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What's up, doc? How 'medical influencers' are muddling health facts online

 Dr. Phil McGraw appears in a conversation with writer Mitch Albom at the 12th Annual L.A. Times Festival of Books at Royce Hall on the U.C.L.A. campus on April 29, 2007 in Los Angeles, California.
Dr. Phil McGraw appears in a conversation with writer Mitch Albom at the 12th Annual L.A. Times Festival of Books at Royce Hall on the U.C.L.A. campus on April 29, 2007 in Los Angeles, California.

In May, Dr. Martin Jugenburg (also known as “Dr. 6ix”), a Toronto-based cosmetic surgeon who has 118,000 Instagram followers and is known for sharing graphic photos and videos of procedures on social media, was ordered by the College of Physicians and Surgeons of Ontario to remove security cameras from his consultation and waiting rooms while awaiting a disciplinary hearing that will also address previous allegations of misconduct. Those allegations include violating advertising regulations, permitting a film crew into a surgical procedure without a patient’s consent and posting photos of the patient online without her consent.

Yet, despite the regulatory body taking action in this case, tracking potential misconduct on social media is an increasingly difficult objective as the sheer number of online “medical influencers” continues to explode. Taking a page out of the playbook for Instagram influencers who promote their own personal brands, d octors and nurses around the world post their own staged photos while clad in hospital scrubs. Dermatologists and plastic surgeons attract followers with seemingly miraculous before-and-afters running alongside everything from pimple-popping videos to gory first-hand looks at breast reduction surgeries and liposuction. Doctors specializing in fields like sleep, nutrition and longevity post their favourite smoothie recipes, thoughts on organic mushrooms and personal exercise routines intermixed with medical advice.

Of course, celebrity doctors are nothing new. Phil McGraw (Dr. Phil), Mehmet Oz (Dr. Oz) and Drew Pinsky (Dr. Drew) are all household names and have been so for a long time. While these personalities haven’t been without controversy over the years, there’s one big difference between them and the new crop of internet-famous doctors. Prior to this decade, entirely self-made fame was nonexistent. To reach the public on a mass scale, you needed to book TV shows, speaking gigs and public appearances; you needed to be written about in newspapers or magazines and maybe even given the opportunity to publish a book. This required the approval and buy-in of journalists, editors, producers, event planners, publishers and likely at least one publicist or agent.

This system vetted aspiring celebrity experts and their messages. It was highly unlikely someone with no verifiable medical background could book a morning show segment to spew anti-vaccination rhetoric. Magazines wouldn’t write about plastic surgery procedures without investigating and sharing the risks. A news producer wasn’t just going to take some detox tea company’s word for it when it came to health claims. But that’s all changed.

“Now you have Instagram, Facebook and YouTube, which are the principal ways social media-savvy doctors promote procedures and also sidestep guidelines about what’s an ethical transaction with the public as a licensed physician,” says Dr. Stephen Mulholland, who has been in the business for over 20 years and owns SpaMedica clinic in Toronto. He’s done over 300 television segments, authored two books and won a Gemini Award for his plastic surgeon role in the live cosmetic surgery series Skin Deep. He’s had a first-hand look at the evolution of how doctors interact with media.

“It’s become a treacherous market for consumers to make informed decisions. It’s risky because grey zones are being blurred and becoming more promotional than educational. Back in the early days of broadcast media, there was a lot more actual medical information.”

It’s a problem that has prompted one social media platform to take action. In a Facebook Newsroom post on Tuesday, product manager Travis Yeh announced that the company has taken steps to “reduce posts with exaggerated or sensational health claims and posts attempting to sell products or services based on health-related claims.” However, it’s going to take more than tinkering with an algorithm to address this issue properly.

Gastroenterologist Dr. Austin Chiang recently became the first “chief medical social media officer” at a major medical centre, Jefferson Health in Philadelphia. Dr. Chiang has 23,000 Instagram followers and aims to recruit more doctors, nurses, therapists, dieticians and other health professionals to battle false medical claims online, which he calls the “biggest crisis” in modern healthcare. In May, he became the founding president of the Association for Healthcare Social Media (AHSM), the first “professional society for health professional use of social media.”

