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Health Communities and The Dreaded Echo Chamber

When I say "echo", you say "echo."

Last night, I participated in the Twitter X-treme Sport known as the Sunday night #HCSM chat. The topics were relevant to our community especially. Topic 2, for example, was: “What makes a health care web site credible? How can you tell? Does credibility matter anymore?” and a great conversation happened in the blink of an eye.

RAwarrior Kelly said: “[I] wish people realized the “poor” info is more likely on a health megasite than an e-patient authored site.”

To which Kerri added: “Mega-sites” repurpose NIH stuff. Patient bloggers tell it like it effing IS.”

As a handful of other Tweeters chimed in on the credibility of patient bloggers, Tweeter hrana to replied: “I think patient bloggers are great. I must say that I worry about echo chambers.

Hrana had a valid point – what about those potential echo chambers? What exactly are they and why is everyone so worried about inadvertently creating one?

Like Scott asked us last night: “Tell me more. Not sure I understand [what] “echo chambers” [are]?”

I replied, “[An] echo chamber is like someone says “xyz” and everyone goes “…yeah! xyz! yeah!” & just follows the leader.”

(Then Kerri promptly decided to retweet that tweet for the sake of humor.)

Surely I owe Scott a better definition (one not rushed by the pressures of real-time). Read on to get the definition of “echo chamber” – what I consider the Pros and Cons of having them – and my Echo Chamber Prevention Techniques.

___According to Wikipedia, an echo chamber is “any situation in which information, ideas or beliefs are amplified or reinforced by transmission inside an “enclosed” space.” I think the key part is “enclosed space” – like someone’s discussion, blog post, or Youtube video. Wikipedia goes on to explain how echo chambers form: “One purveyor of information will make a claim, which many like-minded people then repeat, overhear, and repeat again (often in an exaggerated or otherwise distorted form).” I agree with this definition – except for maybe the “like-minded” claim. (But more on that in a minute.) Wikipedia’s extrapolation of the downside to echo chambers is that the initial claim is repeated or reposted,until most people assume that some extreme variation of the story is true.” That, I think, is where Hrana’s fear came from. If a patient blogger writes about an experience, people may read it, believe the most extreme is true.

___Isn’t this the biggest fear that doctors and health care professionals have about online health information? This chain of events is also what leads a patient to mis-self-diagnose, isn’t it? Someone notices a small rash, heads to an online symptom-checker, latches onto the most extreme idea available (or most prevalent idea) and goes from there. At its worst – an echo chamber causes someone intense fear and encourages them to potentially hurt themselves with online remedies. But I think that’s extremely rare. It’s why we all have clear disclaimers, after all.

___Most often, online echo chambers are basically a game of Telephone gone wrong. Somewhere along the way, someone says something that’s a bit off and, depending on the players – the message may continue to unravel and stray from its original form. But that’s a risk we all take every day with communication. Especially written communication – where you can’t easily convey tone and intent. But just as not every game of Telephone goes off the rails – not every online conversation does either.

___Last night I tweeted, “Echo chambers definitely do happen but less often than their influential alternative” and “Not sure bad info spreads since patient blogs/communities are all experience-based & therefore true.” And I stand by that.

___When reading the awesome health blogs that our community members write – do some common themes emerge? Of course. But this is exactly why so many Health Activists took to the internet in the first place! So many folks have said, “Once I went online I realized – I’m not alone. Others are going through the same thing I am.” That’s exactly where online health communities start – and what keeps them strong at the core. Without that common ground, that initial echo chamber – we wouldn’t have anything to go off of. Don’t fear all echoes – just think of bats and underwater animals, who use echolocation to find what they need.

___But back to the risks with echo chambers. The biggest problem, I think, is that the loudest voice may get the most attention – whether that voice is right or not. We see this happen with political extremists – and we all know where the volatile combination of vulnerable masses and a really charismatic leader can end up. For a less upsetting example, think back to the movie Mean Girls. Remember when popular Queen Bee Regina said or did something that was instantly repeated regardless of how ridiculous or wrong it was? That’s an echo chamber. High school is rife with them. Whether it’s the smartest kid in class, the prettiest one, the loudest one, or simply the one who raises their hand the first – others are more likely to follow along. And worse – shy people or new people are more likely to take the echo-way-out of just nodding. Their complacency, then, backs the impact of that initial leader.

___So where does this come into play in our health communities? Echo chambers have a place. Think of democracy – without a round of “yea”s – we wouldn’t get things done. Support is necessary for enacting change and for running an effective health community. But you don’t want an echo chamber on every blog post or discussions won’t transpire.

