Finding a social media home after Twitter

Personally, I find Bluesky a helpful place to be – but is it the best social media option for medics and researchers?

Dr Muiris Houston

How are you finding social media recently? A lot of people say it’s not what it once was, with higher levels of aggression now par for the course.

I never got into Facebook, but I took a shine to Twitter. It was a pithy way to communicate as well as a place to source reliable scientific and medical information. But then, in 2022, billionaire Elon Musk took over, changed its name to X, and altered its modus operandi. Instead of posts appearing chronologically, they were run using an algorithm to show the most popular posts.

X has less moderation than Twitter, so there is more disinformation evident on the site. Salomé Saqué, a French journalist, told The Guardian the changes to X now amplify “those who weaponise the platform for hate, propaganda, and manipulation”. She said that the decline in diverse opinions on X “feels like a defeat for critical thinking, checked information, and the democratic exchange of ideas”.

For medics and scientists, X is less likely to offer different reasonable opinions on issues such as vaccines and more likely to attract rabidly aggressive anti-science views. This level of personal aggression has left many former ‘Twitterati’ very uncomfortable.

So what’s the alternative? Threads is a short text message-based platform like X. It has an expanding user base thanks to it being a spin-off of Instagram (Instagram users can create a Threads profile using the same account). But it can be difficult to find relevant content on the platform as it uses an algorithm to display posts. And as it attempts to keep discourse more civil, users complain that the moderation appears to suppress health and science content.

Mastodon – a service that works similarly to X – has its advocates, but many users say that it is difficult to use and to find relevant people to follow.

Of all the alternatives the most promising is Bluesky. This is a social network that tries to recreate the original Twitter before Musk took over. It works, looks, and feels like Twitter used to be, with posts published to a timeline and displayed chronologically. Users can follow other users – and topics – that align with their interests. Bluesky has emerged as a likely successor to X as a meeting ground for science and health experts, finding a scale of commenting and engagement that has been missing on other alternatives like Mastodon and Threads. 

Bluesky was conceived by former Twitter CEO Jack Dorsey and launched in February 2023. The number of accounts on Bluesky has surpassed 27 million, including the owners of many of X’s top-followed accounts posting on science, medicine, and health policy. In contrast, however, X has hundreds of millions of users, though estimates vary depending on the source.

Each post on Bluesky has a character limit of 300 compared to 280 characters on X. Pictures, videos, gifs, and links can be included, and hashtags can be used to mark topics. Users can also set up and follow “topic groups”, which are similar to “lists” or hashtags that could be followed on X/Twitter. #MedSky has been set up by users as one such group for those involved in medicine.

According to a recent British Medical Journal (BMJ) analysis, Bluesky works in a “decentralised” way. Instead of being housed on a single server owned and managed by one company, profiles are spread across a network of interconnected servers. This decentralised structure enables users to move between servers without losing their accounts or followers, and it also allows individuals to set up their own Bluesky servers if they wish. Proponents view this model as more “democratic” and suggest that it minimises the potential for censorship or control by a central authority – an issue that has been widely criticised in relation to Musk and X.

Bluesky also claims to have a stronger, more customisable content moderation policy. “Bluesky’s moderation service combines around-the-clock coverage by our team to resolve user reports according to our community guidelines with several automated moderation systems,” according to the analysis.

Is Bluesky a good communication option for doctors? A November 2024 analysis by Danish science communicators identified over 40,000 “influential scientists” on the platform – defined as those followed by at least 30 other scientists within the same network.

Personally, I find Bluesky (@maurizioblanco.bsky.social) a helpful place to be. A key entry point for new users is the availability of starter packs. These are lists of users on Bluesky compiled to assist people starting out on the platform to find others interested in a particular subject.

The BMJ has collated a starter pack of accounts in the medical and health space, including specialised starter packs, which can be found on its Bluesky page.