And you thought Mastadons were extinct…


Until last week, for me, “mastodon” only meant the giant animal that went extinct several thousand years ago (I was, it appears, unaware of the heavy metal band Mastodon). Now, as the result of Elon Musk’s purchase of Twitter, many Twitter users are being forced to take a look at alternatives, such as the social networking site Mastodon.

It’s possible that we are about the witness the Myspace-ization of Twitter, brought down by competition, bad management, and bad product decisions. In my usual “there must be a pony in here somewhere” fashion, there may be some lessons in the Twitter saga that healthcare might want to pay attention to.

As most know by now, Mr. Musk has been a Twitter power user for many years, and a frequent critic. In March of this year he started discussions about purchasing it. In short order, he threw out a bold bid, was rejected then accepted by Twitter’s board, tried to get out of the deal, was sued by Twitter, and closed the deal late last month. 

Then things got really rocky.   

Mr. Musk tried to reassure squeamish advertisers, only to make them and others even more nervous when he retweeted some disinformation. After a spike in hate speech on the site, he promised that, as much as he was buying Twitter out of his love for free speech, Twitter “cannot become a free-for-all hellscape, where anything can be said with no consequences!” Then he shocked observers (and Twitter employees) by suddenly laying off half the workforce, including much of the content moderation staff. Some are now being asked back, being told they were laid off “by mistake.”   

He then floated a balloon about charging $20 a month for Twitter’s blue verification, had a tweet argument with Stephen King about it, then went forward with a $7.99 plan, only to be punked by users illustrating the flaws. At this writing, the plan now appears to be on hold, at least until Tuesday’s mid-term elections. 

Advertisers appear to be fleeing, or at least curtailing spending.

As The Wall Street Journal put it: “In Elon Musk’s first week at Twitter Inc., he flouted much of the advice management gurus have dished out for decades.” It’s no wonder many Twitter users are looking at Mastodon.

Mastodon has been around since 2016, but only recently has seen large increases in users, now up to a million users (versus, it must be noted, Twitter’s 230+ million users).  It was founded by Eugen Rochko, who may be the only actual employee. He says: “The solution isn’t a copy of Twitter without Elon Musk. The solution is a different paradigm of social media.”

The Mastodon paradigm is “decentralized, open source, not for sale, and interoperable.” It is a collection of “servers” (there are reportedly some 3,000), each run by a different person or organization, with its own moderation policies and focus (e.g., geographic, topic). Instead of investors, it relies on donations, grants, crowdfunding, sponsorships, and volunteers. 

Users must pick a server to join, some of which (like Mastodon social, the largest) are currently closed or require an invitation. Users can, however, follow users on other servers, although they cannot get as much information about them as ones on the same server.

If it seems like Twitter but more complicated, well, that’s because it is.

It’s not as though Twitter didn’t need change. It has long had content moderation issues, especially with attacks on women and people of color. But thar’s par for social media; just look at Facebook. Equally problematic is that it simply has never been consistently profitable. Layoffs may have been inevitable, as even co-founder and former CEO Jack Dorsey now admits that he may have grown the workforce too rapidly.

Mr. Musk has faced challenges with, and criticism for his actions at, his other companies – Tesla, Space X, Starlink – and yet managed to make each successful, so he may know what he’s doing with Twitter. Or he may have finally bitten off more than he can chew. 

Of course, not everyone who leaves Twitter is likely to go to Mastodon. They may opt out of social media, or make more use of established platforms like Facebook, LinkedIn, or Reddit. Depending on their political views, they might try Truth Social or Tribel. 

Or they wait for Jack Dorsey’s new venture, BlueSky, which purports to be a “decentralized social network” that will foster a “social internet” without data silos. Some 30,000 people joined its waitlist in the week after Mr. Musk took over Twitter. The team emphasizes that corporations should not own your online identity, and that users must have control over the algorithms that decide what they see. 

In research done by Casey Fiesler, an information researcher at the University of Colorado, one participant described online migrations as “watching a shopping mall go slowly out of business.” i.e., there start to be fewer stores or stores of lower quality, so fewer people go, and it becomes a vicious cycle. Twitter may become that dying mall in your community. Or Myspace (which, to my surprise, still exists).


When I think about the lessons of twitter for healthcare, the first thing that came to mind was what happens when Judy Faulkner gives up control of Epic? She’s 79, she’s controlled Epic since its inception, and one has to suspect that her successor will make changes – ones that could threaten (or expand) its dominance.

Or what would happen if Cerner, the #2 EHR, was bought by another opinionated billionaire with big ideas for changing it – oh, wait, Larry Ellison already did that, and he’s not making little plans.

And I think about how something like 3D printing will revolutionize pharma and the medical device industry. What about when synthetic biology changes our whole model of healthcare, knowing how to “program biology? We’re going to see whole healthcare industries collapse.

When I think about Mastodon and BlueSky in particular, I also wonder when/where healthcare’s open source, decentralized solutions will come – and come they will. Maybe they’ll be DAOs, or maybe a Linux or Wikipedia for healthcare. The solutions won’t necessarily look like what we’re used to.

So the moral of Elon Musk and Twitter for healthcare is: you may think you are essential to your users.  You may think you can treat them however you want. But you’re wrong. All you are doing is giving people more reason to leave when they have a choice.      

Mastodons aren’t the only thing that can go extinct.

Kim is a former emarketing exec at a major Blues plan, editor of the late & lamented, and now regular THCB contributor.

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