In 2020, Dr. Muneeb Shah started posting on TikTok. As a resident dermatologist at Campbell University in North Carolina, he figured he’d make videos about skin issues that frequently came up during his clinic sessions.
Two years later, he’s still posting the same kind of content—but now with 13.8 million TikTok followers watching.
“I figured that if I just told everybody what ingredients were good, what ingredients to avoid, teach them about conditions, that they would be able to then go and make better decisions for their skin and for their health and save money and not be tricked by marketing scams,” Shah says in the latest episode of Fast Company‘s podcast Creative Control. “It was basically because of how I felt when I first started getting into skincare. As a male, getting into skincare, I didn’t have a good outlet of information.”
As an influencer, Shah, ironically, doesn’t aim to influence.
“If I can educate them, then I’m not influencing them, because now they’re going to make their own decisions,” he says. “It may not be the product I recommend. But they’re going to make the right choice for them.”
Shah’s presentation of his content as general information rather than direct advice also helps him navigate the “grey area” of bioethics on social media. “We have to take the initiative on our side to try to define what that means,” he says. “[And to] put in safeguards, as well, because you could also be dangerous at that scale.”
The American Medical Association (AMA) does have a set of guidelines for doctors on social media, but it primarily addresses such issues as professionalism and protecting a patient’s privacy. What isn’t immediately clear are measures on how doctors should navigate brand deals and endorsements, what constitutes advice versus general information, and other knotty issues presented by broadcasting content via social media. Making matters more complicated is the sheer scale of the major platforms, such as TikTok, and how easily people can gain a sizable following with no real vetting process.
“It’s the Wild West,” says Dom Sisti, an assistant professor in the department of medical ethics and health policy at the University of Pennsylvania. “Social media was something that we as bioethicists just didn’t have our eyes on—and it’s coming back now to haunt us.”
To Sisti, there should have been a more serious conversation about bioethics online even before the advent of influencers.
“We were so preoccupied with the Human Genome Project in the 1990s. There was all this grant money for bioethicists to look at the ethics of genetics,” he says. “All the while, the internet was mushrooming into what we have today—this gigantic thing that has propelled societies to change dramatically in a very short amount of time.
“While we were over here looking at genetics and cloning,” he continues, “social media was happening, and it has had a profound impact on healthcare and on the way we think about medicine.”
Medical information as entertainment has made TV stars out of a number of doctors including Sandra Lee (Dr. Pimple Popper), Ian Smith (The Doctors), Younan Nowzaradan (My 600-lb Life), and Mehmet Oz (The Dr. Oz Show). There are AMA ethics guidelines for doctors on TV, and those medical performers also have the additional safety net of in-house legal teams at the production companies and networks that produce and air their shows to help keep topics and segments in bounds. It also stands to reason that networks would be incredibly mindful of which doctors they platform. On social media, though, a doctor doesn’t need a TV show to have influence over an audience. As evidenced by conversations around COVID-19 and vaccines, it’s difficult to police content at that scale.
“The COVID pandemic has revealed that there are unscrupulous physicians who are willing to say pretty much anything to increase their follower count,” Sisti says. “When a physician is out there speculating about ivermectin or some other medicine that is purported to help with, say, COVID, but there’s no evidence and they’re out talking about it as if it’s like a legitimate thing, that’s problematic. There’ll be people who [will say], ‘If they have an MD after their name, they must know what they’re talking about.'”
Even if one sets aside something as globally significant as COVID-19, Sisti believes that social platforms aren’t doing enough to combat medical misinformation across the board. “The platforms are starting to kind of think about it, but they’re driven by clicks,” he says. “They don’t really care about these higher ‘ethical norms.’ It’s just, can we get more clicks? Can our advertisers get more clicks? It’s not really about any of us. It’s not even about the influencers, to be honest—they’re kind of a product as well.”
Fast Company reached out to TikTok and Twitter for comment. TikTok referred us to its current guidelines, and Twitter says it is working “closely with trusted partners, including public health authorities, NGOs, and governments, and other authoritative sources to elevate credible info and add context to content across the service so that people on Twitter can make informed decisions.”
