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Social media during epidemics: a poisoned chalice?

5 Jan, 15 | by BMJ

Social networking is now the most popular online activity worldwide. Social networking sites account for nearly 1 in every 5 minutes spent online globally, reaching 82 percent of the world’s Internet population. As such, sites such as Facebook and Twitter have become an unavoidable part of crisis communication. However, opinion is mixed as to whether this pervasiveness is a blessing or a curse to organisations charged with protecting public health. The very attributes that make social media invaluable to communicators (instantaneous, wide-reaching) also make it incredibly difficult to control and moderate.


One concern about social media is that it has the potential to generate and perpetuate rumour. Following the first diagnosis of an Ebola case in the United States on 30th Sep 2013, mentions of the virus on Twitter leapt from 100 per minute to more than 6,000. In Iowa, the Department of Public Health was forced to issue a statement dispelling social media rumours that Ebola had arrived in the state. Meanwhile, a steady stream of posts claiming that Ebola can be spread through air, water and food appeared; all of which are inaccurate.

Trying to stem the spread of incorrect information online shares many similarities with containing a virus in the real world. Internet users who have been given false messages from an inaccurate media report, another person on social media or word-of-mouth, proceed to “infect” others with each false tweet or Facebook post. “We have millions and millions of people on these social networks,” says Ceren Budak, a researcher who studies online communications at Microsoft Research. “Most of them in certain cases are not going to have reliable information, but they’re still going to keep talking.”

Part of the issue is thought to be the piecemeal way in which news is now consumed. According to a Pew Research Center study, almost a third of US adults get at least some of their news from Facebook, where recognised sources are competing with friends and relatives. Studies show that people are far more likely to trust information that comes from people they know than faceless organisations. This is how a single false statement on Twitter can affect thousands.

However, a report produced by the TELL ME project argues that “whilst on an open platform such as Twitter, users are free to post any message…the vast collaborative networks that comprise social media often question and correct rumours posted”.  Whilst there is more information online than ever before, users have learned to verify information and question where it is from. “Whilst the ‘citizen journalist’ can report on events ahead of reports by other media outlets or organisations, users are still wary of sources and, even on Twitter, hold official sources in high esteem, often seeking verification before believing alarmist messages”.

The Guardian did a great job of illustrating how one user’s tweet was retweeted several times during the Birmingham riots in England, August 2011, leading to a rapid spread of misinformation. Within half an hour the rumour of riots in a Birmingham children’s hospital spread through the simple process of people retweeting a dramatic and unfounded tweet. Despite this misinformation gaining momentum, within a period of two hours, the Twitter community was able to discredit the rumour. This demonstrates that users of social networks readily collaborate to make informed decisions on the quality of information they are receiving.


Whether or not social media is seen as a force for good or evil during pandemics, it is a communication channel that those seeking to protect public health cannot ignore. Nor can organisations and individuals involved in crisis communication be reactive to messages shared and posted in this competitive environment. They must instead take a proactive stance in establishing an authoritative presence on social media channels before and during a crisis.

At the recent TELL ME conference, Alexander Talbott, a digital communications consultant specialising in healthcare, offered the following guidance on realising this objective:



TELL ME (Transparent communication in Epidemics: Learning Lessons from experience, delivering effective Messages, providing Evidence) is a European Commission funded, collaborative project that has systematically reviewed existing evidence to develop practical guidance, online tools and models for improved risk and crisis communication during pandemics.

BMJ was the responsible partner for the report on New Social Media referenced above.

Robot doctors: could science fiction become science fact?

31 Oct, 14 | by BMJ

Earlier this month, The Guardian released a video that has given certain sectors of society the heebie jeebies.

The overriding message, that “new technology can destroy jobs”, is not particularly new but previously the jobs at risk were ‘unskilled’. It seems that technology is now so advanced that traditional middle class professions are starting to worry. But are robot doctors, online lawyers and automated architects really becoming a reality?

