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‘It’s sort of the Wild West’: How Instagram influencers are disrupting healthcare

More and more social media influencers are being tapped to spread the word about public health campaigns, pharmaceuticals, even medical devices. It’s a booming but complicated business.

‘It’s sort of the Wild West’: How Instagram influencers are disrupting healthcare
[Photos: spukkato/iStock; MUSTAFFA KAMAL IKLIL/iStock]

Earlier this year, Ashley Haby spotted a gig that piqued her interest: Walgreens was asking social media influencers to apply for a new digital campaign that advertised their flu shots.

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Haby, who runs the Southern Suds and Simple Living account (self-described “Jesus lover, wifey, blogger, and mompreneur”), signed up. Although she rarely posts about health⁠—and herself eschewed the shot for several years⁠—Haby changed her mind when her great-grandmother grew increasingly sick. Suddenly, she had to get a shot in order to be around a loved one.

“We had always gone to my kid’s pediatrician to get the shot,” she recalls, “and there’s nothing against that, but the wait is horrendous. It’s anywhere from two to three hours⁠—just for a flu shot.”

Those are the exact anecdotes and authentic personal stories that Walgreens was looking for⁠—and Haby was quickly approved, with compensation reportedly ranging from $200 to $400 for one post. (Due to confidentiality agreements, influencers cannot report their exact payment.) Weeks later, Haby fulfilled her end of the bargain: She and her husband posed in a Walgreens pharmacy aisle, flexing muscles that boasted bright orange Band-Aids and flashing satisfied customer smiles.

“Head to your local Walgreens for all of your flu shot needs and be in and out in minutes!” read the photo caption. “Now really who wore it better??”

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#Ad Who wore it better? The @walgreens bandaid that is ???? As we enter the flu season hubby and I are making sure we keep ourselves protected as flu-fighters so we can love on all of the babies + elderly in our family this holiday season. Head to your local Walgreens for all of your flu shot needs and be in and out in minutes! Now really who wore it better?? ???????? • • #hubbyandwifey #goals #marriage #flu #holidayseason #autumn #fallfashion #marriagegoals #love #coldweather #mamablogger #mamabear #mompreneur #blessed #matchymatchy #dateyourspouse #travel #texas #styles #longhairdontcare #holiday #bekind #beyourself #homedecor #homeinspiration #lifestyle #fluawareness #healthcare

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The CDC recommends the flu shot for everyone six months and older, though such advice doesn’t interest certain parenting groups. The hashtags that Walgreens suggested influencers such as Haby include in their posts, such as #walgreensflufighter, quickly attracted a circle of anti-vaxxers.

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The critics called the shot “poison for sale” while others posted false claims that the shot increased rates of hospitalization in children. Questions and conspiracies mounted: Why does the CDC own 56 vaccine patents? Why are the four companies that make vaccines all felony-convicted businesses that paid over $35 billion since 2009 for defrauding regulators? How does it feel being a pharmaceutical shill?

Haby didn’t sign up to defend the existence of the flu shot (nor does she have the patience for such shenanigans). Besides, she wasn’t giving health advice per se: The post simply alerted her audience to the service being offered at Walgreens. “I didn’t really go into the benefits of the solution or why you should get the flu shot,” she says. “I wasn’t pushing it down anyone’s throat.”

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ARE YOU A #FLUFIGHTER THIS FALL? ???? {#ad} Two years ago, I lived the scariest night of my life when Christian walked out of bed into a hot bath in the middle of the night, and asked me to turn on my phone in case he didn’t make it… little did we know that he had the flu… ???? This was the one year he’d skipped his flu shot at work… and we almost had to cancel our Caribbean family cruise… Since then, we get the whole family vaccinated early in the Fall at @walgreens ! Our local pharmacy offers walk-ins and takes most insurances for free vaccins! Get vaccinated soon and become a Flu Fighter this Fall! ???? Share your own Flu Story and tag #walgreensflufighter to encourage other families to protect themselves! ???? #stayhealthy #motherhood #mommytips #healthykids #kidsofig #childhoodunplugged #happyfall

A post shared by LAURA | Frugal For Luxury (@frugalforluxury) on

Tired of the vitriol thrown at their influencers, Walgreens eventually retired the hashtag for fear the anti-vaxxers would overshadow the campaign. Overall, however, the retailer considered the digital campaign to be a success, with over 40 influencers sharing their personal reasons for getting the flu shot.

It’s one of several new campaigns to raise awareness of public health campaigns⁠—companies pushing everything from smoking cessation to medical adherence, even HIV prevention. But it does raise questions about best practices for what is still an emerging niche within the influencer community. How do companies and cities best get out the word about important health initiatives—and in a responsible way? Who are the best people to do that? How do we equip them to best educate their followers⁠—and handle tough questions?

“Not there to provide medical advice”

In truth, the healthcare industry needs influencers. The last few decades have seen consumer trust wane as numerous scandals nipped at the medical establishment’s authority. Pharma giants such as Johnson & Johnson face multiple lawsuits related to the opioid crisis, while women continuously report being misdiagnosed or flat out ignored by doctors. That’s in addition to the trend of people increasingly turning to Dr. Google for medical information versus discussing issues with their doctors. (To be fair, the average doctor’s visit lasts 17 minutes, which leaves little time to build relationships or discuss medical issues in depth.)

