Discussions fail after Britain refuses to pay billions of euros in fees

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 of approximately 500 million. The site uses the ‘microblogging’ format, which is a character-limited short form of content posted by users.The site became a popular medium with scientists and physicians to communicate, share ideas, and network [1]. The infectious disease community was strongly represented, with a peak of interest from the wider medical and scientific community, not to mention the public at large, arising from the COVID-19 pandemic. From June 2019 to March 2023, there were nearly 450 000 ‘tweets’ tagged with #IDTwitter (Infectious Diseases Twitter), resulting in an astonishing 1.8 billion impressions (the number of times a post appeared on users’ timelines) [2]. At its height, #IDTwitter included journal clubs [3], recruitment opportunities for jobs and fellowships, robust case discussions, thoughtful educational content, and live conference updates [4].However, in October 2022, Twitter was purchased by technology entrepreneur Elon Musk, who renamed it ‘X’ and implemented a series of changes that have significantly altered the functionality and culture of the platform. These changes, the owner’s erratic behaviour, and the platform’s role in advancing a polarized and partisan agenda have led to mass exit of scientists and clinicians, among others, a phenomenon sometimes dubbed the ‘X-odus’.Whether there is still value in having an active presence on Twitter/X is a topic of contention. Herein, we present opposing views from two infectious disease physicians who have been active on social media regarding the question of whether infection specialists should leave the platform known as ‘X’.No: the case for staying by Dr Neil R.H. StoneDespite these undeniable challenges posed by the changes that have been implemented on the site, I argue that it is incumbent upon scientists and experts to remain engaged with it.1.Conceding space to extremism: By leaving, this creates space for the most extreme voices to perpetuate disinformation and misinformation unchecked. Challenging these narratives is essential, and the very failure to do so has allowed falsehoods to perpetuate and take hold. We find ourselves in an atmosphere of antiscience and a contempt for expertise, in part, because as infection professionals ourselves, we have not done enough to counter it. The answer is to stand up for our perspective rather than to raise the white flag and retreat.2.Avoiding an echo chamber: While debating the most extreme viewpoints is often ineffective and a poor use of time, it can be healthy to understand and be aware of staunch proponents of views that are often diametrically opposed to your own. Retreating to friendly ‘echo chambers’ where everyone around you shares the same views as you can lead to insularity and blinkered thinking. Confirmation bias feels good, but it is not helpful in terms of scientific critique. It has been argued that alternative sites, such as BlueSky, have simply become a ‘left-wing’ mirror image of largely conservative/right-wing X, where views that do not conform to the supposedly left-wing/liberal/progressive orthodoxy dominant on that site are disdained and denigrated [5].3.Volatility of the social media space: Social media sites are relatively new to humanity and are rapidly evolving. They are unpredictable and can change quickly, as evidenced by the rapid transformation from Twitter to X. Given its huge user base and market dominance, X is likely to undergo further changes and perhaps a change in management. ‘Playing the long game’ and staying on the site for this eventuality could pay off.4.Communicating with the public: The majority of Americans now get their news from social media [6], with Twitter/X being one of the major sources. Clearly, social media reaches an audience far wider than the narrow confines of a medical or scientific community. Social media sites, such as Twitter/X, therefore allow for effective science communication with the public at large, who would otherwise receive messaging primarily from antivaccine voices and activists. No other site comes close in terms of size of public audience; newer sites, such as BlueSky, contribute to a tiny proportion of news consumption.5.Access to journalists: Twitter/X remains a prime source of information and networking for media professionals. This can lead to direct quotation or invitation to comment or interview in print or visual media, including the powerful medium of podcasts. Leaving the site risks losing these valuable opportunities for public science communications.6.Access to policymakers: Politicians and senior policymakers across many fields have a strong presence. All 100 U.S. Senators maintain a presence on Twitter/X, allowing for direct engagement with and access to those who can directly influence health and science policy.7.No viable alternatives: Like it or not, there is no alternative that offers anywhere near the engagement of Twitter/X. BlueSky, although receiving a surge of new users fleeing Twitter/X around the time of the 2024 U.S. Presidential election, has failed to capitalize on this, and engagement remains a tiny fraction of that of Twitter/X [5].Twitter/X is clearly imperfect, now more than ever. However, it remains the dominant social media platform and an essential part of the media landscape. Opinions are formed by its content, including those expressed in mass media and in key policy-making positions. Scientists and doctors leaving the