In 2013, the Associated Press tried to ascertain exactly which professions were being hit hardest by new technology. Through a combination of employment data analysis and expert interviews, they discovered that almost all the jobs that had disappeared in the past few years were not the low-skilled, low-paid roles one might expect, but fairly well-paid positions in traditionally middle-class careers.

In 2012, Silicon Valley investor Vinod Khosla predicted that algorithms and machines would replace 80% of what doctors do within a generation. He argued that much of their current workload (checkups, testing, diagnosis, prescription, etc.) could be done better by sensors, passive and active data collection, and analytics. Expert radiologists are already routinely outperformed by pattern-recognition software, he argues, and diagnosticians by simple computer questionnaires.

XPRIZE, a self-proclaimed “innovation engine”, offers $10m prizes to those inventors who manage to solve some of technology’s most troublesome challenges. One such award will be given to the first team to produce a working “tricorder” – a handheld device capable of diagnosing a set of 15 diseases without the presence of a medical professional. If you think this sounds like something straight out of science fiction, you’d be right. The Tricorder is the multifunction hand-held device used for sensor scanning, data analysis, and recording data by the medical officers in Star Trek. However, it may soon be science fact: the CEO of XPRIZE, Dr Pete Diamandis, expects someone to succeed in the next five years.

He asserts that following this breakthrough, it’ll only be a matter of time before diagnosis is within the primary remit of machines. “It’s a matter of providing the computer with the data. Once it has the data, it’s able to consider thousands or millions of times more parameters than a human can hold in their head.” We will still need medical professionals to guide us and provide the human touch – but doctors will have to accept that computers are better at parts of the job than they are.

It’s not just software and diagnosis, either: surgeons will have to make way for smarter machines. He cites the work of Silicon Valley firm Intuitive Surgical, which has created a “surgical system” named Da Vinci, which an expert surgeon can control online from anywhere in the world.

This technology is already being put to good use in certain areas of the world. For example, Liu Chunming almost died after a car crash in July in Taihe, a remote county in China’s southeast Jiangxi province, but survived serious abdominal injuries thanks to specialist doctors who led his treatment from 1,000 kms (621 miles) away. From a central “operations room” in the eastern city of Hangzhou, doctors diagnosed and directed treatment for the 48-year-old using live video feeds and software that shares patient scans and files to aid consultation.

“Eventually, where this is going,” says Diamandis, “is that the robot will end up doing the surgeries on its own. I can imagine a day in the future where the patient walks into the hospital and the patient needs, say, cardiac surgery, and the conversation goes something like this: ‘No, no, no, I do not want that human touching me. I want the robot that’s done it 1,000 times perfectly.'”

However, many argue that there are some things that may never be codified or driven into algorithms. Davis Liu, a US-based GP and author, sums this up nicely: “Call it a doctor’s experience, intuition, and therapeutic touch and listening. If start-ups can clear the obstacles and restore the timeless doctor-patient relationship and human connection, then perhaps the future of healthcare is bright after all… I know healthcare can’t simply be solved by smart people in Silicon Valley alone. To solve healthcare we need everyone to collaborate.”

New twitter analytics: how many people see your tweets?

1 Sep, 14 | by BMJ

Back in July, Twitter launched an impressive analytics dashboard that was only accessible by advertisers and verified users. As of last week, however, this wealth of data became available to the public.

A bit like Google Analytics for tweets, this new toolkit allows you to gauge the performance of each and every tweet you send. Twitter users can identify in real time which tweets are getting the most attention and therefore determine the best strategies for reaching their audience.

To view your Tweet activity dashboard, visit whilst logged into your account.

The first dashboard tab in Twitter analytics provides an overview of your tweets’ performance. You can find numbers for impressions, engagement, link clicks, retweets, favorites and replies. Twitter also offers measurement data for the previous 28 days so you can see how today’s performance compares to past performance.

