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Marcus Johnson (00:01):

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(00:24):

Hey gang, it's Monday, March 23rd. Beth, Rajiv, and listeners, welcome to Behind the Numbers, the emarket podcast made possible by Rokt. I'm Marcus, and joining me for today's conversation, we have two of our senior digital health analysts with us. Living in Pennsylvania joining us, Beth Snyder Bulik. Welcome to the show.

Beth Snyder Bulik (00:42):

Hey, Marcus. Thanks for having me.

Marcus Johnson (00:43):

Hello. Yes, indeed.

Beth Snyder Bulik (00:44):

Happy to be here.

Marcus Johnson (00:46):

We're also joined, indeed, we're also joined by ... No. Yes. Living in New Jersey, we're also joined by Rajiv Leventhal.

Rajiv Leventhal (00:54):

Hey, Marcus. How are you?

Marcus Johnson (00:55):

Hello, sir. Very good. How are you?

Rajiv Leventhal (00:58):

I am good.

Marcus Johnson (00:59):

Fantastic. Today's fact. I thought this was quite appropriate, this fact of the day, given what we're talking about. Where did the term snake oil salesmen come from? We're talking about health influencers, and some of them are telling the truth, some of them not so much, whether on purpose or accidentally. It seems as though health misinformation has quite a long history. It goes back to this term snake oil salesman, which originated in the 19th century. It started when Chinese railroad workers brought authentic anti-inflammatory, Omega-3 rich Chinese watersnake oil over and used it for joint pain, but then there was an American entrepreneur, if you can call them that, Clark Stanley, who rebranded this and was selling fake, non-effective, ineffective, rattlesnake oil remedies. It was 1916 to '17, federal investigation determined that Stanley's snake oil had nothing to do with snakes and was in fact just mineral oil, and so that's where we get the term snake oil salesman.

Rajiv Leventhal (02:18):

Always comes back to healthcare, huh? Apparently.

Marcus Johnson (02:24):

Today's real topic is social media's growing role in healthcare decisions. All right. Beth, 55% of American adults say they use social media to access health information and advice. At least occasionally, according to KFF, Kaiser Family Foundation, these shares increase when asking young adults and people of color, but why? Why are people turning to social media for health advice?

Beth Snyder Bulik (03:01):

Yeah, I mean, it's a great question, but I would say at its base or at the base level, it's just like people turn to their social networks for advice about beauty trends or fashion, they're also looking to those same social networks for advice and information about health conditions, or health and wellness trends, or even products. Of course, health conditions are more serious than beauty products, of course, and that's part of the reason why they're looking to physicians and patient influencers most, so physicians, professionals with a medical degree, nurses and others. Then also, on the patient side, people who have the same condition that they might have, or that a family member might have and they're going through the same health journey.

(03:43):

We also know that to a lesser extent, celebrities are being followed by people for healthcare information. That's about 24% according to our survey, so about a quarter of people are following celebrities who offer health information. A lot of the times when you see a celebrity offering health information or health advice, it's around a loved one or themselves having that condition, as well, so they fall into the patient category as well.

Marcus Johnson (04:06):

Right, right. Okay. There's lots of different groups of people here. We've got celebrities, we've got physicians, we've got people with the condition. We've just got just other people who are talking about the condition, but they're on social media, and social media is something that we do a lot every day. Our numbers, our forecasting team says that we're on social media about somewhere between an hour-and-a-half to two hours every single day. Part of this, Rajiv, is just, isn't it just they're turning to social media for health advice because it's convenient?

Rajiv Leventhal (04:41):

Yeah.

Marcus Johnson (04:41):

Americans were asked what they liked most about getting news on social media, just regular news, and they overwhelmingly said the convenience according to Peer Research Center, so part of this is just they're there already.

Rajiv Leventhal (04:53):

Right. Yeah, and technology in general, of course, has kind of bridged the gap between consumers and expert opinions or professional information, and healthcare is really no different. I think in addition to what Beth said at the top, another big piece is that the healthcare system isn't always accessible for everybody. That often varies depending on your situation in terms of where you live and what insurance coverage you have, factors that drive people to technology and to online tools to look up information, engage with others. In an ideal world, that type of information, I think, would supplement what your regular physician or what a medical professional tells you from their expert opinion and experience, but that's not always the case. It can be a thing where it sort of overpowers the traditional access to the medical system.

