Musk, death threats and the tinfoil hats — should doctors quit Twitter for good?
For some, it is a seething malignancy of vitriolic hate laced with fake news and tinfoil conspiracy theories — a virtual reality fostering a new species of human stupidity.
In more recent times, it has been seen as a mechanism for authoritarian control, a virtual town square menaced, in the words of former RACGP president Adjunct Clinical Professor Karen Price, by thuggery.
So should doctors be spending their time on Elon Musk’s X platform, the social network formerly known as Twitter?
Are they not just wasting their time? Or is walking away the sleep of reason that produces monsters?
Last month, the Pasteur Institute for biomedical research, whose scientists were the first to isolate the HIV virus as well as develop the first effective TB vaccine, announced it was leaving the social media platform.
It cited the swamp of misinformation on X since it was purchased by Musk in 2022 for $US44 billion.
The institute encouraged others to follow, saying it was sounding the “alarm about the growing threats that are jeopardising the practice of science and the responsible exercise of free speech”.
“The Institut Pasteur is extremely concerned by the influence exerted by Elon Musk,” it said in a statement.
“Over and above the clear bias introduced in this space under the guise of freedom of expression, we condemn the ideas that are promoted in this way, many of which are spreading disinformation and which we feel are incompatible with the principles of rationality, humanism and diversity that we have upheld at the Institut Pasteur for many years.”
It went on to accuse Musk of orchestrating a campaign to “weaken democracies and destabilise Europe’s institutional foundations, legal systems and unifying ethical principles”.
There have been a number of individuals and medical organisations that have jumped ship since Musk’s arrival.
Among them is Professor Trish Greenhalgh, professor of primary care health sciences at the University of Oxford.
The UK GP used Twitter throughout the pandemic, including discussing evidence for masking and COVID-19 vaccinations, but says she is dismayed by how far X has digressed from a platform where scientific debate can thrive.
“I joined Twitter because it was the ultimate town square: lots of lively and congenial discussions on both work topics (for me, medicine and health) and fun/hobby topics (for me, wild swimming, knitting, sourdough breadmaking),” Professor Greenhalgh tells AusDoc.
“I built up a great network of followers — some of whom agreed with me and some of whom did not, but the pushbacks were almost always good-natured and took me to places I would not have gone to if I had been in a narrow bubble.”
But then the platform “lost its buzz”.
She noticed her posts were getting less traction despite having the blue tick — originally the mark of verification and often associated with posts of public interest.
Post Musk’s takeover, the blue tick changed; it now signals that the user has paid at least $US8 ($13) a month for a subscription to X Premium.
She was shedding followers by the day, she says, no matter how often people who had been booted from her followers list re-followed her.
“In other words, someone had loaded the algorithm against me,” Professor Greenhalgh says.
“The platform changed, obviously. People were rude, immature, dull and sometimes threatening, although never to the extent that I was scared.
It was just tedious, like being in a pub next to a table of 14-year-olds,” Professor Greenhalgh says.
So she “nuked” her X account last November. She now posts on Bluesky, the alternative network which she joined in 2023 when she saw the writing on the wall.
“The final straw was that Musk turned X into his personal megaphone, and it quickly became overtly political, ideological and sinister — for example, not being able to block people fully so the creeps could still breathe down your neck.”
The all-important Twitter algorithm, according to Twitter, is engineered to distil 500 million Tweets posted each day to stick on the user’s feed.
Put another way, it contains the set of instructions that determines the form of reality (or otherwise) of the user’s world once they journey through the mystic portal.
This distillation, of course, is simply intended to reflect their interests based on their own behaviour on the platform, a mechanism nothing more insidious than to give the customer what they want.
But the exact workings of the algorithm is like Kentucky Fried Chicken’s herbs and spices, the Coca-Cola recipe and the Wizard of Oz before Dorothy opens the curtains… it’s a mystery.
A couple of years ago, given the controversy surrounding its activities, Musk released the algorithm for public viewing.
Associate Professor Tauel Harper, from the Murdoch University School of Media and Communication in Perth, is sceptical of the insights this gesture to the open society offered.
“Yes, they have provided the code repository for the machine learning models they use, but that is like showing people the mixer you used to bake the cake, instead of the cake itself, to explain what the cake is like.
“If you do not have the data (the ingredients), you cannot really tell what they are doing with it, and they will be using humans to check how the machine learning is progressing, to make ‘corrections’ and provide feedback to that process.”
There is an added complication now with the addition of an AI chatbot called Grok.
Professor Harper says Grok has compounded the explosion of misinformation produced by bots after content moderation by X employees was replaced by community fact-checking by platform users.