Clicking on individual tweets also reveals more data, including the number of impressions over the past 24 hours, plus other valuable metrics like:

  • User profile clicks (clicks on name, @handle, or Twitter author profile photo
  • Retweets
  • Embedded media clicks (clicks to view a photo/video when applicable)
  • Detail expands (# of times a user clicked to view details of a tweet)
  • Favorites
  • Replies
  • Link clicks (clicks on URL or Twitter card)

As a bonus, all this data can be easily exported. The exported table data includes the full tweet text, the tweet permalinks, plus extra information like:

  • Timestamps
  • Hashtag clicks
  • App opens
  • Follows
  • Tweets emailed

In the next dashboard tab marked ‘Followers,’ marketers can track follower growth and extract important follower data.

You’ll see trends in your follower count displayed by a line chart and demographic data including:

  • # of followers in different locations
  • Your followers’ gender
  • Other accounts that your followers also follow
  • Your followers’ top interests
  • Your followers’ ‘unique’ interests

Picture3 Picture4

So, what does all this mean? Social media measurement just got easier. Twitter analytics can’t fail to help marketers measure social media performance and therefore become more adept at matching Twitter activities to business goals.

Can mobile technology improve mental health?

18 Aug, 14 | by BMJ

Mental health, specifically depression, is in the spotlight due to the untimely death of Robin Williams last week. It has sparked much discussion of how mental healthcare could be improved to reduce the likelihood of such tragedies. One area that has the potential to make significant and cost-effective contributions to mental healthcare is technology.

There are already individual cases of technology being put to good use for this specific purpose. Research from Oxford University has shown that text messaging and voice calls can be used to assess mental health status, provide talking therapies such as cognitive behavioural therapy and encourage behavioural change.  More advanced devices such as smartphones and tablets deliver similar functionality but in more user-friendly ways. Kindly, for example, is a mobile app that promises to connect users with “a mobile network of compassionate and helpful listeners,” all of whom are anonymous. Users can share or receive short conversation prompts in categories like “addiction/recovery,” “marriage/divorce,” “work/business” and “creativity/inspiration.” The app then makes use of an algorithm to try and match the person who put out the prompt with another who may be a good listener.

The app is still in its early days so it should come as little surprise that it has a relatively small community. To help bolster the number and quality of “listeners” in the app, a number of psychology students have been recruited from the University of Southern California, Vassar College and New York University.

Kindly is certainly not the first or only service trying to provide a space for people who need to talk things out anonymously. 7 Cups of Tea connects users with anonymous “active listeners” online and social networks like Whisper aims to let users share secrets online and engage in private messaging. Whisper has even launched YourVoice, which includes videos from those who have overcome difficulties, and resources for anxiety, bullying, stress, sexual abuse and more. Those who want to share their experiences can submit their own videos for consideration.

Another advantage of multimedia apps is that they can draw on a wide range of sensors and capabilities to produce richer data and more intelligent interventions – e.g. accelerometers, GPS and camera. The Mobilyze! system developed in Chicago uses 38 smartphone sensor values alongside user input to predict psychological status and deliver tailored therapeutic interventions for unipolar depression.

What next?

Mobile mental health already has the capacity to transform the way mental illness is evaluated, monitored and treated, especially in poorer countries where mental health workforces barely exist. It is believed that smartphones will soon be able to deduce our emotional status from our social interactions and tone of voice, while wearable sensors will collect data on a range of factors relevant to mental health, including sleep quality, cardiovascular status and galvanic skin response. Fragmented monitoring and highly-personalised ‘smart’ treatments seem to be the future of mental healthcare; a future made possible by mobile technology.


What does it mean to be Social at Heart?

11 Jul, 14 | by BMJ

Last week I attended the IAB annual social media event; ‘Social at Heart’. Here’s a round up of key messages presented by an impressive group of speakers, including representatives from BuzzFeed, Twitter, Google and UNICEF.

