In between posts about the anatomy lab and long hours, med students are making extra cash endorsing products. Is it ethical?
In 2018 America, chances are high that you’ve come across the work of a celebrity physician in some form: Maybe you’ve passively watched Dr. Oz while waiting at a doctor’s office, or flipped through one of Deepak Chopra’s books on alternative medicine.
Celebrity physicians often catapult to fame via their mastery of traditional media, like television or radio or books or magazines, and we’re used to seeing medical advice and expertise there. What you may have yet to encounter, or haven’t fully noticed yet, is the growing group of current medical students who are perhaps on track to achieve even greater fame, through their prodigious and aggressive use of social media, particularly Instagram. Even before receiving their medical degrees, these future doctors are hard at work growing their audiences (many have well into the thousands of followers), arguably in ways even more savvy than the physicians on social media today.
I first learned of the medical student Instagram influencer community a few months ago, when a friend shared links to a few of these accounts with me, asking if this is what medical school was really like. Curated and meticulously organized, these accounts posted long reflections after anatomy lab sessions, video stories of students huddled around a defibrillator during a CPR training session, pictures of neat study spaces featuring board-prep textbooks next to cups of artisan coffee, and 5 a.m. selfies taken in the surgery locker-room before assisting with a C-section. Initially, I cringed. Sure, they looked vaguely familiar—they were (literally) rose-tinted, glamorized snapshots of relatable moments dispersed over the past few years of my life. But interspersed, and even integrated, into those relatable moments were advertisements and discount codes for study materials and scrub clothing brands. Something about that, in particular, felt impulsively antithetical to my (perhaps wide-eyed) interpretation of medicine’s ideals, of service to others over self-promotion.
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Sufficiently intrigued, I fell into a digital rabbit hole that surfaced dozens of fellow med students moonlighting as social media influencers, and the partnerships grew ever more questionable. Some accounts featured sponsored posts advertising watches and clothes from Lululemon; another linked back to a personal blog that included a page that allowed followers to “shop my Instagram.” A popular fitness-oriented account, hosted by an aspiring M.D., promoted protein powder and pre-workout supplements. A future dermatologist showcased skin care products. Another future M.D.’s account highlights the mattresses, custom maps, furniture rental services, and food brand that, according to the posts, help her seamlessly live the life of a third-year med student.
In the aggregate, the ethics of these accounts left me conflicted. Many of these influencers are using their accounts and personal brands for objectively good, medically sound causes—a number of them promote important public health messages like getting an annual flu shot or registering as an organ donor. I can even empathize with the impulse to partner with companies to advertise products—med school is expensive, and I can imagine advertising is somewhat lucrative. But the companies are almost certainly targeting them because they know that med students can offer some veneer of medical objectivity to their products. By engaging in these partnerships, med students have, perhaps unsuspectingly, chosen to put their “medical credential”—often prominently displayed in a name or Instagram bio—up for sale.
For now, no one seems to have descended into the Dr. Oz universe of snake oil—there are no products on the level of the rapid fat loss pills or cures for the common cold that he promotes. But the potential to take things too far is certainly there, and American medicine is full of stories of physicians promoting products of questionable or no medical value. In the past, physicians have advertised for Camel cigarettes and, more recently, partnered with Coca-Cola. Just last year, a physician in Oklahoma gained notoriety for offering “Jesus shots”—essentially a pricey placebo consisting of two steroids and vitamin B12—to patients and potential customers for chronic pain. On Instagram, med students already toe the line by advertising for products like protein supplements, which can be high in added sugar and can strain kidney function. It doesn’t take an extraordinary leap of imagination to envision a med student being paid to promote a product on Instagram like Juul—a potentially useful harm reduction tool for smokers but a dangerous recommendation for doctors to make for most people. And for better or worse, the stakes are pretty high—for patients and their health, but also for doctors and their credibility. Many of these influencers, with access already to audiences as large as 60,000 followers and growing, will go on to become the next faces of American medicine.
Med students aren’t alone here—physicians and residents have also engaged in native advertising for brands on platforms like Instagram in recent years. One example is Dr. Mike Varshavski, a family medicine physician in New York with more than 2.9 million Instagram followers. He’s promoted Quaker oats, Old Spice deodorant, and Fox’s new medical drama, The Resident, just in the past year. Although ethically in the clear by the standards of professional organizations like the American Medical Association, practicing health professionals are likely more aware of both the good and the bad implications of that decision to advertise.
But for less experienced medical students, the story becomes more complicated. We, only beginning our careers in medicine, sit at the bottom of medicine’s totem pole, lacking the volume of clinical experience of practicing physicians. During our education, we remain in a purgatory of sorts, not quite inside medicine’s ivory tower but going through experiences and observing moments in medicine that most people simply don’t get to see. And social media, by its nature, makes it difficult to separate our lives in lecture halls or in the hospital from our lives at home. It practically invites us to share professional opinions alongside personal views, where posts and tweets can easily get misinterpreted. Is a doctor’s personal devotion to a product an endorsement that it’s a good medical choice for everyone? The uncharted ethics of social media are already confusing, and that’s before you add in the influence of outside interests, many of which are ready to take advantage of students’ ability to offer some stamp of medical authority to the general public about a product or idea without asking too many questions.
This is not to say that doctors shouldn’t share opinions: Many physicians already do this responsibly online. On Twitter in particular, physicians have created a virtual community that opens academic debates on evidence-based research to the public, fosters camaraderie and professional support to one another, and enables physicians to speak out about important social causes (the most recent example being the #ThisIsMyLane movement). But there is a difference between using your expertise to inform arguments and using your expertise to make some extra cash selling products to consumers. And how to ethically handle the social capital associated with a medical degree is rarely, if ever, discussed in our training. It is something we instead quietly grapple with ourselves and are expected learn how to handle with time.
The problem is broader than Instagram, too: I’ve personally seen how groups outside of medicine seek the endorsement of med students and the weight behind their future degrees. Since starting med school, political organizations have asked me and my classmates to attend protests in white coats, rather than in plainclothes as private citizens. And as both a freelance writer and med student, companies have approached me to endorse their products or even the visions of their CEOs.
In other words, the issue shows no signs of going away anytime soon. And solutions to address it aren’t clear. Firm regulations by professional societies on what we can and can’t say doesn’t seem to be a great answer—whatever is written will quickly become outdated, given how fast social media can evolve. But on Instagram, at least, a large contingent of health professionals have pushed for transparency and self-regulation through the #VerifyHealthCare movement, which asks influencers to explicitly list out their credentials, conflicts of interests, and clarification that personal endorsements are not always professional ones.
Encouraging and teaching students to carry a greater respect for the significance of the two letters that eventually appear after our names may be the best path forward. Public trust in physicians (and other institutions) has declined over the past half-century, but a majority of Americans still believe that their physician is honest and highly ethical in their practice. As outside interests—particularly corporations and advertisers—vie for our endorsements, we should do our best, for the sake of our patients, not to give it away so cheaply.
Date: December 4, 2018