site will be – and are being – replaced by pseudoscientists and charlatans with fringe, unproven views. Conceding the world’s largest microblogging site to these antiscientific voices will only lead to the further spread of disinformation, misinformation, and poorly informed damaging health policy.Staying the course needs a thick skin, but ultimately, science and reason can still shine, even in the most hostile environment.Yes: the case for leaving by Dr Ilan S. SchwartzThere is an understandable temptation to wistfully return to one’s former stomping grounds, where meaningful and productive conversations once took place and relationships flourished, even after new ownership has transformed the joint into something ugly, even unrecognizable. However, I argue that remaining on Twitter/X is counterproductive for the infectious diseases community, which wishes for a social media platform that allows them to cordially engage with one another outside audiences, share science, and increase their visibility within our profession.Since purchasing Twitter and rebranding it ‘X’, Elon Musk has repeatedly implemented changes that have made the platform a more toxic and intolerable place [7,8]. He doctored the algorithm to determine which posts are visible to whom, inundating users with content that is irrelevant or unwelcome, including misinformation, polarizing political content, and bigotry against minoritized groups. He disbanded the workforce responsible for content moderation and safety, while welcoming back accounts exiled for misinformation and hateful conduct [9]. He scrapped a system of authenticating notable accounts, replacing it with a scheme granting any paying user the blue check that previously denoted legitimacy, irrespective of whether they are bots (automated or semiautomated accounts that can be deployed en masse to sway public opinion) or trolls (rage-baiting online provocateurs), or actual people. He disabled a safety feature that allowed users to block harassers from viewing their posts [10]. By monetizing user engagement, he added direct financial incentivization for provoking outrage [11]. The net effects of these changes included the accelerated growth of antiscience misinformation and hostility towards infection professionals (among many others). He embedded into the site a large language model-powered chatbot called Grok to engage with users and train off their data, periodically tinkering with its settings to increase output of extremist propaganda (like answering unrelated queries with talking points about ‘White genocide’) and blatant fascism (like espousing Nazi ideology while dubbing itself ‘MechaHitler‘) [12].These and other changes to Twitter/X led many academics and clinicians to leave the platform in waves that began soon after the takeover. However, some optimistic holdouts, undeterred by Twitter/X’s worsening functionality and toxicity, finally abandoned the site following the cruel and consequential foray of its owner into U.S. and global politics. For many, Musk’s financing of Donald Trump’s Presidential campaign and his use of Twitter/X as a bullhorn, not just for Trump’s return to the White House but also for far-right parties around the world [13], hastened their exits. For others, the final straw was Musk’s cruel and gleeful destruction of the United States Agency for International Development, a government agency that oversaw foreign aid, including programmes to prevent and control infectious diseases in resource-poor settings [14].If all that were not enough, the fact is that science communication on Twitter/X is now ineffectual [15]. Posts with links outside the platform (e.g. to journals or public health websites) are suppressed in the algorithm. Posts from nonpaying users are deamplified and drowned out by boosted, paying accounts. Moreover, the algorithm is biased against apolitical posts, favouring partisan accounts, especially those aligned with the political stance of the site’s owner [16]. Some scientists report that the post-Musk era has been associated with levels of engagement with their posts, which have plummeted by 90% or more [17].Whereas Twitter/X once had a near monopoly as the preferred platform for academics and clinicians, this is no longer the case. Several viable alternatives now exist among social media sites, most notably Bluesky, a decentralized platform created by Twitter’s brain trust, which spun off independently when Musk acquired Twitter. The Bluesky timeline has a look and feel reminiscent of Twitter/X, but with several notable enhancements. First, user safety is prioritized, and abusive accounts can be easily blocked; in fact, users can subscribe to specific curated block lists, which block abusive or spam accounts en masse. Second, users can curate customized timelines, termed ‘feeds’, which can compartmentalize content according to one’s interests. For instance, one can follow an ‘IDSky’ (infectious diseases on Bluesky) feed that shows just posts that include this term, a feed comprised posts from followed accounts sharing academic articles, or – should the need arise – a feed comprised entirely of photos of corgis. Third, the ability to create account ‘starter packs’ of curated user lists can facilitate reconnection with one’s professional or social networks. More than a dozen IDSky starter packs exist [18], each with 150 accounts, to help rebuild connections lost during the mass migration.In addition to Bluesky, many former Twitter/X users have found functionality in LinkedIn, which has matured since its