This has skewed the platform towards Musk’s world view, which put briefly is that “oligarchs and engineers are the saviours of the world”.
“Grok’s issue with hallucinations around misinformation is also compounded by the fact that it draws its answers from the corpus of all X tweets,” he adds.
“That means, even as an average, it will be producing answers that X users believe are true or answers that bots have proliferated, not what is true.
“Grok’s algorithm has been trained by X employees — again, giving rise to biases. And then, no-one knows how they have weighted the value of particular posts and profiles.
“I would not be surprised if what Musk thinks is given more weight than others in determining Grok’s answers.”
Professor Harper says Musk overpaid for the platform two years ago.
“I am not surprised he is seeking to make his investment work for him.
“Now, whether his removal of in-house content moderation was a money-saving measure or an intentional attempt to disrupt public information, the effect is that the platform cannot be trusted.
“Really, the state of social media is a mess and the most pressing issue facing democracy at this time,” Professor Harper says.
He points to political theorist Hannah Arendt, who spent her intellectual life exploring the corruption of the public realm and its consequences, not least the way open societies mutate into authoritarian regimes.
As she stated: “The result of a consistent and total substitution of lies for factual truth is not that the lie will now be accepted as truth and truth be defamed as a lie but that the sense by which we take our bearings in the real world — and the category of truth versus falsehood is among the mental means to this end — is being destroyed.”
But X has become part of the town hall. It is a forum populated (and these are estimates) by 580 million users and is widely used by institutions, governments and (obviously) political rulers.
It is not just the image-making machinery for US President Donald Trump (101 million followers) but for leaders like Narendra Modi (105 million followers), the Indian Prime Minister, whose dealings with democracy have also been open to criticism. X is a deeply political space where power declares its intent.
And it also remains a space where the medical community, whose values are rooted in transparency and openness, can communicate with the wider world, unpicking the charlatans, the phonies and the quacks who bastardise the language and concepts of medical science to push their delusions.
The shonky research underpinning the wonders of ivermectin as a COVID cure? Belle Gibson, the fake cancer survivor spruiking diet and healthy living as a cure for cancer? Doctors then and now can be found on X posting about it.
And the human biology that explains how and why vaccines work, the bit that the anti-vaxers also attempt to distort, you can find the scientists to explain it through the X platform.
And that is why, for many, walking away and leaving the misinformation unchallenged is a bad idea.
Professor Price was one of the first GPs to understand the power of social platforms, co-founding the Facebook group called GPs Down Under.
Now with some 11,000 followers signed up, it is an attempt to overcome the isolation experienced by many within the specialty, to forge a sense of professional solidarity and shared experiences that can be more easily secured by doctors in the hospital system.
And she has also been a voice on X. She is the first to admit the stresses of dealing with trolls.
She says she felt seriously unsafe when she received emails following her posts suggesting “she should be hung” or sent to “Nuremberg Prison”.
But she believes in X’s importance.
“When I joined a decade ago, it was like being an editor of your own paper or journal. You could follow the account of individual experts or those of medical publications and organisations, and the updates on the topics that interested you would flow in.”
The first turning point for X’s transition was the lead-up to the 2016 US presidential election, she believes.
“And with that polarisation came what I would call ideological prisons, where people started saying, ‘If you have got a different opinion, you are a bad person,’ which is completely flawed logic.
“The irony was that this was not at all what we were experiencing in the medical community, where there was dialogue and you could change your opinion as a result of the evidence as it emerged.”
Professor Price says elements of the social platform have become deplorable under Musk’s ownership.
“The town square has been infiltrated by thuggery.”
But she is staying.
She knows her posts are not changing the minds of deep conspiracy theorists and anti-vaxxers, but there are lurkers who are trying to make up their minds.
“It is my medical duty to provide the right medical information.”
Professor Price points out that social media is monitored by political advisers, who ultimately influence political decisions that affect lives.
“I know that the political advisers for healthcare are on X and are monitoring the media. They get a daily read of what has been said by whom and what it is about in general, particularly healthcare leaders.
“So it is important for us to be there. It is important for us to help shape some of the discourse.”
“I think GPs have got so much on their plate. I am not going to apply a moral obligation through them. But they are a pillar of the community, and they need to be mindful of their professional obligations.
“If you look at the Hippocratic oath, we have had a respected role in knowledge brokering for a long time, and that is what we do.”
Read more:
- Social media is awash with medical lies: As doctors, we have a moral obligation to fight back
- ‘I’ve had to call the police’: Professor Eddie Holmes on being a target of Twitter’s wrath
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