IAB Social at Heart Event

Social & Content
Will Hayward, Vice President, Advertising at BuzzFeed

  • BuzzFeed receives 75% of visits from social platforms and 50% from mobile
  • It’s better to target small niche groups of people than a broad audience – they are much more likely to share your content with their peers
  • Sharing is the new system of distribution and brands must think about how and why content spreads
  • Memes = Participatory Mass Media
  • “Start with the consumer, do something special” – what are we actually offering consumers that will interest them?
  • Creating content that is relevant will always succeed
  • Do not be the person at the party that only talks about themselves
  • Ensure you’re engaging with your audience on their terms in an environment that is right for them

Social & Social 
Paul Guerrieria, Digital Planner, Google & Will Scougal, Brand Strategy & Creative, Twitter 

  • Google+ is not just a social platform but a social layer that integrates all Google products
  • Hashtags are now searchable on Google
  • Google+ content from brands is pulled onto the Search Engine Results Page for free but there are also links out to relevant hashtags on Twitter and Facebook 
  • Plan for the moment –> Enhance in the stream –> Keep it simple
  • Be proactive around key events but also reactive to events as they happen

Social & Good
Laila Takeh, Digital Strategist and Leader, Unicef 

  • 479,050 tweets and £5.3m raised during Soccer Aid 2014
  • For UNICEF, social = content + influencers + paid media
  • Twitter cards were the most successful engagement trigger in paid social during Soccer Aid
  • Real-time Google Analytics gave team up to date view of what was and wasn’t working – enabled them to be as fluid and responsive as possible
  • UNICEF encourages its employees to tweet in a personal capacity

Social & Devices
Alex Kozloff, Head of Mobile, IAB UK 

  • 19% of the top 50 UK retailers with a mobile site
    have built one that is not transactional 
  • Q4 2013 – 53% of Facebook revenue comes from mobile
  • 4% of the top 50 UK retailers don’t have a transactional PC website
  • 19% of the top the top 50 UK retailers with a mobile site, have built one that is NOT transactional
  • 52% of the top 50 UK retailers with a mobile app, have built one that is NOT transactional

Social & Video
Oliver Smith, Managing Director, EMEA at Unruly

  • Celebrities do not drive online ad sharing
  • No creative device drives sharing more than any other, with the exception of personal triump. Focus on emotions, not creative devices
  • Poorly branding your ad is like throwing away your marketing budget. The average branded video takes 30 seconds to reveal the brand. There is no correlation between level of branding and shareability
  • Pack an emotional punch – videos that elicit a strong emotional response are twice as likely to be shared

Is the ‘Internet of Things’ becoming a reality?

19 Jun, 14 | by BMJ

You might not be aware but we are currently approaching the end of Internet of Things Week 2014. For those who aren’t familiar with the concept, the Internet of Things (or IoT, or M2M, or machine to machine) refers to an expanding network of interconnected internet-enabled devices.

It’s currently a very hot topic over in Silicon Valley, where they describe it as “a global, immersive, invisible, ambient networked computing environment built through the continued proliferation of smart sensors, cameras, software, databases and massive data centres in a world-spanning information fabric”.

So what does that actually mean and what is being done to realise this vision?

Translated into layman’s terms, IoT is billions of gadgets, each one of them connected to the internet and communicating with one another without much in the way of human intervention. John Naughton sums it up nicely: “So your fridge can talk to your smartphone to tell it that you’re running out of milk, while your bathroom scales messages your GP’s computer to let it know that you’re not sticking to your diet plan, and the webcam in your living room sends you a text to tell you that the cat has been sick on the sofa, and cool stuff like that”.

Technology giants are already on the case, viewing IoT as a logical progression from the personal computer and smartphone races of previous years. At its Worldwide Developers conference (WWDC) , Apple introduced Homekit, an Internet of Things platform that will bring together various third-party home automation accessories, enabling users to unlock doors or turn on lights via an iPhone.

Google, too, demonstrated its enthusiasm by paying £1.9bn earlier this year to buy Nest Labs, a home automation company co-founded by the creator of the iPod. Already recognised for its connected thermostats and smoke detectors, the company is currently exploring a range of other applications related to the home – everything from health tracking to security systems.