(06:05):

In many parts of the country, you can't get an appointment with a specialist or even a primary care doctor for a long time. Even if you could, it might require taking time off of work, or transportation, or some sort of other financial piece that might not be realistic or reasonable, and this turns people to influencers and really just to information in general via digital channels such as social media.

Marcus Johnson (06:34):

There's a number to back that up. There's a great, great, great CNET article by Anna Graggart, and she was noting a 2023 study by the National Association of Community Health Centers and the American Academy of Family Physicians found over a hundred million Americans, so a third of people, face barriers to accessing primary care. That's doubled over the last 12 years.

Rajiv Leventhal (06:57):

Yeah, and medical professionals, whether it's healthcare and pharmaceutical brands, they know this and they need to be meeting people on the digital channels where they're spending more and more and more time on social media, just for an example of that.

Marcus Johnson (07:13):

Yeah. There's also a bunch of other problems. There's fallen reimbursement rates. There's the admin challenges facing smaller practices. There's family medicine being one of the lower paying specialties, and students are less inclined to get involved there, so there's a host of reasons why it's harder to get access to a smaller local GP and why people are turning to the people online.

(07:43):

Beth, one of the findings from your recent research on this that struck me was that one of the main reasons, which it seems to be also one of the main reasons people go to the doctor, but one of the main reasons people were telling these people on social media for health advice was empathy.

Beth Snyder Bulik (07:59):

Yeah. Edelman does an annual trust study, and the reason why people turn to health influencers who aren't healthcare professionals, I should say-

Marcus Johnson (08:10):

Right.

Beth Snyder Bulik (08:11):

... the top reason was because they're looking for empathy.

Marcus Johnson (08:15):

Yeah, more so than having direct experience with a specific health issue.

Beth Snyder Bulik (08:21):

Right.

Marcus Johnson (08:21):

They wanted to [inaudible 00:08:22].

Beth Snyder Bulik (08:22):

Although that was one of the top things, too. Yeah.

Marcus Johnson (08:24):

It was high. It was high. Yes. Yes. It was really interesting.

Beth Snyder Bulik (08:25):

That would be the more of the patient experience, that you're in my shoes, too, talk to me. The empathy is a really interesting part of this, and it could be, as Rajiv said, there's time pressure and then there's fewer physicians, so you're spending less time with patients. It may not be purely a lack of empathy on the healthcare professionals part-

Marcus Johnson (08:48):

Right.

Beth Snyder Bulik (08:48):

... but that they're time crunched, they just don't have the amount of time to sit and talk whereas you can go online and find a healthcare influencer who's going through your same thing. And it could be a doctor as well who's talking about it from their professional point of view; here's what this condition is, here's what it means, here's what you should be thinking about. I don't think that a lot of influencers give outright advice just because everyone's cautious about that. Certainly physicians don't give advice on social media, but general health guidelines and those sorts of things. Then the patients are talking about their own journey. Actually, you're probably more likely to get patients talking about the kind of drugs they're taking or giving advice because they don't follow those same medical ethic codes, ethical codes.

Marcus Johnson (09:32):

Yeah.

Rajiv Leventhal (09:32):

And related-

Marcus Johnson (09:33):

Please.

Rajiv Leventhal (09:33):

... quickly to the empathy piece, I think is people who feel that their symptoms have either gotten misdiagnosed, or misunderstood, or unaddressed somehow, which happens a lot, especially for certain symptoms and conditions, whether that's women's health or weight loss or mental health, or maybe even issues that are highly sensitive and you're not comfortable really talking to a doctor who you might not know really well.

Marcus Johnson (10:00):

Good point.

Rajiv Leventhal (10:01):

Well, now you have different types of communities online of people, whether they're patients or physicians who are specifically talking about and discussing and bringing to the forefront these types of maybe previously stigmatized issues or misdiagnosed unaddressed issues. You kind of have this whole other world where you can get access to that information other than being maybe a little bit embarrassed, and that might not be the best word, but just a little bit hesitant to go to the doctor to talk about a specific issue or symptom.

Marcus Johnson (10:36):

Yeah. Yeah. I was trying to think through why you would go to the doctor because I was saying to Beth, and you, Rajiv, as well, why would people turn to social media? It just doesn't make any sense to me. But then there's so many reasons that you guys brought up, which got me thinking as to why, and one of them we're talking about. One is that before if you could get a 15-minute quick appointment with a doctor a month down the road, you'd be lucky. And with social media and influencers, you can spend a lot more time with them whenever you pull your phone out and feel this kind of parasocial relationship with these folks.

