistants, use social media. Some years ago, one of my research assistants registered me on a few of these platforms but I must admit I seldom use them. I resisted the temptation. To those around me, I must be seen as a dinosaur for not promoting my work through social media.

Has social media made the life of those around me any better? Has it made them any wiser? Hardly. The other day while chatting with one of my residents on the virtues of social media, I purposefully changed the subject and I asked him to name the three protagonist countries on each of the warring sides in WWII. They had no idea except that Canada fought in it and we were on the winning side. The second question I asked them was if they knew the cause of the war. He did not know the answer either. The same resident however knew all the different social media platforms but could not name such important information. As the Russia-Ukraine conflict is escalating (as of the timing of this writing) and the world potentially may be at the brink of a nuclear catastrophe that may lead us to new Stone Age, I would have thought that the history of WWII in which for some of us, our father or grandfather fought in it, was important information to know readily.

I feel that the undeserved attention social media has attained will lead us to a new Dark Age. If we believe that the “truth” is in the pronouncements of the various social media instead of using our critical skills to dissect the evidence we are presented with, then I am afraid the future does not bode well.

It seems that with every technological advance in the last 70 years there is some negative consequence. This applies to social media as well. Let's face it. We live in the digital age and the communication pitfalls attributed to social media are rapidly being recognized.^1,2

Some additional concerns have to do with professional ethics, privacy, confidentiality, and most importantly, information quality. ³ It is this last issue that the editorial attempts to address; the quality of information or at worse, its degradation.

The Greek philosopher Plato's Allegory of the cave and the quest for truth comes to mind. It is very relevant today in our digital age of social media. In Plato's Allegory, a group of men are chained from birth in a cave and separated from the outside world. All they see are shadows on the cave wall in front of them. These are merely blurred reflections of human activity at some distance caused by a bonfire's light. They cannot see the actual human activity behind them because of a tall wall. For the prisoners, the shadows or reflections on the cave wall are the “truth.” If a prisoner escapes and goes to the outside and returns to tell them what the real world looks like they become very angry and threaten to kill him. ⁴

Can we tie Plato's cave allegory to social media? I think we can. Social media is the “internet cave” in which we are kept with an illusory truth. We are constantly bombarded with deceptions that pull us away from the truth. Independent opinions of experts and influencers are concerning. The information we are provided by the social media is nothing more than the shadows in the allegorical cave. If we do not question what we read or lack appraisal skills, then we are likely to believe the various falsehoods and deceptions we are exposed to. The biomedical literature, where about 85% of what is published is faulty,^5,6 is not immune. Be aware of it!

Can we win the battle for the truth? It is possible but it will require an extraordinary effort. Plato recognized this difficulty some 2500 years ago! We should be paying more attention to scientific inquiry and less so to social media. Whether one's scientific work is worth reading should not be through the recommendations of others on Twitter or Facebook. It should be based on our ability to critically appraise the evidence in front of us. In surgery and medicine, we have guides ⁷ and resources^8–10 to teach us the skills of critical appraisal.

Who wins the battle for the truth remains to be seen. I hope we are training physicians who will be able to separate the proverbial “chaff from the wheat.”