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Tuesday Jan 30, 2018

What a Load of Goop: Overcoming Misguided Health Advice

We have heard the stories, and we have treated the side effects. Celebrities' medical advice indeed exists, and it is as plentiful as it is unreliable.

[person on crossroad staring at opinions and facts signs]

With the growing pervasiveness of social media, celebrities carry more influence than ever. Before, their thoughts had to be amplified by a traditional news outlet to reach the public, but now, from the comfort of their bedrooms, they can guide our patients with often cringe-worthy advice. Models, actors and reality TV stars have serious influence over our patients' medical choices.

Unfortunately, the situation doesn't end with the occasional "healthy" recommendation from celebrities. The Internet has spawned a new generation of health gurus I label as IKA experts (I Know All). Most of these "experts" do not have a medical education, and they take advantage of a gray zone in health care -- an area where modern, evidence-based science has not yet provided us with definitive answers.

For example, we have seen autism rates increase in the United States, but the scientific community has not come to clear consensus on why this is the case. So, the IKA experts jump in to offer "theories," but they treat their opinions as facts. This type of overconfidence not only confuses patients but often encourages them to believe and follow the IKA expert's advice. Some people are quick to write these off as innocent or empty remarks, but they carry real consequences. Jenny McCarthy's IKA belief that vaccines are linked to autism,(transcripts.cnn.com) for example, has endangered the health of countless children who weren't vaccinated because of it.

IKA experts also thrive in areas where hard work and dedication are mandatory. Losing weight, improving cholesterol and decreasing cancer risk all require effort, and there are no proven shortcuts. We can repeat this to our patients until we turn blue in the face, but if they have an IKA expert claiming a shortcut exists, they may not listen to us. I have lost count of the number of times one of my patients has asked about a bizarre shortcut for weight loss.

Take, for example, the "waist trainers" made popular by the Kardashians(www.elle.com) or the corset that actress Jessica Alba credits for helping her shed baby weight.(www.shape.com) In 2014, Madonna and Demi Moore swore by a lunar, or werewolf, diet,(www.shape.com) which consists of a fasting juice cleanse following by eating regimens that change with each lunar phase. Unless addressed, these shams can be dangerous and are distractions that can derail the patient from a legitimate treatment plan.

Our advice to patients to put hard work into changing their diet or to begin an exercise program won't gain traction if they are getting conflicting advice elsewhere. Our guidance will not be propagated through social media in the same way as a testimonial from actress Gwyneth Paltrow to insert a jade egg into the vagina(www.washingtonpost.com) for improved sex and fertilization.

Modern media thrives on clicks and views and they, in turn, are driven by shock and awe. The more shocking or "breakthrough" the recommendation, the more widespread it becomes. Unfortunately, Paltrow's wellness-focused goop.com has no shortage of bizarre recommendations. Recently, it was hawking a $135 coffee enema kit.(www.forbes.com)  

Why do our patients buy into such absurdity? We need to understand that people are more likely to take advice, regardless of its accuracy, if it comes from a familiar face.(www.marketingcharts.com) Even the most diligent patient spends more time watching Tom Cruise than they do listening to you in your office.

People also are more easily influenced during moments of stress. Tali Sharot, Ph.D., gives a great example of this in her book The Influential Mind. In the days before the Sept. 11 terror attacks, someone running down the streets of Manhattan would have been shrugged off as just another crazy person in New York. On Sept. 12, 2001, we were a different people; the stress level in New York was incredibly high, and if the same person ran that day, hundreds would likely have followed. As a survival mechanism, our primitive brains follow guidance from others more readily during moments of stress. Celebrities often tap into this anxiety by using words like "death" and "disease" or heighten our emotions even further by making their message personal, talking about a relatable terrifying event that happened directly to them.

One of the many powerful tools we family physicians have is our ability to communicate, and we rely on this skill to disprove IKA theories. We already feel time-crunched during our discussions with patients, but there is a simple way to determine whether poor advice has influenced them. We must ask, "What do you think is going on?" Not only will asking the question improve the quality of their visit, but it can save time by eliminating redundancies.

Forgetting celebrities for a moment, think about how many other sources our patients use to diagnose and treat their ailments before they visit you (Dr. Google, Grandma, friends, other doctors, social media, etc.). They aren't coming into our offices with a clean slate even if they don't utilize social media. For instance, if a patient heard that coughing must be related to lung cancer and you explain why their viral illness doesn't require antibiotics, you aren't addressing their primary concern. It's crucial to ask about their thoughts or theories before issuing advice, not only to adequately address their concerns but also to spot shoddy guidance.

On recognizing that our patient is misguided, we have to inform them about the low-quality advice they have received. Instinctively, when a patient presents a flawed theory, we want to disprove it using facts and figures. However, this is not an impactful way to dismantle someone's position. Many patients don't understand technical scientific details. Nor can they judge between the quality meta-analysis that you provide and the single poorly designed observational trial they heard about elsewhere. It helps to first find a point of common ground that doesn't necessarily disprove their belief so much as it supports our recommendation. For example, when it comes to vaccines, anyone can agree that measles is a deadly disease and that protecting a child's welfare is paramount. Creating this commonality is more impactful than directly attacking the patient's belief, and it will lay the groundwork for compromise.

We can strike back against IKA experts in a macro approach, as well. Ironically enough, that means logging onto social media. We can use the same platforms that fuel this dilemma to stop it in its tracks.

I made the point in a previous post, but it's even more relevant today: Patients trust social media, so we must be their trusted source of information online. I truly believe that doctors' fear of and absence in digital media has partially been responsible for the relatively unobstructed flourishing of IKA experts. As if it were not bad enough that adults are heeding the advice of internet "experts," a recent survey by New York Life found that YouTube is a top influencer for the career aspirations of children.(www.fatherly.com) Understanding the benefits of instilling healthy habits early on, this should give us even more incentive to tackle cyberspace.

Whether we use Twitter, Facebook or YouTube, we need to establish our digital footprint in the land of the Internet because it has, indeed, become the misinformation superhighway.

Mikhail Varshavski, D.O., is a family physician in New York City and a leading voice in the social media health space. You can follow him on YouTube,(www.youtube.com) on Twitter @RealDoctorMike,(twitter.com) and on Instagram @Doctor.Mike.(www.instagram.com)

Posted at 01:41PM Jan 30, 2018 by Mikhail Varshavski, D.O.

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