Gullible Us!

"Now you have Instagram, Facebook and YouTube, which are the principal ways social media-savvy doctors promote procedures and also sidestep guidelines about what's an ethical transaction with the public as a licensed physician."
"It's become a treacherous market for consumers to make informed decisions. It's risky because grey zones are being blurred and becoming more promotional than educational."
"Back in the early days of broadcast media, there was a lot more actual medical information."
"The risks are consumers may not get a balanced representation of benefits, risks and recovery. Patient testimonials may be paid for or bought with free procedures and there are confidentiality issues."
Dr. Stephen Mulholland, SpaMedica clinic, Toronto

"[Facebook has taken steps to] reduce posts with exaggerated or sensational health claims and posts attempting to sell products or services based on health-related claims."
Facebook product manager Travis Yeh

"You don't have to do the best work or be the most qualified to be famous these days; you just have to have a great on-camera personality and enjoy promoting yourself."
"Where are the credentials?"
"We're not supposed to have before-and-after photos of testimonials [under professional regulatory guidelines], yet they're everywhere on social media." 
"The problem is the industry has taken off at a rapid rate, and it's a huge task for the college to undertake. Without any regulations being enforced, it's gotten to be potentially dangerous [to the consuming public]." 
Dr. Diane Wong, founder, medical director, Glow Medi Spa, Toronto

Image credit: Shutterstock.com

Most medical-licensing jurisdictions all over the world expect licensed practitioners to observe ethical professional regulations governing how health practitioners promote themselves. Unfortunately, social media appears to have opened the door to both fake 'doctors' and licensed medical practitioners who bypass those rules in the greater personal interests of achieving public acclaim, a social-medical reputation and a pathway to growing a lucrative business.

Complicated by the fact that many jurisdictional rules imposed on the medical professional at an age before the advent of social media are not only outdated but also neither tracked nor seen to be properly upheld by the very professional governing bodies whose own responsibility seems to have been abdicated in the face of popular resistance. Dr. Austin Chiang, a gastroenterologist, became the first "chief medical social media officer" at Jefferson Health in Philadelphia, a major medical centre.

Starting with his influence through 23,000 Instagram followers, he plans to recruit health professionals to join in a battle against false online medical claims, claims he names as the "biggest crisis" in modern health care. He became founding president of the Association for Healthcare Social Media in May, the first such "professional society for health professional use of social media".

This is a complex dilemma, where certified medical professionals have taken to giving advice on social media in fields they have little-to-no experience in. These doctors and "nursefluencers" are tech-savvy millennials not yet graduated, or just recently graduated from medical school, and they have amassed large followers.

Social media and global healthcare. Pexels.com

Alongside their own entrepreneurial spirit they are in league with Mommy bloggers and fitness influencers who share paid endorsements of medical implements such as contraction monitors used by pregnant women, breast implants, psoriasis medications -- along with an assortment of untested supplements and tinctures.This, apart from a growing cohort of ambitious, tech-savvy entrepreneurs claiming to be medical professionals as they build their careers.

To take the College of Physicians and Surgeons of Ontario, their regulations are badly in need of an update. Those regulations which were mandated in 1994 before the avalanche of social media medical gurus swept the consumers of social media off their feet, are not themselves enforced. An 2013 update, "Appropriate Use of Social Media by Physicians" guidelines failed to establish new expectations for physician behaviour on social media.

Instagram influencers promote personal brands, while doctors and nurses post their own staged photos, themselves dressed in hospital scrubs for that authentic look. Dermatologists and plastic surgeons are attractive to the public which is exposed to miraculous before-and-after photographs of breast reduction or enhancement surgeries and liposuction. Unsurprisingly, most videos are geared toward a female audience.

Specialties such as sleep nutrition and longevity enjoy a popular general appeal. Doctors who post their thoughts and recommendations also post recipes and personal exercise routines along with the medical advice they proffer to the gullible public. According to Shae Greenfield, the College of Physicians and Surgeons of Ontario senior communications advisor, its guidelines are "intended to help physicians apply existing policy and legislative requirements to the use of social media".

"That policy advises physicians to exercise caution when posting information online that relates to an actual patient and to avoid posting content that could be viewed as unprofessional." Indeterminate enough to be interpreted in such a way that it can benefit the eye of the beholder. As for enforcing rules: "The College works to enforce these regulations, but the recent proliferation of social media has made this work more challenging. In light of these changes, the College is exploring options to better communicate to physicians about their obligations when using social media." By-and-by.


Dr. Jen Gunter, OB-GYN -- as well as a pain medicine physician -- known as "Twitter's resident gynecologist" with her 182,000 followers, proposes the creation of a better medical internet and to challenge rampant distortions about the female reproductive tract. Gwyneth Paltrow's natural birth control plants, coffee enemas and garlic in one's vagina are all outrageous to her professional and moral compass.

Dr. Matthew Alker, a professor of neuroscience at UC Berkeley, and sleep scientist at Google, along with Dr. David Gorski, surgical oncologist at the Barbara Ann Karmanos Cancer Institute, don't feel the need to have Instagram accounts, but they represent the most principled of certified medical practitioners, prioritizing information distribution and education over self-promotion.

"I'm not sure someone's going to die because of social media, but it leads patients into unregulated environments."
"They may go in for what seems like a [harmless] injection around the eye, and end up going blind permanently."
Dr. Stephen Mulholland

Salzhauer performs surgery while a social media assistant records it on Snapchat.Photograph by Jeffery Salter. Redux Pictures.