Cancel Social Media?

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Two EP Monthly editorial board members square off on a controversial topic.

Editor-In-Chief Salim R. Rezaie, MD debates Senior Board member William Sullivan, DO, JD, on the benefits and downfall of social media.

Social media isn’t just bad, it’s evil.

Social media didn’t start out evil. However social media has changed from a medium in which civil participants could exchange ideas into some combination of a mosh pit, a Mad Max world of battle, and a bad iteration of the Sims.


Long ago I joined Facebook … for about three weeks. Then a familiar ED patient sent me obscene and berating messages because I refused to prescribe narcotics for her chronic abdominal pain since, ironically, she “was NOT a drug seeker.” Profiles of my family were linked to my Facebook account and when I realized how easy social media made it to blur the distinction between my personal life and my professional life, I nuked my account.

My stint on Twitter lasted a little longer. However, political vitriol increased and Twitter overlords censored those with whom they did not agree. I chose to reject the echo chamber and deleted my Twitter account.

Some of my children followed my example. In doing so, they slowly changed from neurotic high-strung sycophants obsessively refreshing their screens to see how many “likes” the latest posts received into better adjusted, more relaxed and much happier young adults. Now I stick to my blog where I can post articles at my leisure and return to civil scholarly debate.


Social media can be a quick way to find and disseminate information. However, the sheer volumes of information make it difficult to pick out the nuggets of useful data. With increasing pressure to create content, the signal-to-noise ratio has decreased significantly. The struggle for reader eyeballs is intense. Social media algorithms often favor controversial topics that drive more people to click, comment and combat, which increase engagement while dividing us further.

Without caution, social media can cause patients to lose their privacy, cause physicians to lose their jobs and ruin longstanding relationships. Decades-old posts on social media can be used to attack someone who dares to disagree with an “influencer.”

Words or pictures taken out of context can be used to assassinate a person’s character. Failing to be politically correct or daring to question social media dogma has suddenly become worse than committing a felony in the eyes of many.

Few question assaults, theft or destruction of property when committed in response to a perceived social wrong, but those who dare to assert that men cannot get pregnant or who express a negative opinion about COVID vaccination are subject to relentless hounding, doxxing, censorship  and punishment.


Many refuse to speak out on social media due to fear. Fear of attacks to their family. Fear of losing a job. Fear of losing professional status. When did such retaliation suddenly become OK?

Write the wrong thing to the wrong person and your life can be ruined before you know it. Social media no longer encourages the expression of opinions or scholarly debate.

Social media only encourages the expression of “acceptable” opinions — or else. Rather than express opinions, followers “like” similar opinions made by “influencers.” Those “likes” beget more “likes,” which then increase the power and reach of the influencers whose agendas, in turn, become more difficult to question.

Then there’s the “dead internet theory.” By some estimates, half of internet traffic is “nonhuman.”

Many posts on social media are from “bots” programmed to sway opinion using advanced AI language algorithms. Before you roll your eyes, check out this Reddit forum in which all posts and replies are solely from bots.

Want to sway opinion on COVID vaccination? There’s a bot for that. Our nightly news is not immune to an issue so “extremely dangerous to our Democracy”  (watch the video to understand the quotation marks). I even had AI write part of this response. Can you tell where?

Every medium of communication has a life cycle. MySpace, telephone landlines and even backyard conversations have come and gone. Social media needs to be added to this list. Until then, be circumspect in your online interactions.

Social Media can be a Useful Tool

If you believe social media is evil, then you are simply not using the tool correctly.  Social media is simply an information stream of what you choose to follow.  Who and what you follow matters.  Crap in equals crap out.

So really the first thing you have to decide is what purpose is social media fulfilling for you?  For me it is a professional personal learning network.  Another way to say this is online interactions with others in different environments to help solidify constructs of nuanced topics.  Does this sound evil to you?

It has been shown that the majority of published research findings require years to benefit patient care (i.e. knowledge translation).[1]  It can take six to 13 years for incorporation of research into reviews, guidelines and textbooks. Social media has helped decrease this time to help potentially improve patient outcomes.[2][3]

A nice example of this was early in the COVID-19 pandemic.  Several influential emergency medicine Twitter users in the US delivered many tweets pertaining to news stories and research directly relating to patient care.[4]  The study showed how when used correctly social media can be used in a positive manner to share information during a rapidly evolving situation.

What about the quality of the information?  Disinformation has been a pandemic within a pandemic when it comes to COVID-19.  Luckily there has been research done on credibility of social media.[5]

A test of 151 possible quality indicators were evaluated to identify the most reliable social media sources.  This was narrowed down by many experts to the most important quality indicators of social media. This can help users of social media to limit what resources to follow and consider accurate, credible, clear and coherent.

Finally, in one study,[6] when looking at social media, following the #FOAMed hashtag on Twitter, three overarching themes were identified in information sharing: appraising evidence/guidelines, sharing specialist/technical advice and personal/social engagement.

Many of the contributors were from a variety of different disciplinary backgrounds and from countries all around the world.  There is a clear cohesive and resourceful community in social media that shares a purpose to information dissemination and online communication.

So is social media evil?  Every tool has its pros and cons, but maybe instead of blaming the tool, consider improving the way you use the tool.  As I stated at the beginning, the who and what you follow matters.


  1. Diner, BM et al. Graduate Medical Education and Knowledge Translation: Role Models, Information Pipelines, and Practice Change Thresholds. Acad Emerg Med 2007. PMID: 17967963
  2. Syed S et al. FOAMed and Social Media – Innovation or Disruption? CJEM 2018. PMID: 30484425
  3. Thoma B et al. The Impact of Social Media Promotion with Infographics and Podcasts on Research Dissemination and Readership. CJEM 2018. PMID: 28899440
  4. Leibowitz MK et al. Emergency Medicine Influencers’ Twitter Use During the COVID-19 Pandemic: A Mixed-Methods Analysis. WJEM 2021. PMID: 34125052
  5. Thoma B et al. Emergency Medicine and Critical Care Blogs and Podcasts: Establishing an International Consensus on Quality. Ann Emerg Med 2015. PMID: 25840846
  6. Rashid MA et al. Sharing is Caring: An Analysis of #FOAMed Twitter Posts During the COVID-19 Pandemic. BMJ 2020. [Link]



EDITOR-IN-CHIEF Dr. Rezaie is founder and editor of R.E.B.E.L EM.

SENIOR EDITOR DR. SULLIVAN, an emergency physician and clinical assistant professor at Midwestern University in Illinois, is EPM’s resident legal expert. As a health law attorney, Dr. Sullivan represents medical providers and has published many articles on legal issues in medicine. He is a past president of the Illinois College of Emergency Physicians and a past chair and current member of the American College of Emergency Physicians’ Medical Legal Committee. He can be reached at his legal web site

1 Comment

  1. I wish we could go back to the days when social media was “social” and not political, controversial or weaponized. I would like to see FB, google, twitter and all their tentacles to go back to the original idea of connecting people, not dividing them. Social media today is giving us a generation of insecure, codependent and hypersensitive individuals without actual social skills, disconnected from reality and incapable of feeling empathy for others. Really… I just want to post pictures with my dog and see the photos of my nephews and nieces birthdays. I am not interested in all the other content that doesn’t bring anything constrictive to me or the people I care about. Is that too much to ask?!

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