HIV and ID Observations

Twitter is much in the news recently, mostly for not-good reasons. Rather than rehash-tag (see what I did there?) its various struggles and controversies since the new owner took over, I’m going to let others cover that territory.

Instead, I’d like to go in a different direction, and share how this site remains one of the most valuable tools for learning about ID — and other medical and not-so-medical news.

It’s also a ton of fun. That is, if you’re careful, and know the rules, which I’ll get to in a moment.

First, here’s brief summary of how I figured out Twitter. I’m hopeful by sharing that you’ll consider joining. Plus, the more smart, engaged, and nice people we have on Twitter — people actively communicating about our fascinating field — the better it becomes.

It began for me in 2009, shortly after the tech writer David Pogue wrote about Twitter in the New York Times. He described a chaotic mess with essentially no rules — a place where you could crowdsource solutions to complex problems, or “entertain” people by sharing what you cooked for breakfast, or market your latest business idea, or link a piece of writing you found particularly profound, or show a puppy video that makes you gasp at the cuteness.

Or, all of the above.

But the best part of his piece was this comment:

DON’T KNOCK IT TILL YOU’VE TRIED IT. Of course, this advice goes for anything in life. But listen: even my own masterful prose can’t capture what you’ll feel when you try Twitter. So try it. If you don’t get any value from it, close the window and never come back; that’s fine.

As a big Pogue fan, and with nothing to lose, I thought — why not? So I signed up. Then, after trying it for 10 minutes or so, and remaining utterly baffled, I then just ignored it completely — for the next 6 years.

What changed?

Several things, happening all around the same time. First, I noticed that both some of my younger colleagues — and especially the medical residents and ID fellows — could cite recently published or presented research I hadn’t yet heard. Where’d they get this cutting-edge information? They all said one place:  Twitter.

Here’s a recent example of a clinical trial published in JAMA that totally would have been off my radar screen for quite a while without Twitter, posted by the invaluable account @ABsteward:

🆕⚡⚡RCT
Among patients with c. UTI or acute pyelonephritis due GN pathogens cefepime/enmetazobactam, compared with piperacillin/tazobactam, met criteria for noninferiority as well as superiority with respect to clinical cure & microbiological eradicationhttps://t.co/pnaFoZhMky pic.twitter.com/eTXyAQLC2t

— Antibiotic Steward Bassam Ghanem 🅱️C🆔🅿️🌟 (@ABsteward) October 4, 2022

Second, one of my editors here at NEJM Journal Watch, Kristin Kelley, expressed astonishment that I wasn’t promoting my own writing on Twitter. “Every writer does this,” she said, bluntly. Then she gave me a brief tutorial.

Now I do it regularly. Example:

Mask and vaccine mandates? Check. Socializing and networking over meals and drinks? Check. Some thoughts about this uncomfortable paradox here.
Big In-Person Medical Meetings and Cognitive Dissonance for ID Docs https://t.co/TnIz1Kgq2G @PriyaNori

— Paul Sax (@PaulSaxMD) October 17, 2022

Third, after dipping my toes in the water, I started seeing the highlights of major scientific conferences on Twitter without having to travel. No time away from home. No airfare. No registration fee. No hotel charges. For example, the European Society of Clinical Microbiology and Infectious Diseases, or ECCMID, is a terrific meeting I’ve “attended” every year via Twitter since 2016.

Believe me — I am well aware that Twitter can be a place of discord and clashes, a site where people say stupid things they later regret, things that literally ruin their careers. Worse, Twitter can be the source of serious bullying and threats. Having been the target of some of these attacks (which most reliably occur after I post something about the benefits of vaccines), I can only imagine what it’s like to be the target of something broader, or even more sinister.

How then, to stay out of trouble? Here I turn repeatedly to Peter Sagal, best known as host of NPR’s eternally funny “news” show, Wait Wait, Don’t Tell Me. Peter’s “Rules of Twitter” are so effective that not only will adherence to them generally keep you from entering into the toxic fray, but you’ll find yourself applying them to real life too, making you a happier person. That’s pretty great.

So here they are in their entirety, conveniently “pinned” to the top of his profile page:

These are my Rules of Twitter, developed over many years via trial and (mostly) error. They are *my* rules, related to what I want to do On Here and what I want to avoid. Yours may and will differ, but I do suggest figuring out what they are. pic.twitter.com/tib7vZ4ORF

— @petersagal.bsky.social (@petersagal) November 8, 2021

For this year’s IDWeek, I was kindly invited to present the good side of #IDTwitter. The session also included two terrific talks by ID colleagues — Dr. Krutika Kappalli, who discussed what it feels like to be the victim of hate speech and abuse triggered by speaking plainly about science and public health, and Dr. Payal Patel, on how to engage news media from across the political spectrum on ID issues.

People who attended IDWeek can see watch the talks, but for others, I’ve gone ahead and posted a condensed version in a Twitter “thread” — check it out! — then come back here and watch this truly hysterical video.

Which I learned about on Twitter by “following” several talented comedians, including this guy.