earlier days, where it was primarily the domain of job seekers and recruiters, or in Threads, a microblogging site from Meta (the corporation behind Facebook).The medical and scientific communities have already voted with their feet [19]. A Nature poll of nearly 6000 readers (85% of whom identified as working scientists) found that more than half of respondents were former users of Twitter/X who have abandoned the platform. Seventy percent of respondents reported current use of Bluesky [20].Although contemporaneous comparative analyses of platforms are limited due to shielding of Twitter/X user data since Musk’s takeover, there are reasons to think that Bluesky is significantly outperforming Twitter/X for academic engagement. Bluesky posts discussing research were found to be more original and spurred more robust engagement than had previously been reported for Twitter/X [21]. In fact, despite the relatively diminutive size of its user base (reportedly a tenth the size of Twitter/X), Bluesky already drives more web traffic for many journals [22], and Altmetric (which tracks online discussion of academic articles) reported that as of March 2025, on most days, journal articles were shared more on Bluesky than on Twitter/X [23].Finally, the argument that users should remain on Twitter/X to hold back the incessant tide of extremism and misinformation is naïve and misguided: it fundamentally misunderstands (or ignores) how algorithmic bias stacks the deck against such an approach. The algorithm prioritizes content that garners more engagement, irrespective of the sentiment elicited. By design, posts that are polarizing and inflammatory are boosted over those that are measured and reasoned. There is nothing valiant about remaining on a toxic platform to endure abuse and to shout into the void, all while bad faith actors spew misinformation and hatred with impunity.In summary, there is no longer either reason or justification for infectious disease professionals or organizations to remain on Twitter/X. Doing so is not just clinging to the nostalgia of what the site once was, but it also provides tacit approval for what it has become. While social media can still hold significant value for infection specialists, it is no longer to be found on Twitter/X.ConclusionSocial media is a fact of life in the modern world. The ‘information age’ has undoubtedly brought both benefits and challenges to humanity, and the field of infectious diseases is no different. Given the especially high public awareness of infectious diseases since the onset of the COVID-19 pandemic, and the fractious discourse around vaccine policy globally (but particularly in the United States), social media remains a powerful, yet controversial, and easily abused tool. Core principles of upholding science, evidence, and protecting patient confidentiality must always be upheld.Ultimately, it remains the decision of individuals whether to use social media and, if so, which platform. Despite constant attacks on our legitimacy and expertise, infection clinicians and scientists still have a crucial role in informing the public and stand to benefit professionally and socially from connecting in digital spaces with their peers. For some individuals, there may still be something worth staying for on Twitter/X, while for others, there are bluer skies ahead.Financial reportNo funding was received for the current manuscript.CRediT authorship contribution statementNeil R.H. Stone: Writing – original draft. Ilan S. Schwartz: Writing – original draft.Declaration of competing interestThe authors declare the following financial interests/personal relationships which may be considered as potential competing interests:Neil R.H. Stone reports a relationship with Gilead that includes: speaking and lecture fees and travel reimbursement. Neil R.H. Stone reports a relationship with Pfizer that includes: speaking and lecture fees. Neil R.H. Stone reports a relationship with Hikma Pharmaceuticals PLC Amman that includes: speaking and lecture fees and travel reimbursement. Neil R.H. Stone reports a relationship with Shionogi Inc that includes: speaking and lecture fees. Neil R.H. Stone reports a relationship with Napp Pharmaceuticals Ltd that includes: speaking and lecture fees. If there are other authors, they declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.AcknowledgementsThe views expressed by the authors are their own and do not necessarily reflect those of their institutions, the journal, the European Society for Clinical Microbiology and Infectious Diseases, or Elsevier.

After the Zika outbreak ended in Brazil, many families faced a new reality: a child whose life was irrevocably altered after the mother contracted the virus while pregnant. Here's what happened next.

Host body temperature can define a virus’s replicative profile—influenza A viruses (IAVs) adapted to 40° to 42°C in birds are less temperature sensitive in vitro compared with human isolates adapted t...

Frontline NHS staff are feeling an increasing sense of exclusion and intimidation from the surge of St George’s flags displayed on homes

The Putin-Trump surrender plan will lay the groundwork for Russia to expand its attacks on other parts of Europe

"The best way I can put it is it feels like we're on a hijacked airplane."

US health secretary said he told agency to update website to claim the fact vaccines do not cause autism is not evidence based

Report on handling of pandemic contains stinging criticism of ‘toxic and chaotic’ culture inside Boris Johnson’s No 10