“And so, of course, I have completely stopped eating red meat.”
The “of course” is galling, especially since we have been using precious bags of blood to top up my patient’s haemoglobin.
“Why have you stopped eating red meat?’
‘Because it dilutes my chemo.”
“How?”
“I saw it on Insta.”
My malnourished, anaemic patient can ill afford to ditch important nutrients or lose weight. Our worried nurse has exhorted me to “please educate” and I am trying.
“You are right to avoid excessive red meat but, say, once-a-week intake would boost your haemoglobin.”
“Hmm …”
The next patient has forsaken all dairy and the one after that wonders why his sugars are uncontrolled on a “hand-squeezed juice only” regimen.
Quirky diets are concerning enough but life-threatening issues can arise when patients heed influencers over qualified professionals. A case in point is the “ivermectin cures cancer” patient whom every oncologist is coming across.
When I entered medicine, the term “wellness influencer” did not exist. If it did, I would have innocently considered myself one. After all, I was committing 15 years to learning how to keep patients well. And what did a good doctor do if not influence her patients towards a healthy outcome?
But as a recent study shows, today’s most influential wellness influencers are certainly not doctors or nurses with legitimate qualifications.
Previously, wellness advice came from Facebook. My cancer patients would ask: “My Facebook group is eating apricot kernels. Can I try it?”
I’d say: “It could kill you.”
Some listened, others didn’t but there was a degree of trust.
Today’s patients are watching Instagram and TikTok reels while their doctor keeps them waiting.
And who is talking to them about their health? According to a large study, few conventional doctors, dentists and nurses (17%). Even fewer mental health professionals (4%) and qualified dietitians (6%), which is notable given the ubiquity of mental health and diet advice on social media.
Today’s wellness influencers are life coaches promising transformation (31%), business owners hawking a product (28%) and a motley crew of chiropractors, authors, activists and “functional” health practitioners (a new one for my lexicon). Indeed, 16% don’t even bother to offer credentials, trumpeting instead their “lived experience” of parenting (“ADHD mom”) or illness (“Cancer Warrior”).
Why does this matter?
Because of the nearly 7,000 influencers in the study, all had more than 100,000 followers and nearly one in 10 had more than a million followers. These are numbers that doctors might only dream of influencing.
Given the number of times my mum asks me about outlandish health claims she finds on social media, I know that conventional medicine increasingly has sceptics.
Trust in doctors has not recovered after the pandemic. Many people balk at medical bills. A few doctors do untold damage to the broader profession by violating the sanctity of the doctor-patient relationship. And of course, doctors make tragic errors. But I would argue that they are governed by expectations and regulations from inside and outside the profession. The law eventually catches up to doctors behaving badly.
And it’s one thing for an influencer to teach how to apply eyeliner, do a proper push-up or prepare a healthy lunch but quite another to trust an unlicensed, unqualified person on matters of giving birth, treating depression, curbing addiction and curing cancer.
Who is listening to the influencers?
A lot of us. Half of US adults under age 50 get their health information from wellness influencers.
Two-thirds of Australian teenagers get theirs from social media. Concerningly, neither kid nor parent knows how to distinguish fact from fiction.
Noting that nearly every citizen consumes health-related media, China has banned unqualified influencers from offering health advice.
The generation of youth with the worst mental health is the one most influenced by influencers.
I worry that the people with one good chance at controlling their cancer are the ones tempted by influencers peddling alternative schemes.
Thanks to rampant misinformation, vaccine refusal is on the rise.
Doctors don’t quite know what to do about wellness influencers. I suspect there is a hint of smugness that patients will figure out what’s best for them and round back to the professionals. But given the rise and rise of influencers, we dismiss them at our peril.
Instead, we need to meet the challenge and own our part.
As in any relationship, so in the doctor-patient relationship – taking the time to understand another perspective helps. We should also support the work of professionally credible influencers. Institutions cannot remain silent in this space – they must tailor information to educate people about the hazards of influencers as advisers. Let’s start with posters in different languages in waiting rooms.
To be an oncologist is to see the worst of harm caused by wellness influencers but I never changed a patient’s mind with outrage. Where I have had limited success is by dispassionately explaining the evidence, humbly acknowledging the (many) things medicine doesn’t know or do well and gently offering to leave the door open.
This may be the best way I know of being a wellness influencer.
