Robert Califf and the Rise of Medicine's Peanut Gallery

This Journal of the American College of Cardiology Case Reports editorial, A Perspective on the K-Index, by Dr. Robert Califf has drawn a lot of dialog. Through a critical discussion of the K-Index he questions the value of social commentary by non-research physicians.

Central to Califf’s thinking is that those not integrated in the traditional medical research construct are the peanut gallery. Once invisible to those who controlled the journal presses, Califf’s peanut gallery has demonstrated that there are new ways to discuss science and medicine. New public platforms have spawned voices that can be heard without the once-mandated prepublication nod of approval. But despite this inclusion of diverse physician voices in the conversation, Califf suggests that the work of critiquing research should be within the domain those who have done it.

New media and challenges to medical authority

Buried between the lines is the fear is that a dark horse could emerge that influences the trajectory of medical thinking — a trajectory once shaped and controlled by a select group of physicians. This perspective perpetuates the idea that capacity for commentary should be based on pedigree rather than the originality of one’s thinking. Unfortunately, this way of seeing the world sits in contrast to how the medical profession is beginning to share information and contruct new ideas.

The institutions and societies that once defined medicine’s professional matrix are being slowly nudged by public networks. These networks are changing the way doctors organize and see themselves. And with these changes come challenges to traditional authority and thinking.

One challenge to democratized medical media (shared by Califf) is the potential to conflate authority and influence. I share this concern. Because without careful consideration the same hierarchical elements that constrained 20th century medical communication will come to shape networked communication. With exceptions, physician influence does not equate to expertise and authority is not based on follower count. I’ve started the discussion here and would love to carry it further.

(While we’re at it, medical microcelebrity and the creeping rise of digital influence needs deeper dialog) 

Balancing opportunity and risk

Engagement with a broader global community presents an unrivaled opportunity for clinicians and researchers. In fact, the next generation of medical leadership will use the tools of public engagement to advance knowledge, research and patient understanding. The concept of a public physician has moved beyond a digital curiosity to a new professional responsibility.

In an Information Age overrun with medical misinformation the peanut gallery serves as a critical interface to a growing public conversation. Despite concerns and challenges of physician communities, we individually shape the quality of the professional dialog with our conversations and curation. It’s far from perfect, as Dr. Robert Califf points out. But it’s our participation, open discussion, and growing network effect that will make it powerful.


If you like this post you might check out the 33 charts Digital Influence Archives. In fact, every post on 33c has tags right below the post (have a look) that will help steer you to related writing. Check it out!

Modified photo by Tofan Silviu Beniamin on Unsplash