Social Media as Black Swan?

Originally posted on the Mayo Clinic Center for Social Media, August 11, 2011
Recent data from Pew Research show that 59% of U.S. adults go online on for health information on 15 health topics surveyed.  Clearly, many of us find valuable information about health online.  But if a key goal of medicine is to avoid harm, then Nassim Nicholas Taleb’s concept of the Black Swan may be helpful to consider how social media may affect our health.
Many recognize that social media is changing how we interact, but does that mean we know where it’s taking us, or what risks or benefits it may bring?  The concept of the Black Swan is that it is an event, or sequence of events, that is an “outlier outside the realm of regular expectations…carries extreme impact…[and] human nature makes us create explanations after the fact to make it explainable and predictable” (page xxii of 2nd edition paperback).
How does this apply to our health?  Social media encompasses many varied communication technologies:  blogs, wikis, social networks, and others.  Each medium has certain facets that distinguish them, but each allow creation of user-generated content and can:

1. Lower or eliminate barriers to communication;
2. Be easily used without computer expertise;
3. Permit global access and dissemination immediately to other users.

Black swans are more likely to occur in more connected, scalable environments. And social media has connected many of us very rapidly, leaving little time for reflection about how social networks, microblogging or online marketing influences our decision-making processes and our health.
What makes social media’s key features both promising and potentially dangerously exposed to Black Swans:

1. Some forms of communication can be detrimental to our health (e.g. cyberbullying, sharing misinformation);
2. Increased ease of use means more increased exposure to multiple sources of harm or benefit (e.g. privacy violations, online support groups);
3. Because scalable mistakes that affect our health can create effects on a global level, not just in individual interactions or within a single health care system.
4. Immediate dissemination of content and propagation by other users creates the potential for higher impact rare events.

This is particularly important in health care, where there is a great deal of uncertainty, variability, and complexity. And Taleb cautions, “we overestimate what we know, and underestimate uncertainty, by compressing the range of possible uncertain states.” (p.140)
From my perspective, social media are tools -- that’s it.  Technology provides us tools or methods, literally meaning the study of art, skill or craft.  Technology is used for a purpose but is not an end unto itself.  Within health care, social media tools should be evaluated critically, no differently than others we use to improve our health.   Does surgery, radiation or chemotherapy work for cancer?  It depends but has been carefully studied.  Why should we expect any less with social media if it to be taken seriously and used effectively?
And why should we risk only seeing the obvious after a potentially avoidable problem with social media has occurred?  If we can find the negative Black Swans and eliminate or lessen the risk, then it allows the better aspects of social media to flourish in health care and help more people.  If a major fiasco occurs and social media is blamed, a backlash against its use may delay a lot of the benefits it can bring.
In my next post, I’ll touch on some of the areas that I think we need to explore to hunt for potential Black Swans, as well as how to better decide how social media fits into health care.