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Social media influencers, it can be said, offer health providers and medical companies a way back in. (The American Medical Association fully supports the dissemination of scientifically proven information aimed at promoting public health, though it does not offer guidance on organizations’ use of social media.)

Recently, Kaiser Permanente partnered with the Public Good Projects (PGP), the public health nonprofit responsible for the StopFlu campaign. The goal was to narrow the health disparity gap that showed African American, Hispanic, and Latinx communities get fewer flu vaccinations than their white or Asian counterparts. Upon delving into demographic research, the campaign’s team concluded that such groups are more heavily influenced by those they deem relatable and authentic.

“If messages come from people who you perceive to be basically more like you⁠—your friend, neighbor, coworker⁠—the more likely it is to have an impact or be more open to performing certain behaviors,” explains Joe Smyser, CEO of PGP.

PGP partnered with 120 micro-influencers who overindex in African American or Hispanic/Latino communities within Kaiser Permanente service regions. They specifically wanted those whose number of followers capped at 10,000, reasoning that it would make them seem more relatable. “Our thinking was the more famous somebody is, the less they’re like you,” notes Smyser.

Each influencer underwent a vetting process, which more or less scanned for red flags such as racism or bad words.

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The campaign worked: The average post garnered 500 comments, of which 93% were positive. In comparison, says Smyser, health department or CDC flu promotion campaigns get comments that are overwhelmingly negative or that debate the efficacy of solutions. In addition, follow-up surveys found targeted regions showed “significant decreases” in negative attitudes toward the flu vaccine, though Smyser wouldn’t provide exact numbers or data.

But PGP was also careful to prep influencers, reiterating that if they receive a medical question they were not qualified to answer, they were to direct followers to resources on the Kaiser Permanente site.

“Nobody went off-script and tried to pretend that they were a doctor,” says Smyser.

Likewise, Walgreens advised influencers to tell their audience to talk to their local pharmacist. “They’re not there to provide medical advice or tell someone what they should do,” says Megan Boyd, healthcare communications manager for Walgreens. “They’re there to simply give people the tools to figure out what the right decision is for them.”

While some might feel uneasy about everyday people pushing topics they know little about, Smyser advocates getting the help of community members⁠—and some might say social media leaders⁠—in raising awareness. As he notes, it’s the new normal: “We need to open ourselves up and allow more people to be part of the conversation.”

It’s not an issue to tap influencers for vaccinations or common-sense advice such as washing one’s hands, says Holly Fernandez Lynch, assistant professor of medical ethics at the Perelman School of Medicine, University of Pennsylvania.

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“But if it’s something that requires some level of clinical knowledge and expertise, then I would be worried about having a celebrity or influencer posting that kind of information,” she tells Fast Company. “And if they’re recommending a product, ideally they would have tried it. Otherwise, it would be misleading.”

A booming (but complicated) business

A number of companies now connect the medical establishment with influencers of all kinds. WEGO Health, for example, is the largest network of patient and caregiver influencers⁠—with over 100,000 participants to date. It works with many of the top 10 pharma companies, including Pfizer, GSK, and Novartis, as well as life sciences and digital therapeutics companies.

The company recently worked on a campaign involving a very rare disease that disproportionately impacts minority women. Before working with WEGO Health, the company saw little success: “One of the big underlying problems that pharma and other companies in healthcare face is trust,” says WEGO Health chief strategy officer David Goldsmith. “Those influencers are really building a bridge for those big brands to the patient community and helping them overcome the trust deficit.”

Goldsmith says big pharma’s interest in social media influence “exploded” in the last couple of years, though there are still expectations to manage. He mentions how one potential client wanted to publicize a new medical app without offering it to influencers to actually use themselves.

“That will only work if the patient influencers they’re working with have had an opportunity to use the app themselves and are convinced of its value,” says Goldsmith.

The FDA offers guidelines on what social media influencers need to explain when it comes to third-party promotions. Individuals must add an “ad” or “sponsored” hashtag, though due to character-count restrictions, they are not obliged to post the full list of potential risks and side effects⁠—as traditionally done in TV ads. Instead, they can offer a landing-page link that hosts the full information.

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For health campaigns that don’t mention a specific brand or products⁠—such as flu shot awareness⁠—such disclosures are not necessary. That often proves problematic, as it gives companies an incentive to promote a product without as many restrictions.

The FDA finds out about potential violations from consumer and trade industry complaints, as well as from their own surveillance team, which scouts platforms. The agency will send warning letters to those who have potentially violated the rules, such as when Kim Kardashian posted misleading efficacy claims for morning sickness drug Diclegis in 2015.

But there have been an increasing number of instances in which consumers were left confused as to whether influencers who usually hawk shoes and leggings have the authority to weigh in on more serious health conditions. Lifestyle blogger Louise Roe touted psoriasis drug Celgene on Instagram, while actress Julianne Hough posted content for pharmaceutical Abbvie’s “EndoMEtriosis” campaign. And there are mommy influencers promoting wellness products for which the FDA does not ensure efficacy, such as pregnancy monitoring contraptions.

