Death and dying online

I am currently completing my new book, entitled Digital Health: Critical Perspectives (to be published by Routledge early next year). One of the chapters focuses on the ways in which human bodies are portrayed in digital media. I wanted to write some paragraphs about digital representations of dying and dead bodies, but not much previous research that I can find has addressed this issue. There is a growing body of literature on how the dead are memorialised on social media, but very little about actual images of the dying and dead online. This is interesting in itself, given that death is such a taboo and often avoided subject.

Here is some material I have found and included in the chapter.

It is now possible for audiences to find images of death and dying at all phases of human life. The Visible Human Project developed by the US National Library of Medicine is one example of how dead human flesh has been rendered into a digital format and placed on the internet for all to view. The Visual Human Project used computer technologies to represent in fine detail the anatomical structure of male and female cadavers. Each body was cross-sectioned transversely from head to toe and images of the sections of their bodies using magnetic resonance imaging, computed tomography and anatomical images were uploaded to a computer website and can also be viewed at the National Museum of Health and Medicine in Washington DC.

Social media platforms host images of dead bodies and first-person accounts of dying. One example that created controversy in the news media was the Instagram account of an American pathologist. She posted hundreds of images of autopsied corpses on her account, claiming it to be a form of public education. Another website, Unidentified Dead Bodies, has been established in India as a public service to assist with the identification of corpses. It features images of the bodies and details about where they were found, asking viewers to contact police or the coroner in charge of the case with any information they may have about the dead people portrayed on the site. A Chicago medical examiner’s office has undertaken a similar exercise, posting photographs of unidentified bodies that have come in for examination on its website. Several other examples of this type of publication of images of corpses can be found online. Indeed, simply typing in ‘unidentified dead bodies’ into a search engine gives ready access to many of these images.

Some people who have confronted a fatal illness have blogged about their experiences, presenting a written portrayal of their last days, sometimes accompanied by images of their failing bodies. There are numerous videos posted on YouTube showing the end of  life stages of mortally ill people, death and after-death scenes posted by friends or family members of the dead. Many memorial blogs and YouTube videos feature parents mourning pregnancy loss and stillborn infants, often featuring images of the dead foetuses or infants (I discuss this in my book The Social Worlds of the Unborn).

These are the kind of accounts and images of the dying and dead human body that until the advent of the internet would have received little or no exposure. While bereaved people in the Victorian era often had photographs taken of dead relatives, especially babies and children (sometimes with the living relatives posing alongside them), these images were kept to the private domain. Some may find these images distasteful, ghoulish or confronting. Yet advocates see their publication as a positive move towards better knowledge of death and dying.


Twitter and health

Surprisingly little research by sociologists or media studies researchers has investigated how Twitter is used to discuss health and medical issues. Yet there are many interesting issues and topics to explore.

The Healthcare Hashtag Project operated by Symplur, a healthcare social media analytics company, provides a publicly available online resource that demonstrates the diversity of health and medical topics that are discussed on Twitter. When I checked the website in early May 2016, the Project had identified close to 13,000 healthcare topics, over 10,000 hashtags related to healthcare and almost 4,000 contributors to these discussions on Twitter. The diseases that were receiving attention on Twitter on that day included breast cancer, migraine, brain tumours, lymphoma, heart disease, diabetes, lung cancer, attention deficit disorder and leukaemia (these were the top ten trending diseases in order).

The site also shows the ‘influencers’ in the Twitter discussions it documents as well as the latest tweets related to the hashtags it collects. This information demonstrates the sheer diversity of actors who engage in discussions about medical conditions and healthcare on Twitter. The top ten (by mentions) ‘influencers’ for the hashtag #BCSM (denoting ‘breast cancer social media’) were a clinical professor in surgery, four individual breast cancer survivors, a medical school and a research institute, two patient coalitions (one for men with breast cancer and one for young women with breast cancer) and the Journal of the American Medical Association.

The story is quite different if the hashtag #digitalhealth is examined. Another market research company has analysed over 200,000 tweets and almost 30,000 engaged users to identify the top influencers and brands in Twitter discussions using #digitalhealth. The company looked at tweets using this hashtag over a period of four months spanning January to April 2016 and produced a list of the top 100 influencers (based on PageRank analytics that takes into account the number and quality of textual references).

The first four influencers listed (who gained much higher influence scores than any of the 96 others on the list), included Hungarian doctor, genomic scientist, digital health consultant and self-described ‘medical futurist’ Bertalan Mesko, followed by American John Nosta, another digital health consultant who runs his own think tank and is a member of the Google Health Advisory Board. A British health technologist, Alex Butler is next and fourth is American Paul Sonnier, another digital health consultant. These influencers are followed by more representatives of private digital health consulting or technology companies, some tech journalists and a representative from massive American pharmaceutical chain Walgreens. Academics are not well represented in the top 20: only three appear, beginning from number 13 on the list. Practising doctors and individual patients, or organisations for doctors or patients, are scarce.

The most common topics discussed by the top influencers were data (by a long way, accounting for a quarter of the tweets), the Internet of Things and wearable tech. The topics of apps, cancer, artificial intelligence, cybersecurity and telemedicine were the next-most discussed (however, they all received less than 10 per cent of discussion across the tweets).

It is evident from this report that digital health discussions on Twitter (at least those that use #digitalhealth to signify their content) are dominated by commercial and entrepreneurial interests rather than by the experiences of doctors or patients. With the exception of Susannah Fox from the US Department of Health and Human Services, spokespeople from government agencies appear to have little influence in these discussions. This is borne out by the list of top-most influential brands, which are again dominated by commercial enterprises (although the NHS England is included towards the bottom of the top 25).

These data raise some interesting questions for a digital health sociologist. How do voices other than commercial enterprises get heard on Twitter? What makes some conditions or diseases more talked about on Twitter than others? For example, why is breast cancer so prominent — is it because there are far more patient advocates and organisations for patients devoting attention to discussing this , or is it because it is a common form of cancer, or are other factors involved? Why do some practising doctors and medical specialists decide to get involved in Twitter discussions on a particular condition or a digital health technology? How do all the different actors engage with each other –- who pays attention to whom? What kinds of networks are formed between actors from the different groups who are advocates or healthcare providers or developers?