Misinformation by omission
Of course, one form of misinformation is not enough information.
“It’s the art of medicine—there’s art and a science component to it,” says Dr. Ifey Ifeanyi, an anesthesiologist at MD Anderson Cancer Center in Houston. (Yes, she’s my sister—and also the inspiration, in part, for my investigation into this topic.) “So if you’re trying to distill one problem into, like, a little TikTok video of 30 seconds or a minute, that’s irresponsible to me.”
Shah admits that short-form content doesn’t allow the nuances needed for certain topics. “A lot of medicine has a lot of nuance in it,” he says. “On YouTube, which I also do, I can get into the 20 minutes on the pros and cons and get into the weeds of things. Then, that way, I feel like it’s more of a complete education. But I look at TikTok as just snippets of information.”
With those snippets, Shah says he tries to be careful with what he disseminates not only for his sake but for the sake of his profession.
“As a dermatologist on social media, you are a lot of times representing the specialty. You may be the only touchpoint that a person has ever had with a dermatologist or dermatology,” he says. “So it’s very important, and I’m very conscious of this. Is [the content] encouraging trust in the profession, or is it pushing people away?”
Even still, some doctors like Ifeanyi are concerned with patients using the information they receive on social media as an excuse to not go to the doctor. “Doctors have a hard enough time bringing patients into the hospital to get checked out for preventative medicine and primary care,” Ifeanyi says. “So I feel like people getting on TikTok and googling things gives them even more of an excuse. ‘Oh, I googled it. So I know what I have.’ It’s even more of a reason to not show up and get that physical examination.”
What concerns Ifeanyi the most are people who may have a symptom like shortness of breath that can be attributed to a number of issues, ranging from benign to severe. However, in her estimation, people tend not to think the worst for themselves.
“There’s a rule in medicine: Everyone lies,” Dr. Ifeanyi says. “Most people are going to minimize their symptoms and always think that something is less serious than it is.”
A prescription for caution
When talking about bioethics on social media, what doctors are selling is as important as what they’re saying.
For content creators, brand deals are practically an inevitability, and, of course, there are rules to disclosing posts that are paid ads. But conceivably, there’s a deeper level of trust that audiences may have with doctors who are suggesting a product by virtue of their title alone. So one could argue there should be extra scrutiny toward doctors doing endorsements, especially if it’s for a health-related product or drug.
To Sisti, this unfortunately falls in step with the overall state of healthcare, particularly in the United States, being overly commoditized. “We’ve made patients into consumers, and so that model is now with us everywhere,” Sisti says. “Healthcare, to me, [is] a very different sector. It shouldn’t be treated as though it’s a commodity like any other, because we’re talking about people’s health.”
Sisti says that doctors should be even more transparent than the average influencer on what they’re selling to their followers “almost down to the cent [of] how much they’re getting to hock the product.”
When it comes to the brands that Shah works with, for example, he considers if he’d recommend that product to his family, as well as if the product is consistent with the information he’s given in previous videos. “Anyone who does this at scale realizes very quickly that the platform was given by the audience and can be taken away by the audience,” he says. “If I say I don’t like this particular ingredient, or I don’t like this particular product or this particular brand, and then six months later I get this amazing offer to work with the brand, and then all of a sudden I start contradicting myself, people are going to call you out right away.”
There is a home for doctors on social media
There’s no doubt that doctors can have a positive impact on social media by demystifying medicine for the average person. There are any number of doctors who, so far, have been doing it right. However, because this intersection of bioethics and social media is still a grey area, Shah says that he’s inspired to help other doctors move into the social space with a clearer sense of the landscape than he had.
“[I want to] pass the baton onto other people and guide them through what I learned over the last two years,” he says. “What are the ethical implications? How can you protect yourself? What insurance do you need? How do you negotiate a brand deal?”
Shah sees this as a media company or platform where he’s essentially “a Ryan Seacrest of dermatology.”
“I don’t wanna be the guy,” he says. “I want to be the guy who’s asking the questions.”