Do health influencers actually know what they’re talking about?

A generation or two ago, when you had a medical question, the solution was obvious: Ask your doctor.

But these days, as trust in doctors and other traditional medical authorities like the Centers for Disease Control and Prevention has eroded, Americans are more and more likely to consult their Instagram or TikTok feed.

According to a major new study of popular health- and wellness-related influencers from the Pew Research Center, 40 percent of Americans — and half of adults under the age of 50 — get medical and/or wellness information from social media accounts.

What they’re encountering is a chaotic ecosystem where MDs promoting evidence-based medicine coexist alongside life coaches selling unproven peptides. Nuanced portrayals of mental health problems and how to manage them commingle with accounts that blend Jungian psychology and astrology. A registered dietitian could be promoting a whole foods diet to reduce chronic inflammation and then the next video is a self-proclaimed “nutritionist” urging you to take sea moss supplements for the same reason.

Alternative medicine is hardly new. A century ago, newspapers hawked all kinds of unproven and potentially dangerous elixirs. But social media has allowed it to proliferate and reach more people than ever before. The pandemic served as an accelerant: The nation spent months inside, scrolling our phones, desperate for information on a public health emergency. People doubted the government’s experts and sought out their own (mis)information.

Public health experts struggled to respond to the widespread skepticism, while influencers rushed in to fill the trust vacuum.

“It’s not an information deficit problem; it’s a trust problem,” Jessica Steier, a public health scientist and co-host of the Unbiased Science podcast, told me. “There’s a holier-than-thou sort of attitude [in medicine], very paternalistic. I don’t think we’re doing [ourselves] any favors.”

And so even as Covid began to subside, the distrust remained, egged on by people like now-US Health Secretary Robert F. Kennedy Jr., people who took full advantage of social media to push their own political agendas — and, often, to try to sell you something. Today, Instagram Reels and TikTok trends play a major role in the public discourse around health, perhaps rivaling prestigious medical journals.

The Pew study is a rigorous survey of this all-important digital landscape, the focal point of what I now think of as the DIY era of healthcare. Its findings reveal how and why people engage with this content — and the challenges the medical system faces in restoring Americans’ trust in evidence-based care, challenges that are multiplied by the influencer culture seeping into the federal government under Kennedy.

After reading the report and talking with a few experts, I had three big takeaways from its various findings. Let’s get into it.

People seek out health and wellness influencers because the medical system is letting them down

The Pew study shows how distrust or disengagement with the traditional healthcare system drives people toward influencer accounts. For starters, uninsured people are much more likely to get health and wellness information from social media or podcasts: 53 percent versus 38 percent of those with health insurance. It makes sense: If people can’t easily access care, they’re going to get their information from somewhere, and they’re getting it online.

“I don’t ever disparage the people that buy these products and pay attention to these [influencers] because I find that they’re victims of a system that steers them towards this information and then the platforms reinforce it,” Katrine Wallace, an epidemiologist and adjunct assistant professor at the University of Illinois Chicago who goes by “Dr. Kat” on Instagram (with 100,000-plus followers), told me. “They don’t have access to traditional healthcare, so this is what they have.”

People of color are also more likely to seek out influencer content. Hispanic (47 percent) and Black (44 percent) Americans report significantly higher consumption of social media posts or podcasts on healthcare than white Americans (35 percent). Black people in particular are more likely to say that the information they get from the influencer-sphere is extremely or very different from what they receive from traditional sources of medical authority (24 percent) than white people are (16 percent).

These are groups that have legitimate reasons to be skeptical of medical experts, starting with the fact that they are more likely to experience conscious and unconscious prejudice when they go to the doctor or to a hospital. “You do have medical distrust of the system for Black patients, Hispanic patients, Native populations because of historical stuff like Tuskegee or the horrific things that have happened to our native populations and other groups as well over the course of history,” said Dr. Cedric Dark, an emergency physician and associate professor at Baylor College of Medicine.

The Pew survey found that almost 20 percent of Black, Hispanic, and Asian Americans said a major reason they sought out influencer content was to learn about something they did not want to ask their doctor about — twice the rate of white Americans who said the same. If people don’t feel that they can fully trust their healthcare provider, or worry that their doctor won’t be sensitive to or aware of their specific needs, they might be looking online instead.

