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Posted on July 27, 2020 at 1:57 PM

by Andrew Helmers, MDCM, MHSc (Bioethics), MSc, FRCPC

The Journal of Vascular Surgery (and Irony) published a rather odd piece that set Twitter ablaze even amidst the wildfire that is COVID-19. The seemingly innocuous piece was entitled “Prevalence of unprofessional social media content among young vascular surgeons”; it was first published online in advance (December 2019), and was then formally published in the August edition of the journal in question, accompanied by a laudatory commentary piece. It was quickly retracted after the resultant public outcry, but its thankfully brief existence still warrants some reflection here as a cautionary tale vis-à-vis research ethics oversight and medical professionalism.

A group of vascular surgeons became concerned that their junior colleagues might be endangering their professional standing and the profession at large with inappropriate posts on social media. Enthusiastically misinterpreting the adage “physician, heal thyself”, they undertook a Big Brother operation in which they policed the social media posts of vascular surgeons-in-training. A lesson in Irony 101, the grunt work was done by male crusaders, poring over pictures of “young vascular surgeons” whose “provocative posing in bikinis/swimwear” was – unanimously – deemed “clearly unprofessional”. Wielding some hitherto unveiled metric of righteousness, the group similarly classified more than 10% of 235 political, religious and social comments as being “potentially unprofessional”. “There are several limitations of our study” is the only statement in this paper that I can agree with. How did Boston University’s School of Medicine Institutional Review Board (IRB) approve this “study”? They went so far as to waive informed consent, permitting this group of investigators to obtain a database of vascular surgeons-in-training with which they searched (using fake social media accounts) for each trainee’s public posts on social media. Arguably, seeking informed consent would have modified the outcome of this study. But that is irrelevant when, arguably, this study should never have gone forward in the first place.

There is a fundamental conflict of interest when a group of surgeons, no matter how small, endeavors to consciously and anonymously troll the social media accounts of trainees in their specialty across the country for “unprofessional” content. How are we to know that no one in that group will be in a position to hire one of the nine trainees who were dressed in “inappropriate attire”? (The group timed their searches such that most of the trainees had graduated into practice or were actively looking for jobs; the latter group, and those who had graduated but pursued additional fellowship training, would be vulnerable to any conflict of interest arising from this work). And what was the IRB thinking in giving out a license for what, outside of Boston University’s School of Medicine, is generally considered voyeurism? It doesn’t matter that these social media posts were “public”; it matters that an IRB approved a formal mandate to sniff them out. It doesn’t matter that physicians wear bikinis, as the #MedBikini movement was quick to assert (irony again, as social media wrought its revenge); it matters that a group of males received IRB approval to judge them by standards all of their own (to be clear, one author was female, but the online searching was done by males only as per their Methods).

It will perhaps always be tempting to subject medical professionalism to the indignity of statistics, but its values remain rooted in history, philosophy and ethics rather than subgroup analyses: our benighted group of vascular surgeons highlights the danger of that siren call. I’m pleased to see that in the seven months that this piece existed online it was only cited once, by an eclectic journal article proposing a pet-centred social media platform. Unlike the accompanying invited commentary in the August edition of the Journal of Vascular Surgery, which praised the “seminal finding” of “this important article”, I think the retraction and inevitable IRB self-reflection will best achieve the professionalism that this piece claimed to uphold.

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