#MedBikini paper will be retracted

This week, a scientific paper published in the Journal of Vascular Surgery resulted in a heated discussion on Twitter, with the hashtag “#MedBikini” trending among medical professionals on Twitter.

In the paper, “Prevalence of unprofessional social media content among young vascular surgeons“, Hardouin et al., DOI: 10.1016/j.jvs.2019.10.069, three male authors screened young students’ social media posts for “unprofessional” behavior.

After creating an outcry on Twitter, the journal announced that the paper will be retracted.

Unprofessional social media posts

The authors used a registry with names of vascular surgery trainees to find young trainees’ social media accounts. Three male authors then created accounts on those platforms to look at the public content posted by the trainees (how professional is that?). They rated the content of the youngsters as “professional”, “potentially unprofessional”, or “clearly unprofessional”.

The reason behind the study was that the authors argued that patients might choose a physician based on how professional a doctor’s social media account looks. They modeled their study on two previous, very similar, papers by Koo et al. and Langenfeld et al. (both of these papers have not been discussed much, but they are equally eyebrow-raising).

Some of the “unprofessional” content that the authors screened for appears reasonable. A doctor who posts a picture of themselves lying in a pile of vomit next to a bottle of gin (‘clear alcohol intoxication‘) might not be your first choice if you need a vascular surgeon. Similarly, doctors posting identifiable images of patients without their permission are violating HIPAA rules.

Not objective

The largest concern about this paper is that many of items labeled by the authors as “potentially unprofessional” are not objective.

What counts as “unprofessional” comments about “controversial social topics“? Is a doctor who posts about gun control laws after sewing up another gunshot victim being unprofessional? Can a medical trainee voice their opinion about abortion or LGBTQ rights?

The problem of scoring such topics is that this is very subjective. Whether or not one finds those social media posts “unprofessional” might be heavily dependent on the juror’s own opinions. If one of the three authors was against abortion, they might find pro-abortion posts more offensive than pro-life posts. Similarly, if one of the authors was a big fan of the Second Amendment, they might find a post about stricter gun regulations more unprofessional than a photo of a trainee holding a fire weapon.

Thus, scoring other people’s posts on controversial topics can be very biased.

Then, is holding or consuming alcohol unprofessional? Assuming the doctor is not holding a beer while performing open heart surgery, is it unprofessional for a surgeon to hold a glass of wine or beer in a social setting, such as a dinner party or a wedding? Is it unprofessional to post a picture from the beach while sipping a cocktail and enjoying a well-earned vacation?

One could say that such a doctor is a human being who has a life outside of the hospital. They are just a professional who is relaxing until the next gruesome shift.

And how sure were the authors that a person was holding alcohol? That cocktail glass with a festive straw and pineapple slice could be holding a non-alcoholic mango drink.

But the authors did not agree with those points of view. In their opinion, posting images holding or consuming alcohol was potentially unprofessional.

One could also wonder if the authors themselves have never been photographed at a conference reception or a wedding. In fact, a quick screen on Facebook and Twitter brought up several of those “unprofessional” images featuring the authors. And let’s hope they will never, ever be caught with a glass of wine or beer in a photo posted online.

The criterion that is the most subjective and most likely to be misogynistic (prejudiced against women) was the judgment on ‘inappropriate/offensive attire”. In particular, one could wonder if a man posing in swimming trunks would be as likely to be judged as “inappropriate” as a woman posing in a bikini.

Also, it is really hard to buy a Halloween costume for women that does not involve a plunging neckline, skin tight latex, or a short skirt. Just compare the Google image results if you type in “halloween costumes for men” vs. “halloween costumes for women”.

It is very hard to judge people’s attire or hairstyles for ‘appropriate-ness’ in an objective, scientific manner that is not misogynistic or racist.

In short, judging other people’s posts is subjective, not objective. It is not science.

Outcry on social media

The Hardouin et al. paper created a public outcry on social media. In particular, people pointed out that the “inappropriate attire” criterion, defined as “pictures in underwear, provocative Halloween costumes, and provocative posing in bikinis/swimwear” was specifically aimed at judging women for what they wear.

Under the hashtag #MedBikini, many medical professionals started to post on Twitter images of themselves in swimwear, often while sipping a cocktail. By doing so, they stated that it is totally fine to be a professional AND post photos while relaxing.

PubPeer comments

My concerns, as posted on PubPeer were as follows:

• Many of the “clearly” “unprofessional” content criteria seem to be very subjective. How would one define “clear alcohol intoxication”? What is “inappropriate” attire? What do they consider as “provocative posing”? These are not objective measurements. The authors fail to give a clear definition of their inclusion and exclusion criteria. This is not science, it is judgement. Could the authors please tell me the measurements of the bikinis and t-shirts they deemed inappropriate? How many inches from the collar bone was allowed to be not covered by fabric before it was inappropriate? When was a woman looking at the camera in a bikini doing “provocative posing”?
• How is holding a glass of alcohol unprofessional? Let’s hope that none of the authors will be ever spotted holding a glass of wine at a hospital reception or conference.
• All three “screeners” were of the same gender and similar age. This might result in biased opinions of what type of swimwear or Halloween costumes are “inappropriate”, and might result in a particular bias towards what women are wearing. Looking at the tables in the paper, 71% of the screened social media accounts were owned by males, while women were found to have more “unprofessional content” than males (30% vs 24%). Is this caused by screener bias?
• Finally, and admittedly not a very objective measurement, checking out accounts from young students seems …. creepy.

Apologies and retraction announcement

On July 24, the Journal of Vascular Surgery announced they would retract the paper, very appropriately through a tweet and on Facebook.

Two of the authors also posted apologies on Twitter.

And so, a paper about how young professionals should behave on social media caused senior professionals to realize that maybe they were the ones who should have behaved differently. Let’s hope there is more room for diverse points of views in scientific papers.