Twitter was also found to be influential when it came to more traditional means of measuring an article’s reach — mention of the study in other scholarly citations. The research that was published in The Annals of Thoracic Surgery looked at the Altmetric scores of 112 articles and saw that papers that were promoted on Twitter had significantly higher scores than articles in a control group.2

In addition, a year later after being shared on Twitter, those papers also had been cited more often, the authors concluded.

Study coauthor Mara Antonoff, MD, (@maraantonoff), assistant professor of thoracic and cardiovascular surgery at the University of Texas MD Anderson Cancer Center in Houston, said she was curious about the link between frequent tweeting and subsequent citations. “You don’t know if the tweeting led to these citations or whether there was something inherently great about the paper that caused it to have lots of citations,” she said.

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During the randomization process (in which half of the articles were tweeted and the other half weren’t), the studies were sorted by similar topics and data presentations. “They were randomly assigned. It wasn’t like we picked the best ones to tweet about,” said Dr Antonoff. She also said the articles were tweeted by a rotating member of the Thoracic Surgery Social Media Network and then retweeted by all 10 study coauthors without added commentary to minimize their personal influence. “We purposefully didn’t include comments because we didn’t want to draw attention to the articles based on endorsement,” she said.

Since the article’s publication, the researchers’ methodology has come into question. Phil Davis (@ScholarlyChickn), a publishing consultant who runs the website called The Scholarly Kitchen, attempted to replicate their data set, and concluded that there was no clear link between tweeting and increased citations. Last month, the authors of the original research published a response saying they stood by their study’s data.3

So how do you measure the Twitter effect? Narjust Duma, MD (@NarjustDumaMD), assistant professor in hematology and oncology at University of Wisconsin Carbone Cancer Center in Madison (who is using Twitter to recruit people for a survey in sexual dysfunction), said she’d like to see longer follow-up to see if the association endured over time. “A paper could get a temporary bump by Twitter, but citations would only increase if a paper is good,” said Dr Duma. In her own work, she uses peers’ tweets to flag interesting research, bookmarks it, and then evaluates it critically later.

Despite the fact that Twitter can sometimes feel overwhelming, Dr Duma suggested that over time, users have become more discerning about what they read. This is especially the case following ASCO’s clampdown a few years ago on pharmaceutical companies blasting product endorsements on Twitter. “When you had PR teams on there, people couldn’t keep up. I promote my colleagues’ work on Twitter because we need to promote each other, but it’s more organic now,” she said.

Despite the potential for Twitter to broadcast some voices more loudly than others, Deanna Attai, MD (@DrAttai), assistant clinical professor in the department of surgery at UCLA Health at the David Geffen School of Medicine, Burbank, California, said she’s seen the social media force evolve in a positive direction — with more transparent and open dialogue — over the last decade. “Twitter is an open forum where anything goes, but at least in the breast cancer community, it regulates itself,” she said. “Of course, there’s a selection bias. I follow only those I want to listen to. But at least in my bubble, I’ve found people are there to do their best and help share good information, and point out potential flaws in a study, and ask how we can get to the next step and build off the next study.”

Disclosures: Dr Duma disclosed she serves in an advisory role for Inivata and AstraZeneca. Dr Warner disclosed he has a consulting arrangement with Westat and with IBM Watson Health, and he is a cofounder of (uncompensated) and has stock in LLC (no monetary value).


  1. Kuderer NM, Choueiri TK, Shah DP, et al. Clinical impact of COVID-19 on patients with cancer (CCC19): a cohort study. Lancet. 2020;395(10241);1907-1918. doi:10.1016/S0140-6736(20)31187-9
  2. Luc JG, Archer MA, Arora RC, et al. Does tweeting improve citations? One-year results from the TSSMN prospective randomized trial. Ann Thor Surg. Published online June 3, 2020. 2020;S0003-4975(20)30860-2. doi:10.1016/j.athoracsur.2020.04.065[SR6] 
  3. Luc JG, Varghese TK, Antonoff MB, et al. We stand by our data—A call for professional scholarly discourse. Ann Thor Surg. Published online July 20, 2020. 2020;S0003-4975(20)31182-6. doi:10.1016/j.athoracsur.2020.07.007