HIV and ID Observations

Periodically my wife and I will have a bunch of trainees (medical students, or residents, or ID fellows, or a mix) over to dinner. Seated around a big table, with no time-crunch of rounds, pagers, or EPIC orders, we can all get to know one another in this more relaxed setting.

Plus, they get free food, never a bad thing in the years before you start having a real salary.

It helps at these events to have a few icebreaker questions ready in case the guests are nervous, or just because the answers to the questions are so darn interesting. One of our favorites is the classic, What do you love to hate, and hate to love?

To clarify the question, for the purposes of this post, love to hate means something you feel with such a passion that you’ll go on and on about how much you hate it. For years, my answer was readily at hand — football, the American version. I bore people at social events on this topic, despite being in the minority, and once even wrote an opinion piece making my argument.

But for the past 2 years, my response has changed. The thing I now love to hate is what a certain billionaire has done with the site formerly known as Twitter.

(Sorry, I can’t refer to it by the new name. That name is so unimaginative, so eye-rollingly juvenile that it hurts even to write it. Truly.)

As I’ve noted before, the appeal of the original Twitter snuck up on me, with my participation essentially zero for years after I signed up. Then I discovered it was the easiest way to keep up on the latest advances in our field — infectious diseases specifically and medicine in general.

During the pandemic, it became all but indispensable, as changes to the best treatment and prevention strategies came so quickly that I felt I had no way of staying current without it. Experts from around the world — people I otherwise never would have known about or met — enhanced its value, weighing in on strengths and weaknesses of new studies.

I supplemented this informational use of Twitter with several other useful tasks. I could boost the accomplishments of others, promote my own work, and (no small thing) indulge in several miscellaneous hobbies (baseball, tennis, cute dog videos).

The fact that I’d figured out a way to tweak the settings so that attackers couldn’t view or respond to my posts — and strictly followed Peter Sagal’s rules — made some of the more widely publicized limitations of Twitter something I was able to avoid. It was like having an effective social media vaccine.

So what happened? Since October 2022 — note date — my experience on the site has steadily deteriorated. The effectiveness of that vaccine has faded. So what happened?

• Curation now fails. The algorithm either stinks, or most of the people in my field stopped posting interesting things, or both — hence I’m rarely seeing good ID content. Lots of what I get in my feed is irrelevant junk. Pointless ads. Spam.
• Limits on the blocking function. Why on earth would they remove this key safety feature?
• Limits on displaying graphics generated from certain URLs, or limits on those URLs entirely. Surprise, surprise, they might be competitors, or sites that someone (guess who) doesn’t like.
• A certain person’s posts pop up repeatedly, even though I don’t follow him. Hint: He owns the place.
• Bots. Who’s real and who isn’t? Very hard to tell.
• Payment is regularly requested to boost influence. Wasn’t “flattening hierarchies” one of the proposed benefits of Twitter, our “digital town hall”?
• The stupid new name. See above.

That’s plenty. Thanks to the prescient departure from Twitter of my colleague Dr. John Ross years ago, and the energetic assembly of ID “starter packs” by Dr. Ilan Schwartz, I’m joining hundreds of ID docs and millions of others who went over to Bluesky in the past couple of weeks — here I am. That’s a new background photo of Louie, featuring one of the silly plates my wife discovered in a remainder bin.

And wow, this has been a fast switchover, nicely documented both by the mainstream media and more specifically for us ID docs, by Dr. Ken Koon Wong. (That’s his figure on ID engagement at the top of this post, used with his permission.) If you’ve been active as a poster or just lurker on Twitter, I’d encourage you to give Bluesky a try. Here’s Ken’s excellent guide on how to get started.

Let’s see what happens over time. I have no illusions about the permanence of this move, as nicely articulated in a recent piece in The Atlantic. Ignored or abandoned social media sites (MySpace, Friendster, Mastodon, et al.) lay at the bottom of digital scrap heaps like unused USB drives in your desk drawer from a decade ago. Plus, I have no idea how the owners of Bluesky will find a way to support it financially.

Note that the above list of reasons to leave Twitter left off its political associations. Honestly, that is the one thing that I’ll probably miss the most about leaving the site — the exposure to perspectives different from my own. Bluesky has already been accused of being an “echo chamber,” a notorious limitation of social media in general, most notoriously Facebook — of course your “friends” agree with most of your views!

Other limitations of Bluesky are more technical than systemic. You can’t easily bookmark posts. There’s no app optimized for tablets. No polling function. Their servers sometimes struggle with the massive influx of new users. And I have no idea how they plan to make money on this thing, which ultimately I guess will determine its longevity.

Importantly, I haven’t found most of the cute dog feeds yet. But I’m hopeful since WeRateDogs has made the move!

This is Lily. She's been accused of drinking her mom's slushie. Will not be taking any questions at this time. 14/10

— WeRateDogs (@weratedogs.com) 2024-11-15T21:18:48.329Z

I trust you, Lily.

So this is where I’ll be in the social media universe, at least for the time being. Looking forward to more of that great learning I had from Twitter in the pre-2022 era — Bluesky can’t be far off if Dr. Tony Breu has already posted.

And if you’re wondering what I hate to love (the other part of the two-part question), it’s potato chips. Irresistible, but not salubrious.

And it looks like I’m not the only one.

Today in relatable science: Gulls making a mysterious daily trip that turned out to be to a potato chip factory

— Brooke Jarvis (@brookejarvis.bsky.social) 2024-11-15T20:15:15.323Z