For those of us who turn to medical Twitter (#MedTwitter) to learn, debate, and laugh (ideally all three), it has been slim pickings of late. #MedTwitter increasingly seems to vacillate between two extreme poles: obsequious flattery and #MobTwitter.
The flattery part is hard to miss. It aims both at others and oneself. "Congrats to John, who is the world's best boss, mentor, partner, and friend for his amazing new paper!" and "Humbled to be named the most influential doctor in the zip code 46350!"
Outrage comes in cycles and can be justified. Many policies do harm disadvantaged and poor people. Many statements are erroneous and dangerous. Many leaders have failed and misled.
Outrage can be a force for change -- demanding that we do everything in our short lives to make the world better or fairer. Reminding us that many voices care deeply and passionately about a number of issues. Showing how urgent a long-ignored problem can become. At the same time, outrage can take on a life of its own, becoming #MobTwitter.
#MobTwitter happens when the magnitude of the response, the anger, is an order of magnitude larger than the offense. An initial provocation that reached perhaps 10 or 100 people now generates the response of 10,000 or 100,000. A person who penned a tone-deaf, contrarian, or simply misunderstood piece finds themselves on the receiving end of hundreds or thousands of comments that condemn their soul as irredeemable and flawed. One common theme of #MobTwitter is that a group of people may be collectively offended but retaliate against specific individuals.
Reputational damage is one punishment inflicted by the mob, but not the only one. Expunging the offensive tweet, article, video, or op-ed is a common aim. Contacting the offender's place of work, colleagues, or affiliated organizations and asking for censure or boycott is another tactic.
Understanding that there is both a legitimate need for speaking and arguing about what one cares about, but also a risk of going too far, I offer seven suggestions to turn #MobTwitter into #ProductiveOutrage:
1. Review the security camera footage with your own eyes. A common theme of online outrage is a video, podcast, article, or blog considered offensive by someone. In 2020, we all know how a clip taken out of context can mislead. For this reason, it is incumbent on those who wish to amplify that condemnation to fully acquaint themselves with the source material. Add 30 minutes of reading to 5 seconds of tweeting. You might change your mind, you might temper your invective, or God forbid, you might actually learn something.
2. Ignore, don't remove. The Streisand effect is the idea that in an effort to remove offensive material, you may inadvertently draw more attention to it. This happened when Barbara Streisand tried to hide pictures of her Malibu residence, making many more people curious about where she lives (see, you just Googled it, didn't you?). We live at a time where there are hundreds of billions of videos, blogs, tweets, papers -- many of which are problematic. Before confronting any one of them, ask if the confrontation may inadvertently spread the bad message. Even if you convince 90% of your followers the piece is a problem, the other 10% may become new adherents. That may not be worth it.
3. Rebut, don't retract. Retracting academic articles is subject to very strict rules and due process. It is also a bold precedent that opens up institutions to litigation. It must be pursued carefully. A victory may be pyrrhic if an offensive article is retracted, but the author wins in court with a claim of mistreatment or humiliation at the hands of their employer. Rebuttals are a better way to explain to those observing what the deficiencies are and persuade rather than intimidate those on the fence.
4. Remember: not everyone thinks the way you do. We live in a complex country where many people have different points of view. Often it is hard to see, as we surround ourselves in communities where people echo our views. We will never have durable change if we wish to overrule 60%, 50%, or even 40% of folks who disagree with us. We have to persuade them. Persuading people takes time, careful choice of words, and patience. Consider also all the people who disagree with you: How do you want them to treat you when you voice an opinion they are opposed to?
5. Do you want the perpetrator to commit suicide? In the heat of #MobTwitter, sometimes I am taken aback. That tweet got how many replies? 4,000!? If you are the 200th person to tell someone that they are a horrible human being for what they said, wrote, or what people think they said or wrote, someone may do something drastic. Few of us are used to bearing massive peer condemnation, and bad things may result. The offender may turn to alcoholism or substance abuse; it may spark domestic violence or abuse. How would you feel if you are the 205th person to tell someone their tweet makes them a horrible human being, and later you are told that was the last thing they read before committing suicide? If the answer is: you would have remorse, then perhaps don't say it. I propose we cap condemnation as 1/100th the number of followers someone has. If someone has 500 followers, after five pieces of feedback, let's move on.
6. Consider alternate diagnoses. It is easy to conclude that offenders are vehemently wrong, or have antiquated or harmful worldviews, but, as in medicine, consider a broad differential. Is there an alternative diagnosis? Might this person not hold the most extreme and harmful view, but some intermediate view. The hardest view to understand is: disagreeing with others -- even passionately -- but also wanting to preserve their right to say things that are wrong. Anyone who has tweeted anything that has gotten any attention knows that most people misunderstand even the clearest tweet (some willfully) and many assume the worst of you. We talk about early closure in medicine, but it happens in social media too.
7. Mercy, forgiveness, tolerance. One irony of #MobTwitter is that often in an effort to get someone to see the pain and unfairness in the world, the mob loses the mercy, forgiveness, and tolerance it is preaching. Even folks who hold views we find detestable or wrong or hurtful may themselves be people who are hurting. Unfortunately, in America in 2020, asking someone to be fired from their job, or have their license to work revoked is a death sentence. This means that the person will lose their income, their healthcare, and lose these things for their partners and children. I have read a lot of negative things, even personally directed at me, but would not wish this corporal punishment on anyone for something they said or wrote. I urge us all to reconsider this.
I hope many will agree on my seven tips to turn #MobTwitter into #ProductiveOutrage; it isn't yet too late to regain what we are losing.
Vinay Prasad, MD, MPH, is a hematologist-oncologist and associate professor of medicine at the University of California San Francisco, and author of .