Launched in spring 2024, the podcast Communicable, hosted by the editors of CMI Communications, has quickly become a trusted forum for exploring emerging and sometimes controversial issues in infectio...

To the Editor,I read with interest the article by Stone and Schwartz “Joining the X-odus: Contrasting perspectives on whether infection specialists should leave X (formerly Twitter),” October 2025 [1]. For disclosure, I was an early ScienceTwitter adopter, having established my account in 2009. Before Elon Musk purchased the site in October 2022, I had approximately 132 000 followers and received my “blue check” verification in 2016. I coauthored a 2020 publication touting the “viral power of Twitter for infectious disease” [2]. I coedited a book on the West African Ebola epidemic with colleagues I met via Twitter and credit the site with other collaborations and talk invitations over the years. All of this is to say that I have seen the highs and lows of the site in my 16 years’ worth of observations.One thing I find missing in the Stone and Schwartz [1] analysis is a discussion of the social cost of harassment and threats on Twitter/X, particularly for women. To be sure, Twitter was never a bucolic haven of civility. A preMusk, 2018 report by Amnesty International detailed a “shocking scale of online abuse against women” on the site [3], which increased further during the height of the COVID-19 pandemic [4]. I have personally received harassment from my years on Twitter, ranging from threats to my livelihood, to sexual assault, to wishes of death, and other graphic physical abuse. Most women scientists I know have received similar threats to one extent or another, and it is generally worse for women colleagues of colour [3]. Outspoken women with deep scientific expertise are intensely threatening to patriarchal norms and the extremists who have made their home on Musk’s Twitter.Stone notes that “Staying the course needs a thick skin—but ultimately science and reason can still shine even in the most hostile environment.” I would have once agreed with that statement, but I am no longer convinced. As noted in the original article, part of Musk’s changes upon site purchase were to eliminate much of the existing trust and safety team; to loosen moderation and allow for, or even reward via algorithmic boosting, misinformation on the platform; and to bring back users who had been banned under the prior owners, including those who had promoted vitriolic campaigns against scientists. The already-toxic platform showed an increase in hate speech as an unsurprising outcome [5]. Although the reporting feature was always unreliable, now the option to report an individual user or tweet has been removed altogether, an acknowledgement that there is no behaviour too odious to result in removal from the platform.I have been a science communicator on various sites since 2002, from internet fora to science blogs to Twitter and other social media sites. The depth of my skin is not the issue. Since the Musk takeover, 20 000 of my followers left the site. Because I will not participate in Musk’s new version of pay-to-play verification to boost the position of my tweets in the algorithm, my engagement on the site cratered. Although my profile still exists, I ended active participation in the summer of 2024. I no longer recommend the site to trainees and junior colleagues, as the risk of personal hazard is too great for the minimal engagement in return. Although neither is without fault, I currently find more engagement and productive discussion at Bluesky and Facebook.CRediT authorship contribution statementTara C. Smith: Conceptualization, Writing – original draft.Declaration of competing interestTara Smith has no COI to disclose. No funding was provided for this manuscript. No AI was used in its writing.

In this first-ever collaboration between Communicable and Breakpoints, the podcast of the US Society of Infectious Diseases Pharmacists, hosts Angela Huttner (Geneva, Switzerland) and Erin McCreary (Pittsburgh, USA) join trial investigators Josh Davis (Newcastle, Australia) and Steven Tong (Melbourne, Australia) to unpack the first results coming from the SNAP adaptive platform trial, which were recently presented at ESCMID Global in Vienna. Learn whether penicillin and cefazolin are non-inferior to—and maybe even safer than—flucloxacillin for penicillin-susceptible and methicillin-susceptible Staphylococcus aureus, respectively.This episode was edited by Julie Anne Justo, transcribed by Katie Lambert and Sarah Groome, and peer-reviewed by Megan Klatt and Lacy Worden. Communicable and Breakpoints released this episode on 5 May 2025.Declaration of competing interestS.Y.C.T. has served on an advisory board for AstraZeneca for a staphylococcal monoclonal antibody programme and receives royalties from UpToDate for editing S. aureus–related content. E.K.M. has previously served on scientific advisory boards for the following pharmaceutical companies: Abbvie, Basilea, Melinta, GSK, and serves on the DSMC for the SNAP trial. Other authors declare no financial interests/personal relationships that may be considered as potential competing interests. Note on conflict of interest for SNAP Data Safety Monitoring Committee (DSMC) members:Conflicts of interest were evaluated when choosing individuals to serve on the SNAP DSMC. Aside from being compensated for their duties on the committee, DSMC members have no ongoing financial relationships that relate to the trial and are not involved in the conduct of the trial in any role other than that of a DSMC member. DSMC members have no intellectual conflict of interest or bias and reviewed SNAP data in a fully objective manner.Related podcast episodeCommunicable Episode 26: SNAP out of it - the SNAP trial PSSA/MSSA results https://share.transistor.fm/s/2a3c3bb4Further reading[1]Tong SY, Davis JS, Eichenberger E, Holland TL, Fowler VG Jr. Staphylococcus aureus infections: epidemiology, pathophysiology, clinical manifestations, and management. Clin Microbiol Rev. 2015;28(3):603–61. DOI:https://doi.org/10.1128/CMR.00134-14.[2]SNAP Adaptive trial platform/results of the PSSA & MSSA domains:• https://www.snaptrial.com.au/ESCMID Global April 2025 presentation:• www.online.escmid.org *• https://www.escmid.org/congress-events/escmid-global/programme/scientific-programme/[3]CloCeBa trial results (ESCMID Global April 2025 presentation):• www.online.escmid.org *• https://www.escmid.org/congress-events/escmid-global/programme/scientific-programme/[4]CAMERA 2 trial; Tong SY, Lye DC, Yahav D, et al. Without an antistaphylococcal β-lactam on mortality, bacteremia, relapse, or treatment failure in patients with MRSA bacteremia: a randomized clinical trial. JAMA. 2020;323(6):527–37. DOI:https://doi.org/10.1001/jama.2020.0103.[5]POET trial; Iversen K, Ihlemann N, Gill SU, Madsen T, Elming H, Jensen KT, et al. Partial oral versus intravenous antibiotic treatment of endocarditis. N Engl J Med. 2019;380:415–24. DOI:https://doi.org/10.1056/NEJMoa1808312.[6]POET trial follow-up: Pries-Heje MM, Wiingaard C, Ihlemann N. Five-year outcomes of the partial oral treatment of endocarditis (POET) trial. N Engl J Med. 2022;386:601–02. DOI:https://doi.org/10.1056/NEJMc2114046.*Note on access to online video of ESCMID Global presentations:•In the six months following the congress:• Non-ESCMID members have access if they registered for ESCMID Global• Members have access only if they registered for ESCMID Global•Six months after the congress:• Non-members do not have access, whatever their ESCMID Global registration status• All members have access, whatever their ESCMID Global registration status

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In this episode of Communicable, Erin McCreary and Angela Huttner are...

Social media is a cultural and communications phenomenon that is an integral part of life in the 2020s. Twitter was founded in 2006 and became a leading social media platform with an active user base ...