(11:12):

Part of that, I think, which I thought was a really good point being made, this is from Jessica B. Steyer, who she holds a doctorate in public health and she's executive director of science literacy lab. She was saying that health influencer videos can feel very empowering, as well. She said, "What wellness influencers do very well is make it seem like if you do X, you will be healthier." It makes people feel as though they have a ton of control over their health and that's empowering, so I thought that was a really good point.

Rajiv Leventhal (11:38):

Beth made a good point, I think at the top, though, around it's often not a personalized advice because the influencer or person you're engaged with on social doesn't have all of your lab history and what's been wrong with you and what's your family history and your genetics looks like, so a lot of it is often that general wellness advice, public health messaging, things like that, try this product. I think it's important to just have the disclaimer, or not even the disclaimer, but important to keep in mind that it's not a one-to-one replacement for doctors. It's a tool that should provide, hopefully will provide good, reliable health information, but still not the same type of advice that your doctor could give.

Marcus Johnson (12:31):

I found something that was speaking to that kind of overgeneralized health messaging piece, the study by the University of Vienna published in the National Library of Medicine, noting that health expert content creators highlighted the complex role of social media influences in public health, acknowledging their potential to promote positive health behaviors, whilst also noting the risks associated with the spread of inaccurate or oversimplified health messaging. The findings emphasize the urgent need to broaden health communication research, to address not only misinformation, but also overgeneralized health messaging, which can be equally as detrimental. We talked about the groups of health influencers. There was some research, I believe this was in your report as well, Beth, looking at who they are, so doctors or other medical professionals, that's most of them or the biggest share. Then you've got medical people with an interest in the medical condition. Then you've got celebrities that's seeing a lot of growth. Caregivers is another group. But who are they? Do we have some examples, Beth, as some popular health influencers?

Beth Snyder Bulik (13:29):

Yeah, I mean, first of all, I would say a health influencer can be anyone. Anyone with a social media account who talks about health issues and has a following.

Marcus Johnson (13:36):

Right.

Beth Snyder Bulik (13:37):

We do talk about there's nano or micro influencers who may have small groups of following, just a couple of thousand. I think those are more common around things like rare conditions. There's a young man named James Parkin. He's a YouTuber and a Facebooker who has a, he calls it living life DMD style. He has a muscular dystrophy condition called Duchenne Muscular Dystrophy, which only affects males, and he talks about living life DMD style, and he only has a couple of thousand followers.

(14:15):

But I think when you're talking about some of the popular well-known healthcare influencers, one of my favorites is Dr. Sandra Lee. She's the Dr. Pimple Popper. She's a dermatologist. She has TV shows on TLC and Lifetime. She has 4.6 million Instagram followers, and she does talk about her dermatology cases, and the pimple popping, of course, and the behind the scenes of her show, but she also has several sponsorships. She works for SunPharma. She's got an acne campaign that's active with them. UCB Pharma as well for a particular condition, this is a rare condition called hydrodonitis superativa, which is a really serious cystic skin condition and it happens more often in women of color. There are those partnerships, and sometimes people know about them and sometimes they don't with those big well-known influencers. I think you know more often because they're very upfront, they have to be. It says sponsored or an ad tag to them.

(15:20):

There's another one, another very popular healthcare influencer named Dr. Zach Rubin. I actually follow him. He's a pediatric allergist and a clinical immunologist. He came to prominence during the COVID era, I guess we're going to call it that. Anyway, he has two million TikTok and Instagram followers. I follow him because my kids have allergies and food allergies, but also I really like the way that he explains things in medical terms, current events in a really relatable way. He's very empathetic. He does debunk misinformation, but he's really kind and relatable. I think I'm probably typical of people who follow health influencers, right? I follow him for a reason, my kids have allergies, but also I can understand his content. He talks to me in an empathetic, kind way. The thing that everybody said, right, they want empathy.

Marcus Johnson (16:14):

Yeah. Yeah. Rajiv, who are some of the ones that stand out for you?

Rajiv Leventhal (16:18):

Yeah, and I think the key point is that really anybody can be an influencer. You have these medical professionals who have specialized areas that they discuss. They have maybe brand deals with drug company, medicine companies that create products for these conditions. And then, you have celebrities who you wouldn't even think are remotely involved with healthcare. Tom Brady is an influencer, and you might think, how? Well, he's got the brand connection with a fitness company now. He's the chief wellness officer at this company called eMed that's essentially a health management and telehealth company that's involved in weight loss drugs, and you might think, well, what is he influencing? Well, if someone as famous as Tom Brady, who almost everyone in the world knows, is promoting something, is discussing something, you're an influencer, right? And then I think of influencers. I think this sort of market really emerged, at least in the healthcare space, during the pandemic, during the COVID pandemic.

