Following celebrities’ medical advice: meta-narrative analysis

Objective To synthesise what is known about how celebrities influence people’s decisions on health. Design Meta-narrative analysis of economics, marketing, psychology, and sociology literatures. Data sources Systematic searches of electronic databases: BusinessSource Complete (1886-), Communication & Mass Media Complete (1915-), Humanities Abstracts (1984-), ProQuest Political Science (1985-), PsycINFO (1806-), PubMed (1966-), and Sociology Abstracts (1952-). Inclusion criteria Studies discussing mechanisms of celebrities’ influence on people in any context. Results Economics literature shows that celebrity endorsements act as signals of credibility that differentiate products or ideas from competitors and can catalyse herd behaviour. Marketing studies show that celebrities transfer their desirable attributes to products and use their success to boost their perceived credibility. Psychology shows that people are classically conditioned to react positively to the advice of celebrities, experience cognitive dissonance if they do not, and are influenced by congruencies with their self conceptions. Sociology helps explain the spread of celebrity medical advice as a contagion that diffuses through social networks and people’s desire to acquire celebrities’ social capital. Conclusions The influence of celebrity status is a deeply rooted process that can be harnessed for good or abused for harm. A better understanding of celebrity can empower health professionals to take this phenomenon seriously and use patient encounters to educate the public about sources of health information and their trustworthiness. Public health authorities can use these insights to implement regulations and restrictions on celebrity endorsements and design counter marketing initiatives—perhaps even partnering with celebrities—to discredit bogus medical advice while promoting evidence based practices. Introduction Celebrities frequently give medical advice and people often follow it. Whether motivated by good intentions or financial rewards, celebrities can generate much publicity for health campaigns by virtue of their visibility, public interest, and perceived newsworthiness. When journalist Katie Couric televised her colonoscopy on NBC’s Today Show in 2000, colorectal cancer screenings by 400 American endoscopists increased by 21% the next month. Following actor-singer Kylie Minogue’s diagnosis of breast cancer, bookings for mammograms rose by 40% in four Australian states. Twice as many screenings for cervical cancer were conducted in England during March 2009 compared with the same month one year earlier, corresponding to reality TV star Jade Goody’s death from the disease. Many celebrities have mobilised their influence for good. Actor Michael J Fox’s foundation has raised over $350m (£215m; €260m) for research into Parkinson’s disease, whereas singer Sir Elton John’s charity has raised more than $300m towards research into HIV/AIDS. But the messages espoused by celebrities can also conflict with those recommended by health professionals, public health authorities, and the best available research evidence. British television presenter Sir Michael Parkinson⇓ promoted an unsupported self diagnosis technique for prostate cancer based on his own experiences: “The test is if you can pee against a wall from two feet, you haven’t got it.” Having breast cancer at age 36, actor Christina Applegate promoted magnetic resonance imaging for early detection; yet the US National Cancer Institute does not endorse such investigations for those at average risk of breast cancer. Actor Suzanne Somers advocates her own brand ofmedicine, including Correspondence to: S J Hoffman [email protected] Extra material supplied by the author (see http://www.bmj.com/content/347/bmj.f7151?tab=related#datasupp) Full search protocol and results No commercial reuse: See rights and reprints http://www.bmj.com/permissions Subscribe: http://www.bmj.com/subscribe BMJ 2013;347:f7151 doi: 10.1136/bmj.f7151 (Published 17 December 2013) Page 1 of 6