Household brands EE, John Lewis and Unilever have pledged their support this week for a £1m Launchpad competition which will provide support for early and growth stage businesses working in the Internet of Things space.

Launched Monday at London Technology Week, the competition is the result of a collaboration between Tech City UK, the Technology Strategy Board and Cambridge Wireless and will provide business and marketing support, mentorship, routes to market and grant funding to successful applicants who are developing ideas, prototypes, or have an existing business, and want to accelerate their development.

They are looking for projects that:

  • may be too risky for companies to take forward without support
  • may take companies into new innovative areas
  • the majority of activities are carried out in Cambridge and/or London.

More information on applying is available here.

Neuromarketing: can science predict (and influence) our purchases?

23 May, 14 | by BMJ

In the 1950s, two scientists at McGill University accidentally discovered an area of the rodent brain now known as ‘the pleasure centre’. Given the opportunity to stimulate their own pleasure centres via a lever-activated electrical current, a group of rats pressed the lever over and over again, going without food and sleep, until many of them died from exhaustion.

Most humans are a little more complex than rats but we are still largely motivated by what makes us feel good, especially in relation to purchasing choices. In light of this, many major corporations are taking a special interest in understanding customers through the mechanics of the human brain. This is the emerging but fast-growing field of ‘neuromarketing’, which uses brain-tracking tools to determine why people prefer some products over others.

What is neuromarketing?

The concept of neuromarketing was developed by psychologists at Harvard University in 1990. For decades, marketers sought to understand what consumers were thinking but have relied on traditional techniques, such as focus groups and surveys. A major advantage of neuromarketing is that metrics are taken solely from brain imaging, removing the possibility of asking the wrong questions or participants not saying what they think.

In 2008, a team of scientists in Germany published a study showing how the brain unconsciously prepares our decisions: several seconds before we consciously decide what we’re going to do, its outcome can be predicted by looking at unconscious activity in our grey matter. “The researchers, from the Max Planck Institute in Leipzig, told participants in the study that they could freely decide if they wanted to press a button with their left or right hands, whenever they wanted, but they had to remember at which time they felt they had made up their mind. They found that it was possible to predict from their brain signals which option they would choose seven seconds before they consciously made their decision.”

Although a nascent field, neuromarketing has been used by larger corporations for some time. In a study published in 2004 in Neuron, 67 people had their brains scanned while being given the “Pepsi Challenge”, a blind taste test of Coke and Pepsi. Half the subjects chose Pepsi, which produced a stronger response than Coke in the region of the brain thought to process feelings of reward. But when the subjects were made aware that they were drinking Coke, 75% said that Coke tasted better. Their brain activity also changed. The area of the brain that scientists say governs high-level cognitive powers, the lateral prefrontal cortex, and an area related to memory, the hippocampus, were now active, showing that the consumers were thinking about Coke and relating it to memories and other impressions. The results demonstrate that Pepsi should in theory have half the market share, but in reality consumers are influenced for reasons related to their experiences with the Coke brand rather than taste preferences.


The field has generated a great deal of controversy, especially in the media. Critics warn of the threat of marketers finding the mythical ‘buy button in the brain’ and deem the field ‘creepy science’, ‘mindreading,’ and the ‘misuse of scientific knowledge’. Some consumer advocate organisations, such as the Center for Digital Democracy, have criticised neuromarketing’s potentially invasive technology. Jeff Chester, the executive director of the organization, claims that neuromarketing is “having an effect on individuals that individuals are not informed about.”

While the emerging field does provide valuable information about the consumer mind, it does not give marketers a “window into the subconscious” or access to a consumer “buy button.” Rather, it is a valuable new tool for market researchers, and definitely one to watch.

