January 15, 2019
The New York Times published several articles related to physicians’ nondisclosure of conflicts of interest over the past few months. A somewhat recent article on the subject called out medical journals for their lack of transparency and due diligence in requiring authors to disclose conflicts. Despite our work on this issue over a decade ago, the efforts of many others and the passing of the Sunshine Act, conflicts of interest remain pervasive. This is a continued failing on the part of the profession, which is still not doing all it can to combat it.
This became particularly concerning to me after reading a Slate article about how medical students are being pursued by advertisers for their value as “social media influencers.” In his piece, author Vishal Khetpal details how med students are blurring professional lines by peddling items like watches and, furniture on their personal Instagram accounts for profit. While the article does not mention students giving medical advice or promoting medical devices (which they absolutely should not be, as they have no credentials to be recommending anything in this vein), it seems a small step from promoting lifestyle brands to the other.
One could see how this might get messy.
Using “influencer marketing” to promote your brand or message is big business these days. It also has the potential to create a whole new level of conflicts of interest, one that the profession—and medical schools in particular—need to prepare for. As Khetpal points out, “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.”
Per the Physician Charter, managing conflicts of interest is about maintaining trust with society, something that is increasingly in peril. Med students in particular need to be reminded that the honorarium of “MD” holds more weight than the qualifications—or lack thereof—of the average social media influencer. As Khetal writes, “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.”
Granted, promoting a particular brand of scrubs or study materials isn’t nearly as egregious as extolling the virtues of a medical device you’re personally invested in. Nonetheless, as the author (and fellow med student) put it, such behavior is “impulsively antithetical to my (perhaps wide-eyed) interpretation of medicine’s ideals, of service to others over self-promotion.” (Emphasis is mine.)
Khetal is not the only one calling out this behavior in his peers. Also addressing this issue is Austin Chiang, MD, MPH, Chief Medical Officer of Social Media at Jefferson Health System. In an effort to promote transparency on social media, Dr. Chiang launched the #VerifyHealthcare campaign. The campaign encourages physicians to disclose their qualifications online and urge other users to examine who is giving them their medical advice. While it’s promising that the new generation of docs is taking up the mantle on this issue the “grown-ups” in the room must not shirk their responsibilities to be better role models. When respected physicians and CMOs of major institutions have conflicts of interest, it sends the wrong message to medical students and residents. Instead, students and residents need to be taught—and more importantly, shown—the value of disclosure and how conflicts of interest fracture the trust between the profession and society.
I hope educators and those who have logged a few years under their belts in the profession will renew their dedication to increased transparency as Dr. Chiang has done around conflicts of interest and honestly stating their credentials. We need to stress to students the importance of this commitment of medical professionalism and encourage them to wield their influence wisely. Above all, we must do what we can to ensure a positive influence on the influencers.
Lisa Miller & Daniel Wolfson