Playing catch up with the fast-moving world of medical influencing

Dr Neasa Conneally

Does the lack of regulation around doctors who are social media ‘influencers’ put trust in the medical profession at risk?

A new phenomenon in recent years that many readers, depending on their generation and how much time they spend glued to their phone, may not be aware of is the increasing reach and popularity of medical influencers.

‘What on earth is an influencer?’ some readers who may be less au fait with the goings on of the internet may ask. An influencer is someone who has generated sufficient online reach, particularly on the photo and video sharing app Instagram, by sharing every aspect of their highly aspirational lives. The most popular influencers can build up many thousands or millions of viewers or ‘followers’ and advertisers and brands have long cottoned on to this reach.

The most popular influencers establish ‘paid partnerships’ with brands and do sponsored posts, or ads essentially, and are given free gifts, which they then broadcast to their followers. This can be incredibly lucrative and being an influencer has become a massive industry in its own right.

Anyone can become an influencer, from a make-up artist to an aspiring model or a teenager in their bedroom. But now doctors are getting in the game too, sharing their lives and posting medical education at the same time. The closest equivalent would probably be a celebrity TV doctor, broadcasting through people’s phones on Instagram. They too are posting ads and sponsored posts and getting generous free gifts.

Almost as quickly as this has started, debate has begun on where the ethical boundaries lie. In Ireland all influencers are nominally held to guidelines drawn by the Advertising Standards Authority of Ireland (ASAI). All ads have to be declared, often with a clearly marked hashtag, such as #ad. This guidance is followed to varying degrees, but most followers make the assumption that if an influencer is showing them something, they have either been paid to do it or have been given it for free.

However, what is acceptable for a beauty blogger or model to do isn’t necessarily acceptable for a doctor to do. It is an indisputable fact that we are held to a higher standard by society. Doctors are consistently ranked in the top three most trusted professions in such surveys and I wonder do we risk that trust by selling our profession to the highest bidder?

For years there have been strict rules on how drug companies interact with doctors in order to maintain professional separation and integrity. Should it then follow that if a drug company cannot even give you a free pen, let alone take you on holiday, is it okay that in return for sharing it with your followers that you can be given a free dress, or a break in a five-star hotel, or a car?

What about doing ads for skincare or supplements or medical products that are sold in pharmacies? Does that not then put into question whether all the advice given in their clinical practice is still impartial and evidence-based or whether there are other motives behind it?

The world of social media moves extremely quickly and changes all the time. It is understandable that the Medical Council isn’t quite up to speed. Their 2019 guidelines on social media make only general references to not communicating directly with patients online, maintaining patient confidentiality, and making sure that any information given is factual and valid.

There are of course many positives to the world of medical influencing. It is accessible to many population groups; in particular teenagers, young women or new mothers. It can be a powerful tool to counter false information, particularly now where everyone has a platform and anyone can speak without any expertise. I would far rather a doctor speak and give accurate information on topics such as preventing the spread of Covid-19, cervical screening, breast feeding or whatever it may be, rather than uninformed or disingenuous viewpoints.

I want to make it very clear that this is not a personal attack on any one particular person or group of people. I cannot see any of them breaching Medical Council guidelines as they currently stand and I’m sure that they would all personally aim to act with the utmost professional integrity. It is rather the lacuna in the guidelines that I am concerned about and how this potentially could lead to poor practice and put the profession into disrepute.

Like so many things on the internet, the world of influencing is moving faster than what society and our regulators can keep up with. Doctors have always had to be advocates for our own personal patients, now we also have to be advocates for society at large. In this atmosphere of fake news and increasing distrust of experts, medical influencing can play an important role in this. But like everything in medicine, in order to be done safely it needs to operate within clear regulations and guidelines.