BMJ Editors’ Retreat: the certainty principle

12 May, 14 | by BMJ

Each year, BMJ invites the editors of its specialist journals to gather at BMA House and discuss the hottest issues affecting medical publishing. The first day of the retreat included presentations from Professor Sir Leszek Borysiewicz, Vice-Chancellor of the University of Cambridge; Sir Muir Gray, Director of Better Value Healthcare; and Jeremy Laurance, The Independent. There was also a lively discussion regarding impact metrics between Marian Hollingsworth of Thomson Reuters and Euan Adie of


Pippa Smart, publishing consultant, led the second day of the retreat, covering topics such as making the news, publication ethics with Chris Graf of COPE, incentivising reviewers and reaching new audiences. She has written the following synopsis:


Get a group of medical editors together in a room, and what do they talk about? (I’m sure there is a joke there somewhere.) It was the second day of the BMJ editors’ retreat and feedback, comments, opinions and challenges were coming across fast and furious. It was an interesting day all round, with plenty of discussion, some disagreement and plenty of cynicism to lighten the debates. From these meetings people take away different things, and for me the highlight of all the discussions was the importance of editorial certainty in an uncertain world.

As a member of the public, and at the receiving end of the medical profession I really, really want certainty. I want my doctors to use tried, tested and accredited protocols and drugs: when I read the papers I want to believe their news items. However, I’m aware that real life, and scientific research, is a lot messier than this.

What editors are faced with every day is a mass of uncertainty. Both articles and authors can prove to be a disappointment – because of a mismatch of what is important and interesting, because of human error, and because they sometimes – frankly – cheat. Awareness of this didn’t however, dent the enthusiasm and energy of most of the participating editors at this meeting – they remained committed to certainty, and adamant in the face of opposing views that couldn’t be backed up with hard evidence.

So when it comes to what should be Press Released they were vehemently opposed to earning “a fast buck” on the back of a dodgy article or a sexed-up news report. (I remember with fondness the supposed life-giving properties of red wine…) When it came to examples of unethical authors they were unanimous in their condemnation (in fact, more draconian than the COPE advice). When it came to peer review they were committed to improving papers, even in the face of unreliable reviewers. And when it came to marketing, they stuck to the importance of making content as error-free, interesting and accessible as possible rather than focusing on sales.

Impressed? Yes I was. Perhaps I am more suspicious of people’s motives and don’t trust in readers’ intellect to the level that this group do. But what impressed me most was not the way that dodgy authors were censored, but the fact that the participants’ editorial certainty was upheld in an environment that they knew comprised uncertainty. Upholding a commitment to absolute values where research may only show partial and relative findings, and where individuals may not provide absolute truths is impressive.

The adherence of these editors to certainty is certainly not unique and I’m always relieved to come across similar values in other editors that I meet. And the principle of certainty and high values was endorsed in the BMJ Awards that took place in the evening of this meeting. Sir Iain Chalmers was honoured for his commitment to transparent clinical trials and research, and his demands for evidence-based medicine (I’m with him on that one). In a world where the press focuses on doom, despair and the occasional titbit of medical information, and where claims and counterclaims seem to bombard the public daily, it is refreshing to know that there is, after all, a backbone of certainty in this shifting landscape – and that it is making a material difference to our health and wellbeing.

In an imperfect world, I take my hat off to them all.

Pippa Smart, Research Communication and Publishing Consultant


We used the hashtag #bmjeds14 to capture conversations held over both days. Analytics and a full transcript can be found by clicking the image below:


What does the social media landscape look like in China?

28 Apr, 14 | by BMJ

Contrary to popular belief, limited access to certain Western websites has done little to harm the development of social media in China. In fact, it is reported that 91% of Chinese internet users have a social media account, compared to 67 per cent in the US. Given that China has become the world’s second largest economy, how can businesses use social media channels to reach its huge consumer base? more…

What value can social media add to conferences?

14 Apr, 14 | by BMJ

Attending the IOC World Conference for Prevention of Injury and Illness in Sport in Monaco last week got me thinking about the value social media adds to such events. Apparently, 84% of organisers use Facebook to promote their events, while 61% use Twitter and 42% use YouTube. It seems that social media not only facilitates knowledge sharing and networking amongst attendees, it can also help create a real buzz that starts before the event and continues long after it ends.


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