Verified public health professionals on Twitter are overwhelmingly men

On Twitter, many users lust after the “blue check,” the official stamp of verification given by the company that “lets people know that an account of public interest is authentic.” That way, users can tell the difference between an actual politician’s account and a parody account (arguably sometimes hard to tell these days).

Physicians are one group that applies for that check, in part because during the pandemic, they’ve amassed large followings and influence online conversations around covid-19. And they often get their blue check — at least the male physicians do. That doesn’t hold true, however, for a good portion of female physicians, according to a new study in the Journal of the American Medical Association (JAMA).

When it comes to physician-held verified Twitter accounts, of the 779 the study’s authors identified, 70.7 percent belonged to males and only 29.3 percent to females.

The results raise questions about Twitter’s verification process, and of course, who is given additional cachet when it comes to health messages reaching a wider audience on social media.

“I was interested in terms of who was getting, for lack of a better term, respect or that extra kind of gold star,” said the study’s co-author, Fumiko Chino, a radiation oncologist at Memorial Sloan Kettering Cancer Center in New York City and a clinical researcher who is interested in health outcomes, health equity and healthcare disparities. Chino is verified on Twitter.

“Unlike for example maybe a celebrity, a verified physician really potentially does have a larger voice and would be trusted a little better than someone who was not verified.”

Getting your blue check and the fast track for health professionals

Twitter representatives did not respond to a request asking them to explain their verification process. But on the company’s website, it lays out a number of categories and requirements that various individuals and companies need to meet in order to become verified — including things like the account must be active, notable, and not recently created.

For “activists and organizers,” where Twitter categorizes medical professionals, requirements state that the “account is reflecting an individual, not an organization” and “account’s follower count is in the top .05% in their region.” However, Twitter says it will verify accounts that do not meet all of its requirements in matters of high public interest, due to their expertise or public role. That includes medical professionals during epidemics.

“Social media has become part of a physician’s professional and public-facing profile,” wrote the study authors. “Verification validates and boosts that status and may have important implications for patient engagement and academic promotion based on digital scholarship.”

Why it matters who has the social media floor

Chino said that she thinks that verification does lend weight to the messages that physicians put out. That can be both good and bad. While people think of science as black and white, it’s actually very, very gray, said Chino.

And as verified physicians spar online over things like wearing masks (some saying you don’t need them) because they are making decisions from various data they’ve reviewed, that can leave others, like immunocompromised or “at-risk” individuals, vulnerable.

“We’ve not done a good job about controlling the stream of information about what the different risk levels are and how we should be behaving,” said Chino.

Anjana Susarla, a professor of responsible AI at Michigan State University who has done research on how people search for healthcare information on social media, said that people seeking out information usually search for trustworthy sources that look like them. While doctors and healthcare professionals may turn to the CDC for example, an average internet user may not be well versed in terms of trustworthy government resources.

“If Twitter is providing verification status to men and women differently it might affect the perception of what is trustworthy information on Twitter,” said Susarla.

Susarla gave an example of someone seeking advice on whether to send their kids back to school. The information from a pediatrician posting advice on Twitter who is a mom might differ from a male pediatrician’s. But if the woman is not verified and the man is, that could impact how people choose to use the information they’re providing. Susarla also said the verification process is notoriously opaque.

Chino has helped co-author additional studies that explore how sex and gender inequities lead some information to be amplified over others. Looking at Twitter influencers in her field of radiation oncology, Chino and her co-authors found that “male academic radiation oncologists based in North America occupy particularly influential positions in virtual communities.”

That males are more likely than females to get the blue check is not new — older studies found the same patterns — but the recent study does show it is a continuing issue. Previous research has shown that generally, men are much more likely to be verified than women.

“We’re in a liminal space right now where voices that are trying to promote a public health message are actually under attack,” said Chino. “I think that we have to be very careful about whose voices we are elevating, because unfortunately, I feel like there’s been a real erosion of trust.”

Thanks to Dave Tepps for copy editing this article.