Premium Communities: A Potentially Financially Viable Innovation to Build Trust on Twitter?
Earlier today, I had an interesting discussion with many fellow tweeps about the future for social media, specifically relating it to healthcare. The recent turmoil on the website since Elon Musk’s purchase of Twitter has led to a migration and a questioning of whether we should even be on this website.
This crisis represents the perfect opportunity to reassess why we are online in the first place. How can social media improve healthcare, the lives of our patience, and our lives? For those who have loved the website, we may want to try to improve it before leaving.
Despite my enthusiasm for social media, I have always had some concerns about scalable harm being a possibility. Could social media be a “Black Swan” that undercuts public trust in medicine? I grew up in the medical family, and watching medicine change as the technology has developed gave me opportunity to see how we must change, while retaining an essential relationship between people with health problems (patients) and people taking care of them formally (health professionals).
My love for Twitter came from the opportunity to learn from and give back to people with cancer, in a way that allowed me to be a better doctor. Since 2013, I have been inspired by a vision that allows clinicians and patients/advocates to work together to improve healthcare. Using social media brings us together, but the financial model supporting viability has led to us being the product: because we are not willing to pay for using websites for health conversations, social media websites make us the product, enticing us to spend more time online, share more information about ourselves, so that advertisers or others can target us all the more precisely.
The current crisis at Twitter is actually an opportunity, in my mind. Now, there is a website that is not beholden to public shareholders. There is an opportunity to change the business model. Mr. Musk already has shown an interest in having some people pay period while that may seem frustrating and offensive, the less the website is dependent upon advertising income, it may allow us to pay as customers to make sure it provides the value that we want.
Social media is inherently at odds with healthcare. We are sharing private information publicly, which creates ethical, legal, and logistic barriers. It requires a lot of thought about how to do it well. If social media is going to be compatible with responsible healthcare, then it must be used to improve the well-being of the people using it. It should build trust, or at least not erode it.
Healthcare professionals have an ethical obligation to try to help others. That includes themselves, though often they forget about that. My thought is that if healthcare professionals and patient/advocate can work together, the current crisis and Twitter presents an opportunity to help the website develop a sustainable model that promotes health and well-being. It may no longer be financially free, but may provide enough value to be worth paying for.
In disease-specific cancer communities on Twitter, I have been fortunate enough to participate in live chats and learning in communities around specific topics or problems. Having helped a specialty specific community develop around a hashtag, I’ve seen that it’s feasible to do, if done well. But the conflict, humble bragging, and other concerning behaviors makes me convinced we need to make sure social media use helps us be better versions of ourselves.
Twitter has Communities which can be developed. So why not create premium communities that allow curating high quality health information, not in the ‘live’ stream of the public square but in designed spaces for reliable information?
A premium Community could be a virtual ‘storefront’ that someone could pay to set up. Let’s say, for $10 a month, but might be higher depending upon the community size. It could then attract people to join that community, because it would have premium options including access to more private, live conversation; ”evergreen” content curated by moderators; and other features that would add value for people to come as a “safe space” for reliable information. It would allow them to still participate in an open Twitter that permits free speech, access to new ideas. But moderators of these premium communities could set rules, enforce them, and people would pay a small price to participate in these communities. The revenue could be split, going to the moderators to cover costs, and to Twitter as another source of revenue.
This approach could permit people to find health information more reliably, if Twitter also made a marketplace that would identify these premium Communities. People could make an informed choice and discover other people with similar interests, whether it be around a disease, a particular area of some other interest. You could go into open Twitter to hear new ideas, but if you wanted to get evidenced based information, you could find those communities supporting that information. Could people still find a lot of misinformation? Yes. But a well-designed Community could develop word of mouth reputation for being reliable.
If Twitter worked with patients and clinicians, it would help ensure that the website could potentially be safe for a variety of different communities of interest, not just for topics related to healthcare. In addition, if Twitter committed to keeping the information in these premium communities private and away from advertisers, it would distinguish itself from Facebook, which data mines even supposedly private Groups. And don’t forget Meta owns Facebook, Instagram and WhatsApp.
To work, it would require treating us as thoughtful human beings and customers, rather than social media addicts. There may need to be better government on the website, and if Twitter wanted to be really radical, it could even permit people sharing high quality content to be paid a small fraction for it. Many patient advocates in healthcare have suggested giving patients data ownership, rather than healthcare organizations. What if Twitter did that? Incentivize people to share the best content they can, and it could allow the company to provide more accurate, balanced information in the end.
So what can doctors, nurses and other health professionals do? If we work together, with patients/advocates, we can push for internal changes that support a healthy environment on the website. That does not mean agreement, but should mean people get a fundamental level of some respect and safety. If we can make it safe for people that are vulnerable in healthcare that want to go online for reliable health information, it may scale to make the entire website more attractive to the current people using it, and might attract others. Clinicians and patient/advocates can do it better working together than either of us can separately. We can’t control the outcomes but we can try to make sure trust is valued between people looking for knowledge and those who have it. Designed well, premium Communities could build trust.
There are specific things I think would be helpful for health professionals to do, but that gets off of this primary topic. What do you think? Would this work, and how could possibly we make this idea (or a better version) attractive to Twitter management?
