Social media has been defined as “a group of Internet-based applications that…allow the creation and exchange of user generated content” [1]. These platforms range from social networking sites such as Facebook, to content sharing sites such as YouTube and Picasa, and even to interactive virtual worlds such as Second Life and World of Warcraft. Rapidly increasing in popularity and influence, social media presents a double-edged sword for proponents of medical technologies. On one hand, social media has transformed how companies communicate with potential consumers of medical pharmaceuticals and technologies. Both consumers and producers have a range of novel communication channels available to them that can rapidly match consumer interests and needs with available products and services. Social media platforms provide companies with new communication channels, relatively inexpensive and targeted advertising opportunities, and a consumer-mediated information stream that could potentially improve consumers’ trust in information and brand loyalty to companies through information shared online. Social media has also given consumers communications tools that enable them to rapidly seek health information, share medical advice, directly manage health conditions, and benefit from, and contribute to, a community discourse by rating, ranking, and describing experiences with medical products. These applications have been developed partly in response to a shift in how consumers see their role in managing their health in an increasingly complex and patient-oriented medical system [2-4].

However, along with these opportunities for empowering both health consumers and producers alike comes potential peril [5]. Social media activities have raised alarms in the medical research community over companies having more effective tools to directly market health products to consumers—an activity regulated in most jurisdictions outside the United States [6,7]. The direct marketing of pharmaceuticals, procedures, devices, and medical tests to consumers is thought to lead to overconsumption or inappropriate consumption of medical technologies [8,9]. Conversely, social media also presents new opportunities for opposition to medical technologies, most notably for those that raise the ire or concern of some citizens, such as religious opposition to stem cell or novel fertility technologies. Social media provides a new platform for these individuals to organize, communicate, and undermine industry messages. It allows these individuals to circumvent traditional communication mechanisms and therefore does not require their messages to be either acceptable or relevant to mainstream broadcasters. It thus permits a minority of motivated individuals to potentially control the discourse and, at times, contribute to the spread of misinformation, damaging an otherwise useful interaction between proponents and consumers. An example of where this disruptive new media has been particularly problematic, and which offers cautionary messages to advocates of other technologies, is in the field of immunization. We have been studying this phenomenon and provide a summary of our experiences and lessons for advocates of new and existing technologies.

Anti-vaccinationism has existed since the introduction of the first vaccine. Individuals who have alternate belief systems have mobilized, typically geographically, to communicate their concerns. This has led to sporadic vaccine rejection movements. More recently, the claim that the MMR (measles-mumps-rubella) vaccine or thimerosal containing vaccines are associated with autism continues to persist despite numerous studies refuting the link [10]. This rumor, largely initiated by a since-withdrawn paper in the Lancet, has resulted in vaccine rejection and contributed to over 26,000 cases of measles in Europe in 2011 [11,12].

What is social media’s role in all of this? Traditionally, geographic proximity was necessary for mobilizing anti-vaccination forces. However, social media has circumvented this potential barrier, allowing individuals from disparate regions who likely would not have otherwise communicated to come into contact. In this process, individuals who had otherwise had their viewpoints rejected and been marginalized can be emboldened and can feel empowered. Social media also provides these individuals with new dynamic mechanisms to communicate their viewpoints. We observed this in several ways while studying vaccine concerns. We first observed the congregation of anti-vaccination viewpoints on YouTube [13]. Individuals utilized YouTube to upload videos that highlighted vaccine concerns and commented on each other’s videos in a quasi social-network manner. Our observation was reinforced by the fact that anti-vaccination videos had more views and higher ratings than pro-vaccine videos. We observed similar vaccine concerns on the social media site MySpace when studying postings related to the HPV vaccine [14]. Examining these blogs revealed geographical clustering of anxiety—with Texas’ attempt to make the HPV vaccine mandatory leading to a plethora of anti-HPV vaccine blogs in that state. Our assessment of the blogging sentiments also revealed potential future challenges in having boys accept the vaccine given that boys’ blogs were determined to be more negative. We even observed organized anti-vaccine behavior when we surveyed health communications in the virtual world Second Life [15] (see Figure 1 for a screen capture showing the Vaccine 911 auditorium; Vaccine 911 is a vaccine critical organization that presents weekly lectures on immunization in Second Life).

As can be surmised, these pernicious activities can pose a real threat to mainstream messaging. If vaccination, one of the most important mechanisms for reducing mortality and morbidity where all established sources of information support the practice, can be undermined by social media activities, more novel technologies are at real risk of being similarly undermined [16]. Other examples of where traditional health messages have been undermined using social media include the promotion of anorexia and the spread of misinformation pertaining to rheumatoid arthritis [17,18].

What strategies should advocates of medical technologies employ to combat the social mobilization of opposition to their products derived from marginalized opinions, hearsay, and inaccurate representation of the science involved? Here are a few recommendations stemming from our observations.