(17:25):

I think of people like Dr. Sanjay Gupta, who was really present and visible on CNN and on his social media accounts as someone who really wanted to set the record straight with what he perceived was misinformation around vaccines and COVID drugs, things like that, treatments that you should take if you have COVID, a lot of, and we don't have to go back, how much misinformation was spreading so rampantly during that time. I think those are some of the people that are most well-known because it's not tied to a product or even a disease. It's really just disseminating reliable, trustworthy, evidence-based medical information to people who badly need to hear it. And again, there's no necessarily endorsement there or even talking about a specialized condition. So it really falls in different buckets. Patients or medical professionals who are talking about a particular health issue, celebrities who probably have some sort of brand deal, and then, honestly, those who are just doing a public good and using their experience and expertise to spread reliable medical information to the public.

Marcus Johnson (18:43):

Yeah. Some of these [inaudible 00:18:46].

Beth Snyder Bulik (18:43):

Yeah, that's a really good point.

Marcus Johnson (18:43):

Please, please. No, no, no.

Beth Snyder Bulik (18:47):

Yeah, I just want to say that because when you talk about rare conditions, or even a typical health condition, say migraine, you may not know anybody else who has migraine, so you don't know what are some good things to do. You go to find a health influencer who also has migraine and then you can join that community or just find that person and listen to what they're doing. I sit in the dark, I took sugar out of my diet, those kinds of things. It doesn't necessarily, yeah, [inaudible 00:19:18] it doesn't have to be straight medical advice or from big platforms. It's that, again, we're back to seeking community, seeking that empathy and reassurance when you have a health condition.

Marcus Johnson (19:32):

A lot of people, sorry, quite a few influencers have pretty big followings. There's one, Dr. Mike Varshavski-

Beth Snyder Bulik (19:40):

Yeah.

Marcus Johnson (19:40):

... Dr. Mike, board certified family medical physician of 29 million social media followers. It can be a good thing if the information that you're providing is accurate. It could be a bad thing if it's not so much. There was this group, in 2021, the Center for Countering Digital Hate found there was 12 anti-vaxxers also known as the [inaudible 00:20:04] information does and responsible for 65% of anti-vaccine content on Facebook and Twitter. This was after they analyzed over 800,000 posts on the platforms. It could be a very small amount of people reaching a ton of other people with information, and so that brings me to the question of how hard is it to disseminate what is good information and what's bad? Also to that point, Beth, how much do people actually trust the information they're hearing from health influencers compared to someone like a physician who's not on social media, I should say, because some physicians are.

Beth Snyder Bulik (20:45):

Sure. I mean, we do know that physicians are the number one trusted source for healthcare, which translates to health influencers who are physicians as well, but in real life, you trust your doctor most. The interesting thing is the people who they trust second is their family and friends, right, so it's, again, an extension of that, family and friends on social. You may not know the person directly, but they're in your network. You've followed them for some time, you consider them a friend.

Marcus Johnson (21:15):

Yeah. Rajiv, it's interesting because there's this paradox, paradoxes with a lot of things, but particularly with people's online behavior. One of them is the social media news paradox where when it comes to getting news on social media, according to peer research, more than half Americans say they get news there, but also the majority of people who get news there say they don't trust the news they encounter on these platforms. What's your take on trusting social media or trusting healthcare influencers?

Rajiv Leventhal (21:41):

Yeah, it's the same thing. I mean, I have a theory, and it might even just be a common sentiment at this point that people like to say they don't trust information on social media, but they do because they continue to engage with it. I'm not saying they trust all of it, but they trust enough of it to go back and continue to interact with it and they act on it. I mean, a big section in Best Report, and a report I have coming up, is how people act on online health information, social media being a big part of that. Often the result is maybe purchasing a product or asking a doctor about a medication or taking some other, or maybe it's just conducting further online research, which is probably the most common type of action taken after seeing an ad on social media, after seeing some social media medical information, some content, a video, what have you. I think it does inspire. It does inspire action.

(22:43):

Just going back to the trust, people, again, when people are polled about this, they'll say they don't trust health information on social. KFF had a good poll late last year asking people about all these different platforms, people who are already on these platforms. And while younger people are a little bit more likely to say that they do trust health information on social than older people, pretty much every platform got worse views and they got worse perceptions, they got positive ones in terms of the health information on there. More people said they trust none of the health information on social than people who say they trust most of it, and that's on TikTok, YouTube, Reddit, Facebook, Instagram, and X, so pretty much every platform, every major platform. So why is that?