The issues surrounding healthcare and social media are myriad. Certified medical professionals provide advice about fields they have little to no experience in. Many of the doctors and “nursefluencers” with the fastest-growing followings are unsurprisingly tech-savvy millennials, often still in or fresh out of medical school. Mommy bloggers and fitness influencers share paid endorsements of contraction monitors for pregnant women, breast implants, psoriasis medications and a variety of untested supplements and tinctures. Some people outright pretend to be doctors. GOOP consistently posts advice for conditions including thyroid cancer from “medical medium” (yes, as in ghost whisperer) Anthony William.

“You don’t have to do the best work or be the most qualified to be famous these days; you just have to have a great on-camera personality and enjoy promoting yourself,” says Dr. Diane Wong, founder and medical director of Toronto’s Glow Medi Spa, who has regularly appeared on TV and in the media over her 18-year career. “Where are the credentials?”

You don’t have to do the best work or be the most qualified to be famous these days; you just have to have a great on-camera personality and enjoy promoting yourself

“The risks are consumers may not get a balanced representation of benefits, risks and recovery, patient testimonials may be paid for or bought with free procedures and there are confidentiality issues,” says Dr. Mulholland. Confidentiality concerns increased exponentially around 2015 after Dr. Michael Salzhauer (also known as “Dr. Miami”) became hugely famous for his Instagram and Snapchat surgery videos, prompting a slew of imitators.

For Ontario medical professionals, as in many other jurisdictions, there are regulations to govern how health practitioners promote themselves. However, these outdated rules are ill equipped to deal with social media and are often plagued by lax enforcement. For instance, The College of Physicians and Surgeons of Ontario’s advertising regulations haven’t been updated since 1994. And even those 1994 regulations are rarely enforced online.

While the College of Physicians and Surgeons of Ontario released “Appropriate Use of Social Media by Physicians” guidelines in 2013, the document is explicitly not a new policy nor did it establish new expectations for physicians when it comes to social media. According to Shae Greenfield, the College’s senior communications advisor, the guidelines are “intended to help physicians apply existing policy and legislative requirements to the use of social media. That policy advises physicians to exercise caution when posting information online that relates to an actual patient and to avoid posting content that could be viewed as unprofessional.”

When it comes to enforcing existing rules, Greenfield states, “The College works to enforce these regulations, but the recent proliferation of social media has made this work more challenging. In light of these changes, the College is exploring options to better communicate to physicians about their obligations when using social media.”

“We’re not supposed to have before-and-after photos or testimonials, yet they’re everywhere on social media,” says Dr. Wong. There also shouldn’t be specific mentions of drugs, appliances or equipment, and information provided to the public should be factual and verifiable, as well as dignified and in good taste. “The problem is the industry has taken off at a rapid rate, and it’s a huge task for the college to undertake. Without any regulations being enforced, it’s gotten to be potentially dangerous.”

The biggest breaches tend to occur in the wellness and cosmetic fields. These mostly consist of elective procedures and consumer products, and their highly visual nature positions them for success on social media. They also predominantly target women, who’ve historically had trouble accessing proper medical care and having their health concerns taken seriously.

Enter the likes of Dr. Jen Gunter, an OB/GYN and a pain medicine physician also commonly referred to as “Twitter’s resident gynecologist” with 182,000 followers. She aims to create a better medical internet and combat rampant untruths about the female reproductive tract. She’s railed against Gwyneth Paltrow, natural birth control plants, coffee enemas and putting garlic in your vagina. Her new show “Jensplaining,” which takes down exploitative beauty and health myths, will air in August on CBC.

It’s worth noting that Dr. Gunter’s highest follower count is on Twitter, perhaps because there’s more focus on text and information over images than other social media platforms. Some of today’s most educational celebrity doctors, like Dr. Matthew Walker, a professor of neuroscience at UC Berkeley and sleep scientist at Google, and Dr. David Gorski, a surgical oncologist at the Barbara Ann Karmanos Cancer Institute, don’t even have Instagram accounts. Doctors who prioritize information distribution and education over self-promotion are also starting to become darlings of the podcast world, where they can speak at length about science and medical research.

While there are certainly ethical doctors online, it can be difficult to decipher who is informed and who is merely seeking attention. If we’ve learned anything over the last few years of headlines, it’s that social media can’t be left unchecked. “I’m not sure someone’s going to die because of social media, but it leads patients into unregulated environments,” says Dr. Mulholland. “They may go in for what seems like a (harmless) injection around the eye, and end up going blind permanently.”

Copyright Postmedia Network Inc., 2019

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