A few weeks ago, I was in Halifax, Nova Scotia, Canada, at the Developmental Pediatrics Clinic of the Izaak Walton Killam (IWK) Health Centre. I was here for a very special reason: to meet with a few people who, nearly 13 years ago, authored an essay that would later become the most popular scholarly paper to ever hit the Internet*.
This paper, written by pediatricians Sarah Shea, Kevin Gordon, Ann Hawkins, Janet Kawchuk, and Donna Smith (a pediatric nurse), was entitled “Pathology in the Hundred Acre Wood: a neurodevelopmental perspective on A.A. Milne” and published in the “Research of the Holiday Kind” section of the Canadian Medical Association Journal (CMAJ, 12 December 2000). Written in humorous yet technically precise prose, the paper provided a tongue-in-cheek look through a medical lens at the familiar, well-loved characters from A. A. Milne’s Winnie the Pooh stories. By delivering psychiatric diagnoses of Pooh (attention deficit hyperactivity disorder and more), Piglet (generalised anxiety disorder), Owl (reading disorder), Rabbit (narcissistic personality disorder), and other characters, Shea et al. inadvertently sparked a massive surge of attention that would persist for more than a decade.
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Due to its enduring appeal, Shea et al.’s paper was a natural choice for the topic of my first Interactions blog post. Interestingly, the Shea et al. paper has always remained at the top of the attention rankings, even though Altmetric only began collecting data from mid-2011 onwards. (The paper now has a massive Altmetric score of over 11,000, which greatly exceeds the scores of all other papers in our database.) The Altmetric score is actually only a lower bound estimate of the true amount of attention that the paper has received.
A conversation with Drs. Sarah Shea and Janet Kawchuk
Having graduated from the Faculty of Medicine at Dalhousie University (which is situated right across the street from the IWK Health Centre), I realised that that I might have mutual acquaintances with the authors of the Shea et al. paper. I contacted my former supervisor, who put me in touch with Dr. Sarah Shea (the first author of the paper) via e-mail. I reached out to Dr. Shea with attention data: specifically, with the Altmetric details page of her article. She was interested, and kindly agreed to meet with me.
I met Drs. Sarah Shea and Janet Kawchuk (first and fourth authors of the paper, respectively) to talk about their paper’s fascinating story. The ideas for the article first came into existence before a serious research meeting, during a casual chat between a group of pediatricians. Dr. Shea described it simply as “idle foolishness” from a relaxed conversation with colleagues. CMAJ had put out a call for papers for their “Research of a Holiday Kind” section, so on one Sunday afternoon, Dr. Shea began to write up the ideas. As Dr. Kawchuk put it, “Sarah did the initial writing, and everyone else shared ideas.”
Some of the inspiration for the paper’s distinctive style came as a spoof on medical histories. The rest came from admiration for A. A. Milne’s stories. “We love Winnie the Pooh,” explained Dr. Shea, “so it was done with love.”
When asked what the responses to the paper were like, Dr. Shea said that the reactions were “completely unexpected and frighteningly massive”. She continued: “We were saying, you’d think we’d cured cancer or something. It’s partly a reflection on how much people do love Winnie the Pooh.” Dr. Kawchuk described the response as “mind-boggling”. The IWK Health Centre was inundated with calls from the media, both from the Canadian and international press, and things got to the point that the hospital’s public relations experts had to step in. (The overwhelming public reaction was discussed in a 2001 editorial in CMAJ.) In the days following the paper’s publication, the media attention was so fierce that Dr. Shea was even stalked by TV reporters, who searched for her name on the Internet and then waited by her house to interview her. (Note: Because the news mentions occurred prior to 2011, Altmetric doesn’t display an accurate listing of news coverage for this paper. Some of the news outlets that covered or mentioned the paper included BBC, New York Times, The Guardian, and Slate.)
What about the reactions from other clinicians? Drs. Shea and Kawchuk both agreed that people read their paper with varying perspectives. “Some people got caught up in the hype and formed opinions based on the coverage,” said Dr. Kawchuk. The majority of readers got the joke and enjoyed the paper, and many people voiced their approval (and sometimes criticism) in responses to the CMAJ. Not everyone saw the humour in the paper, though; some people even complained that research funds had been wasted, even though no research funds had actually been used. When I asked Drs. Shea and Kawchuk about what their thoughts were on the negative reactions, Dr. Shea grinned and said that she’d kept all the cranky letters. She and her colleagues certainly didn’t let the negative comments affect them – in 2001, they published a brilliant reply to the various letters that had been sent to the CMAJ. As Dr. Shea put it, “The response was probably the most fun to write.”
The attention paid to the paper went way beyond the news coverage and the readers of the CMAJ. The paper was nominated for an IgNobel Prize in 2001 (although it didn’t win), and was also the subject of a question on the popular American quiz show, Jeopardy! (This question appeared in the General Ed. category for $800: “Canadian doctors say this Winnie the Pooh character suffered chronic depression & was unable to enjoy life” – Show #4647, aired on 16 November 2004.)
Although their paper wasn’t academic in the strictest sense, Dr. Shea believes that it has been used in serious ways, particularly for educational purposes. She described initiatives from the IWK Health Centre on de-stigmatising mental illness, pointing out that their paper has been referenced in these efforts. Additionally, some psychology textbooks have cited the paper. Interestingly, Dr. Shea said that their unusual way of looking at Winnie the Pooh characters has actually been helpful for the kids in the pediatrics clinic, who would prefer “to be compared to something beloved.”
“If someone is bouncing,” she said, “he’s a Tigger.”
On scholarly social media and altmetrics
Prior to hearing about the massive attention that their paper had received on social media, neither Dr. Shea nor Dr. Kawchuk had heard about altmetrics or realised how often people were using social media in a scholarly capacity. Both doctors agreed that patients search for health-related information online, but Dr. Shea also made the point that it is difficult to recognise the things that influence people’s beliefs and knowledge about health. She said that part of the physician’s job nowadays is to direct patients to better web resources, and that altmetrics could help in this respect. She sums it up like this: “It’s making the point that there are better ways to reach people than the traditional published article.”
I would like to thank Drs. Shea and Kawchuk for this wonderful conversation, and for taking the time out of their busy days to speak with me.
* Popular how, you ask? Specifically, it’s the most publicly shared article on the Internet, based on the data we’ve been collecting since mid-2011 (to the date of publication, 8 August 2013).