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Dilemmas of Celebrity Endorsements

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“Do you want to be Khloe Kardashian or Serena Williams?”

With that line, the attending physician initiated a conversation about newer migraine treatment options for our patient who had been suffering from migraine headaches for decades. Migraine headaches are the second leading cause of years lived with disability in the world. And although humans have been suffering from migraine headaches for millennia, only recently have there been major advancements in treatment. So, it was not surprising that between the last time our patient was seen and now, there were many more treatment options available. By having seen the ads featuring Serena Williams and Khloe Kardashian for new migraine treatments, our patient was able to have a conversation not only about their sponsored medications but also in general about how new treatment paradigms can improve his quality of life. 

Celebrity endorsements in medicine have a complex history. Nearly 65 years ago Elvis Presley was vaccinated on TV with what was at that time a new vaccine for polio. On the other hand, there have more recently been many celebrities questioning the safety of vaccines with concern that this has led to the resurgence of vaccine-preventable diseases and deaths. Another field in medicine where celebrity endorsements have proved controversial is in promotion of cancer screenings, with one study showing how more than half of adult respondents had heard a celebrity talk about mammograms, colonoscopy, or prostate screening antigen testing. In the same vein, after Angelina Jolie’s New York Times editorial announcing her preventative mastectomy in light of BRCA testing, daily BRCA test rates immediately jumped up by more than 50%. But rates of mastectomy in women with BRCA testing fell over that same time period, indicating that the women who were undergoing testing had a much lower likelihood of being BRCA positive and even needing preventative mastectomy in the first place, and leading to more than $13 million of additional expenditure in just the 15 days after the editorial alone. 

But if celebrity-endorsed awareness of cancer screenings has saved even one life, does the additional health care expenditure matter to that particular person or their loved ones? Aside from the increased financial cost, celebrity endorsements can also have much more severe consequences, especially since many of the endorsed products are often unhealthy and make unsubstantiated claims

Consequently, much of the world has banned celebrity endorsements of prescription drugs (which by proxy are the pharmaceutical companies’ way of direct-to-consumer advertising), which are only permitted in the U.S. and New Zealand. And indeed, other countries often look at the downsides of such marketing, ranging from misleading claims, failure to alert the public when the product has been recalled in another country, and failure to provide information of alternative treatments to advocate for continuing bans on direct-to-consumer advertising to promote public health. 

In the U.S., the FDA is tasked with checking for such misleading claims, and as such, their Office of Prescription Drug Promotion sent a letter to Biohaven Pharmaceuticals, the company with whom Ms. Kardashian partnered to promote their migraine medication, regarding misleading claims about the efficacy and risks of the medication. Given the widespread influence and reach of social media, the effectiveness of such warnings is extremely diluted and presents formidable challenges for preventing misinformation. One way to combat this is by expanding fines/restrictions, such as how India has implemented a Consumer Protection Act whereby when misleading claims are advertised, not only can the manufacturer be fined but also the person who did the endorsement can be fined and prohibited from endorsing products. 

As physicians, we strive to partner with our patients to work toward a shared treatment plan, trying to give as informed and thorough an understanding of all options as possible. Such conversations are usually influenced by the pathophysiology of the problem, mechanism of action of the medications, and anecdotal experience. What happens, however, when a celebrity’s perspective trumps all of that and if a patient may desire a treatment solely because of the endorsement and not necessarily because of what's best for their health? In our particular case, I was grateful that our attending physician was the one who initiated the conversation and was able to guide the nuanced discussion. I hope future conversations between patients and their health care team can similarly model this shared decision-making while also navigating the ever-changing landscape of medicine.

What are your thoughts on celebrity drug endorsements? Share in the comments.

Dr. Noor Shaik is a neurology resident at the Hospital of the University of Pennsylvania.

Image by DmitryMo / Getty Images

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