SGEM Xtra: The Matrix – Social Media for Knowledge Translation - The Skeptics Guide to Emergency Medicine

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Date: March 16, 2024

This is an SGEM Xtra episode. Yes, that is two back-to-back SGEM Xtra episodes. The critical appraisal that was lined up for this week’s episode got delayed due to some scheduling problems with clinical responsibilities. You can access all the slides for this episode from this LINK and see the presentation on YouTube.

This episode is from a talk I gave a few years ago on social media for knowledge translation. How this technology could make the world a better place. I’ve come to recognize that many SGEMers are not very familiar with the best movie decade of all time, the 1980’s. Therefore, I created this talk using the Matrix as a more contemporary theme from the late 1990’s early 2000’s.

The Matrix was a groundbreaking movie created by Lana and Lily Wachowski and released in 1999. It started a movie franchise blending science fiction and action in a visual masterpiece. The first movie introduces us to a dystopian future in which humanity is unknowingly trapped inside the Matrix, a simulated reality created by intelligent machines to distract humans while using their bodies as an energy source or batteries. Thomas Anderson (Mr. Anderson), a computer programmer by day and a hacker named Neo by night, discovers the truth about the Matrix. He is drawn into a rebellion against the machines, led by Morpheus and Trinity. Neo is believed to be “The One,” a prophesized hero destined to end the war between humans and machines. The film explores themes of reality, freedom, and control.

Like Morpheus in The Matrix, “all I’m offering is the truth, nothing more”.

“What if I told you”…Morpheus never says that in The Matrix. Yet “what if I told you” is one of the most well-known Memes. There are many quotes from movies that are wrong/misquoted. Here are three examples of movie misquotes. For a list of the top ten movie misquotes click on the LINK:

Play it again Sam (Casablanca 1942): That line is never said in the movie Casablanca. Humphrey Bogart actually says ”You played it for her, you can play it for me. If she can stand it, I can. Play it!”.
Luke, I am your father (Star Wars V The Empire Strikes Back 1980): The actual line by Darth Vader is “No, I am your father.”
If you build it, they will come (Field of Dreams 1989): James Earl Jones says“People will come, Ray.”

Back to the lecture, Morpheus sitting in the chair wearing cool sunglasses and offering Neo the red and blue pill never said “What if I told you”. In the actual dialogue in the scene, Morpheus says: “Do you want to know what ‘it’ is?”.

What it is for today’s lecture is the problem with knowledge translation and how it can be addressed with Social Media. Trinity tells Neo in The Matrix “It’s the question that drives us, Neo. It’s the question that brought you here. You know the question, just as I did. In the movie, the question was “What is the Matrix”? For this lecture, the question is “How long does it take for high-quality clinically relevant information to reach the patient?

There are a few answers to the question of how long knowledge translation takes in medicine. One answer is from Dr. John Jackson who was a British Neurologist. He said, “It takes 50 years to get a wrong idea out of medicine, and 100 years a right one into medicine.” This means it takes decades for knowledge translation. In the age of social media that is way too long.

Max Planck

Another answer to the question about how long knowledge translation takes in science comes from Dr. Max Planck. He was a famous physicist who said “New scientific truth does not triumph by convincing its opponents and making them see the light, but rather because its opponents eventually die, and a die generation grows up that is familiar with it.”

In other words, it is not facts, evidence or logical arguments that convince people to change their position on a subject but rather the old advocates had to die first for the new information to take hold and become accepted. It takes a generation for knowledge translation.

Morris et al published a paper in the Journal of the Royal Society of Medicine in 2011 trying to put an exact number on how long it takes for high-quality, clinically relevant information to reach patients. They came up with the number, 17 years. This is not for 100% of the clinical information but rather only 14%. Journal of the Royal Society of Medicine

While I think that the specific number is not as important as the concept that it can take more than a decade for a minority of clinically relevant evidence to be widely adopted by clinicians.

Why does it take so long in medicine? A model has been put together that identifies seven major issues that prevent patients from getting the best care, based on the best evidence. This has been called the Leaky Pipe Model of knowledge translation. The first five leaks are at the level of the clinician and the last two leaks are patient-level problems.

So, there is a knowledge translation problem in clinical medicine. It takes more than a decade often for even a minority of high-quality, clinically relevant evidence to reach the patient. I would suggest that social media could be a solution to the knowledge translation problem. Things like YouTube, podcasts, blogs, X, TikTok, Instagram, Facebook and other platforms.

The Skeptics’ Guide to Emergency Medicine (SGEM) is the knowledge translation project I started in 2012 after attending the Center for Evidence-Based Medicine (CEBM) at Oxford University. The SGEM consists of a structured critical appraisal of a recent publication delivered as a podcast (iTunes, Google Play and Spotify) and a blog. It is also tied into a Facebook page, active X feed, YouTube channel and Instagram. Each season of the SGEM is also published as PDF books. The SGEM has grown over the 12 years to have greater than 80,000 subscribers and gets 2-3 million X impressions per week.

The goal is to cut the knowledge translation window down from over ten years to less than one year using the power of social media. Ultimately we at the SGEM want patients to get the best care, based on the best evidence.

Does this social media stuff work? Well, the very first leak in the Leaky Pipe model of knowledge translation is awareness. We have evidence that social media can impact this knowledge translation problem.

Thoma et al published in the CJEM demonstrating that infographics and podcasts can increase dissemination and awareness. Infographics had Altmetric score of almost three times that of control articles. The podcasts had Altmetric score of more than five that of control articles.

Altmetric is a service that tracks and analyzes the online activity surrounding the publication of academic literature. It measures the attention that research receives beyond traditional citations, such as mentions in social media. Altmetric provides an “Altmetric Attention Score,” which is a quantifiable measure of the impact and influence of research papers or outputs in the digital environment.

So yes, social media can plug the awareness leak in the leaky pipe model of knowledge translation.

That does not mean there have not been criticisms of social media. Many people have expressed their concerns about using social media for knowledge translation. However, these are generally not new arguments. This criticism about social media goes back at least 2,500 years. An excellent book on this is by Tom Standage called Writing on the Wall: Social Media The First 2,000 Years.

Social media is just another potential tool for knowledge translation. It is how you use the tool. It can be used for great good like Neo (the chosen one) or great evil like Agent Smith in The Matrix.

Social media has shrunk the world. It can be used to address knowledge translation. It has the potential to make the world a better place. It all depends on how we use this technology.

The SGEM will be back next episode doing a structured critical appraisal of a recent publication. Trying to cut the knowledge translation window down from over ten years to less than one year using the power of social media. So, patients get the best care, based on the best evidence.

If you would like a copy of all the slides used in this presentation simply click on the LINK and you can see all the slides on YouTube.