Save for an additional hashtag, none of these posts really look or feel all that different from traditional posts, which is undoubtedly their appeal. Influencers do not need to disclose if they actually even used the medical or health product they’re promoting.

A new kind of influencer

To that end, some hope to inject more expertise into the space. Austin L. Chiang, assistant professor of medicine, gastroenterology, and hepatology at Thomas Jefferson University Hospital, believes the best way to counter misinformation is to transform doctors into influencers themselves. He cofounded the Association for Healthcare Social Media (AHSM), the first nonprofit society for health professionals on social media, and started the #VerifyHealthcare transparency movement.

“In our medical training, we don’t have any sort of marketing training. We don’t have any sort of storytelling training,” says Chiang, “and yet we’re expected to impact our communities and the general public.”

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????10% luck⁣ ????20% skill⁣ ????15% concentrated power of will⁣ ????5% pleasure⁣ ????50% pain⁣ ???? = 100% reason to remember the name⁣ ⁣ …or so @fortminor says. But truthfully, last week brought a series of complex cases. Working at a tertiary care center means the cases I often see are referred from others who have failed or who have passed on even trying.⁣ ⁣ But we rose to the occasion.⁣ ⁣ We got it done.⁣ ⁣ It was 10% luck, 50% pain and all the above.⁣ ⁣ More importantly we discovered the reason why we went into medicine in the first place.⁣ ⁣ And we’ll do it all again this week.⁣ ⁣ #mondaymotivation #motivationalquotes #motivation #fortminor #skill #doctors #medicine #healthcare #medical #hardwork #scrubs #gastroenterology #hospital #chronicillness #heroes #wegotthis #nurses #power #diversity #strength #challengeaccepted

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AHSM is slowly building a network of doctors, nurses, dentists, physical therapists, and clinicians debunking false claims by untrained medical professionals and sharing science-backed advice on social media. This means tackling promoted CBD oils, detox teas, and supplements⁠—some of which carry health risks. “It’s sort of the Wild West right now,” explains Chiang.

Even though the FTC came out with updated guidelines on how to disclose sponsored content, it’s still very loosely regulated. There is very little guidance on disclosing whether professionals have a conflict of interest or even on how to properly cite medical literature.

“If we are expecting the public to trust us again, we need to be able to show them that we’re not just saying things for the sake of saying things,” stresses Chiang. “[We need to show] we have science to back it up and this is the reason why it’s important, and these are our disclosures.”

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???????????????????????????? ???????????????? ???????? ???? ???????????????????? ???????????????????????????????? ????????????????????. It’s a really scary thought honestly.. it’s one of the negatives of being on Social Media with a PUBLIC address. ‼️???????????? ???????????????? ???????????????? ????????????????????????????????????????????‼️ A few things I do: ✅ Save my stories and post after I’ve left the location. Never give away your location! ✅ Change up the routine frequently. Being TOO routine makes you the perfect prey. The pros really keep track of your every move for months before they hit. ✅ Office is double locked when ANYONE is alone, staff included. But whether you are on social media or not, YOU MUST STILL take precautions! Things can happen to anyone, and Docs seem to be prime targets. The real wake up call was when my suite neighbor, a female optometrist was robbed at gun point for her “goods” (sunglasses, etc). ???? Let’s be real, we as women in small business are quite literally defenseless in these situations. We have strength in numbers, a security system, but it’s not enough. We have to stay cautious, be aware, and alert. What I’ve learned in my 5 years as a business owner is that these scams happen ALL THE TIME. They no longer surprise me but still scare me. I remember an incident in my first year of practice where I got a phone call saying that I had forgotten my electricity bill and I needed to pay NOW or my electricity would be shut off. I was mid procedure and felt flustered that the lights would go out with a patient in the chair. I handed my credit card to my front desk and told her to pay. Thank God, she called BS and told me to check my credit card statements. She was right- it was a scam. Later, someone dressed as an electrician showed up at our door and we didn’t let him in. It was scary. I’m not as naive and trusting as I used to be but I’ll never be as crafty as a scammer. It’s important to connect w local colleagues, ie @lovealways.drbetsy who announce when things are going down. ???? Any more tips for staying safe? Pls share!

A post shared by Dr. Joyce Kahng OC Dentist ???? (@joycethedentist) on

Currently, AHSM’s affiliated medical professionals can be found on Instagram, YouTube, Twitter, even TikTok. Much of the organization’s work involves equipping their network with the skills to become influencers as well as tips to handle trolls. They’re also working on a guidebook of best practices in hopes of encouraging more of the healthcare industry⁠—practitioners, academic societies, and medical institutions⁠—to join their feed.

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Does that mean Chiang and his colleagues are figuring out the best lighting techniques and practicing poses? “Many of us have taken it upon ourselves to learn some of these things and to get a little bit of an idea of how to curate artistically,” he says. “And some people hire, you know, professional photographers.”

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