COMMENTARY

Med Student Instagram 'Influencers' No Different From MDs on Pharma Payroll

Vinay Prasad, MD, MPH

Disclosures

May 09, 2019

This transcript has been edited for clarity.

Hi. I'm Vinay Prasad from Oregon Health and Science University, where I'm an associate professor of medicine and hematology-oncology.

I want to talk about something I had read recently. It was about a new class of Instagram influencer. This time it's medical students. The article[1] talked about a few medical students who are quite active on Instagram. They had followers that range from 40,000 to nearly 3 million, and they mostly post pictures of themselves doing the sorts of things medical students do—studying in coffee shops, practicing CPR, wearing scrubs. But these are highly visually appealing photos and they have drawn large followings.

But that wasn't the problematic part. The problematic part was that the students had taken their influence and used it to make a little bit of money. They were advertising things like watches, scrubs, dermatologic products, and protein powder, and they were receiving compensation for posting about those products on their Instagram feeds.

That created quite a controversy on social media. There was a growing perception on social media that this is not what we want. We want medical students who are devoted to being the best doctors they can be, not devoted to making a profit by selling scrubs or watches. We want students who focus on their studies and not on their Instagram accounts. And I think there are a lot of people who share that sentiment; it was a very strong intuition on social media.

I understand that sentiment. But I find it interesting that we don't extend that sentiment to so many other things in biomedicine. Many of the experts in hematology-oncology receive personal financial payments from corporations that sell products to patients. These are the same experts who are then asked to weigh in on the evidence to recommend these products for off-label purposes and recommend them as part of guidelines.

So we have an analogous situation in biomedicine: Academic experts are receiving money from the companies whose products they recommend; it's a lot like medical students receiving money from a scrub maker and then recommending those scrubs. Yet in the case of the students, we view it as problematic, whereas in the case of the doctors, increasingly we accept it.

Over the past few months, we've seen a growing backlash against these relationships. A lot of people have been unhappy with failures to disclose financial conflicts. But the real question is, do we need these conflicts? Do they serve a purpose or are they deeply problematic toward the core professional values of our field?

I'm not talking about research payments. I'm talking about the personal financial payments that both expert physicians and these medical students are receiving. So I want to raise the idea that if you are troubled by your students going on Instagram and selling protein powder, you might need to look in the mirror if you are recommending the off-label use of expensive anticancer medicines with real toxicity in the setting of ambiguous medical evidence, and you're receiving payments from serving on the advisory board of those companies.

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