To prevent echo chambers…


  • Create an open environment. Do this by asking questions. Make sure you make some of the questions “softballs.”
  • Be a good host. Welcome new members. Reply to comments. This will encourage others to share from the get-go.
  • Moderate. Make sure trolls don’t pop up and derail your conversation. Trolls have their own version of an echo chamber and you don’t want them to drag your post down under a bridge somewhere.
  • Don’t ask yes or no questions – those are perfect echo-chamber-fodder.
  • Be open to dissenting opinions but make sure they don’t turn the discussion into an echo of negativity. Time your grand entrance as best you can to show that you allow other opinions and encourage debate but want more than just a Debbie Downer cocktail party.
  • Read your peers! Read other blogs, other communities, and watch other videos. The more you know “what’s out there” the less likely you’ll be to inadvertently create an echo chamber post of your own.
  • Be creative! Use your thesaurus. Use your personal experiences. Use something that will set your writing voice and your community apart from the pack.
  • Respect those who came before. If you come across someone else’s post that says something you wish you’d said – don’t get blog envy. Why not reblog, retweet, re-share and add a quick comment of your own instead? It will make the person feel good (promotion!) and stop you from simply restating their thoughts. Befriending your blog heroes is a great way to open the door to collaboration.

Those are just a few Echo Chamber Prevention Techniques that I came up with. What would you add to the list? What are the pros and cons of echo chambers?


  • Great suggestions!

    I haven’t had this happen so much in health-related online conversations as I have with political conversations, especially on Facebook. I’m sure it doesn’t help matters sometimes that most of my FB friends are as liberal leaning as I am, sometimes even more so. But I’ve got the handful of right-wingers, some of whom I’m related to ;-), and sometimes the conversations just go spiraling off into these weird tangents or tirades that are beyond unhelpful and unenlightening. And sometimes I’m convinced that folks on both sides of the spectrum have been drinking contaminated Kool-Aid.

  • Thanks Amanda!

    Makes perfect sense to me now, and I too can see it from both a beneficial and a detrimental perspective. I like that you included tips for prevention.

  • Amanda

    @ SickMomma: Thanks for your comment! I can definitely relate to your point about the politically-charged discussions with family or old “friends” on Facebook. Troll-city. Almost anything you post on FB can get derailed in an instant (especially with the new Facebook “enter” comment feature). Rarely a well-thought-out debate happens – usually just emotionally-charged mayhem (reminds me of my high school history class where I’d sort of sit in the middle of the left and right and doodle in my notebook 🙂 ) Sometimes the ignorant statuses or particularly offensive ones make ME want to troll – but it’s rarely a good idea to try fight that battle.

    What’s interesting is how rarely I see these political debates in the health blog community. Maybe I’m missing them? But, to me, it seems people are generally really open-minded and neutral (though many do have very strong beliefs about religion and politics personally) they don’t write/talk about it very often – I think it’s pretty admirable that the respect/compassion is there despite the urge to “go there.” Do you agree?

    The balance between being yourself through and through (it is *your* blog after all and readers are reading for you and your individual voice) and keeping the itchy politics/religion discussions out of it is a tough one. These are some topics we’ll hopefully get to in April…

    @Scott – Thanks for inspiring this post with your tweet! Tweetspiration By Scott. Can you pop in and do that more often, please? I can always use more organic “a-ha I will write about *this*” moments! 🙂

  • Amanda,
    This is a great topic – I “found” it at a great time. I too struggle with keeping topics neutral especially on Facebook. Last night I posted that I have admiration for a popular but controversial famous person and gave reasons for my support. Oh my goodness…. there were so many who felt the same way but one person who was so set in their ideas that she wouldn’t even look at the back up information, video interview, or my different perspective. I welcome different perspectives, in fact I crave them but when the person I’m debating won’t step outside their thinking to even take a peek at my view – it’s extremely frustrating. Your “echo chamber” discussion will now be in the forefront of my mind as I learn my way through this online social media world. I always say “don’t go into the weeds” – guess I should take my own advice!

    Jenna
    The Feeding Edge – Ankylosing Spondylitis awareness with an artistic twist!

  • The fact is that there is a dearth of topics in the health arena. We often don’t get the right comments and questions to think about. Even social network sites seem to be one dimensional. This is very good article and quite informative to say the least. Health awareness is so essential. Something needs to be done man.

    • Scott

      Pretty much true!

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