(23:35):

I think people are wary of the misinformation for sure, but it's almost like a psychological thing. If you're asked about trusting internet content, social media content, especially something as serious as health, you're going to be like, no, I know enough to spot out and discern the good information from the bad, but in reality, I think it's a much more gray area than that.

Marcus Johnson (24:05):

Yeah, and the stakes are so much higher here. There's this one example I was reading about, Stephanie Alice Baker, associate professor of sociology at the city, St. George's University of London, analyzed 200 videos in a study last August. She found 81% of cancer cure videos on TikTok featured false or misleading advice. When we were talking about what to cover for this episode, Beth, I was saying to you, where's the good here, and we decided to phrase the question this way. Which areas of the health influencer space raised the fewest concerns?

Beth Snyder Bulik (24:45):

I think it's back to that sort of trust in the medical professionals and the posts and comments, our study found that 55% of people trust medical professional health-related posts and comments. Dr. Social Media was also the most trusted. Boomers especially trust Doctor Social Media content, 61%. Back, again, to the patients, half of people who follow another patient who has the same condition that they do or trust them. I'm sorry, one-third of them say they trust them. Half of them follow someone who has a similar condition. But still, I mean, that's really high. We're back to that who you trust, who do you believe. Like Rajiv just said, you understand you have enough of an understanding about your health, about the healthcare system that you feel like you can discern, so I think that I trust this physician. I trust these patients. It's almost like it's real life on social media. Who do you trust? You trust your doctor in person, you trust your friends and family, you trust other patients, other people like you. It translates to the healthcare influencers who are putting out content online.

Marcus Johnson (25:57):

Yeah. Let's end here. At the end of your report, you have some recommendations for healthcare and pharma marketers. What's your number one?

Beth Snyder Bulik (26:13):

We know that influencers aren't some niche strategy. Most marketers are already thinking about it, growing their plans. Three-fourths of brands say they're going to increase their influencer budgets. I think the focus is shifting from these kinds of one-off campaigns, hiring someone who has, say, a heart condition to represent you, to talk about your medicine, or even just to talk about getting screened for a heart condition on social media, and instead building relationships over time. Brands, marketers are sort of shifting from that one-off relevant, one-off campaign, to more like, okay, let's build a long-term relationship with you and then also with your audience.

Marcus Johnson (26:56):

Yeah. Yeah. Rajiv, anything to add here?

Rajiv Leventhal (26:59):

Yeah, I'm not sure if it's in the report, but thinking through recommendations, it's really understanding the core issues and challenges that people have with the healthcare system and why they're turning to social media to fill that gap. A lot of it's around access and cost. Reddit's a good example of, it certainly is not an influencer heavy platform as it relates to healthcare and pharma specifically, but it could be an opportunity to look at what people are discussing around this medication. They're interacting with people in a community that have maybe a similar condition as them, or they're taking a similar treatment on a similar medication journey, but there's insurance issues, there's cost issues, there's access issues. Understanding those and then trying to develop a marketing strategy or even an influencer strategy to try to address those concerns, I think is something that marketers across healthcare and pharma need to be thinking about.

Marcus Johnson (28:05):

Yeah, many, many more recommendations in the full report that Beth just put out, Healthcare Influencers and Creators 2026. If you're a Pro Plus subscriber, emarketer.com is where you need to head, otherwise, there's a link, of course, in the show notes. Just one more time to promote this article by Anna Graggart, it's a long form piece, and it's absolutely brilliant from CNET, how wellness influencers spreading misinformation signals a deeper problem within our healthcare system. Check that out as well. I'll throw a link in the show notes if we can. That's all we have time for for today's episode, though. Thank you so, so much to my guests. Thank you first to Beth.

Beth Snyder Bulik (28:41):

Thank you, Marcus. Great to be here.

Marcus Johnson (28:43):

And, of course, to Rajiv.

Rajiv Leventhal (28:44):

Thanks, Marcus.

Marcus Johnson (28:46):

Yes, indeed, and thanks to the whole production crew and to everyone for listening in to Behind the Numbers, an emarketer podcast made possible by Rokt. Make sure you subscribe and follow, and leave a rating review if you can. Susie will be here Wednesday with more re-imagining retail. I hope I get to hang out with you on Friday.