Influencers are selling their “life experience” as much as any medical credentials

When people do seek health information on social media, they are often encountering content creators with limited real-life expertise — but a compelling story to tell.

According to the Pew study, 41 percent of health and wellness influencers say they have a background as a healthcare professional, but only 17 percent of this group claims conventional medical credentials. Of all of the influencer accounts researchers looked at, 16 percent claim no particular credentials at all. Others identify as coaches, entrepreneurs, and activists. (The study combined two large public surveys of 5,000 US adults with an analysis of influencer accounts with more than 100,000 followers on Instagram, TikTok or YouTube — about 12,800 accounts in total.)

Women make up the majority of the influencer sphere — 64 percent of the accounts studied by Pew — and they are much more likely to cite their life experiences than men are (16 percent versus 9 percent). Being a parent in particular has been a selling point: People will describe themselves as, for example, an “ADHD mom” to demonstrate their bona fides to their followers.

What becomes clear when you look at these figures is that people want to feel personally connected to their sources of health information. We know that many people have lost faith in medical authorities, in part because they perceive a paternalistic and judgmental attitude from these experts. Women in particular are likely to encounter bias from medical providers, which can sow distrust. Influencers are stepping up and using their humanity — their lack of conventional expertise in some cases — to connect with people. Physicians and other experts who want people to have accurate, factual health information need to find a way to resonate with their audience in the same way.

“I think there’s a trust problem,” Steier said. “It’s not an information problem, right? If we’re trying to reach people, it’s establishing some sort of connection, right? We know that an anecdote is not evidence in and of itself, but we know that an anecdote can help us establish that relationship with the consumer of our information and help our information land.”

Young people take wellness influencers more seriously than anybody else

While I’ll admit I assumed — based on stereotypes — that it must be unsuspecting older people being sold snake oil on social media, the Pew report shows how wrong I was. People over 65 are actually the most skeptical of social media health and wellness content: 36 percent say they trust not too much or none of what they see on social media, much higher than the 24 percent share overall.

Younger people (ages 18 to 29) are the most likely to say they watch health and wellness content for its entertainment value. They are also the most likely to be spooked by what they watch: 36 percent of adults under age 30 say they get more worried about their own health based on what they hear from social media influencers, versus 27 percent for people ages 30 to 49 and less than 20 percent for those over 50.

As Dark, the emergency physician and professor, put it to me, there is a cyclical nature to our relationship with science and medicine. In the early 1900s, you had dentists offering cocaine to their patients. By the middle of the 20th century, antibiotics and new vaccines and imaging advances had ushered in a new golden age of medicine. Today, the pendulum has swung again. “We’re back at snake oil,” Dark said.

That should mean things will get better, though it may take some serious health consequences for people to realize the value of evidence-based medicine. But one of the new risks introduced by social media, and the democratization of healthcare information, is that even the next generation of experts is susceptible to misinformation. That is one of the greatest dangers of the influencer ecosystem: that it misleads not only patients, but young doctors as well. Dark says he has already seen it happen in his emergency room, with students seeking clinical guidance from social media — and sometimes not recognizing when it’s bad advice.

“Where I am more worried is, where do we go when our medical students are using the same sources our patients are and don’t know where to find the right information,” he said. “My task and challenge as an educator is to make sure that the next generation of physicians knows how to find reputable information.”

Be smart when encountering wellness influencers in the wild

The health and wellness influencer ecosystem isn’t going away. Even if you personally ignore it, you may have a friend or loved one who tries to push the ideas on you, or tries them themselves. We all need to be smart consumers of this content, to separate the good ideas from the bad, and to be able to talk with the people in our lives who do seek out this content (or who see it without trying all that hard). It can be difficult: Social media tends to reward sensationalism over nuance.

“We don’t operate in certainties,” Wallace said, noting that genuine scientific information is typically “boring, hedged, uncertain.” But, she continued, “a coach coming on and selling certainty to people, it works, right? … Somebody who’s selling supplements or coaching or maybe doesn’t have a science degree or a medical degree is basically going to win over more people because the medium rewards confidence and clarity over accuracy and caveats.”

One promising finding from the Pew report is people don’t just believe influencers by default: Only 10 percent of adults said they trusted most or all of the information from these accounts. But another 65 percent said they trusted “some” of it. The trick is knowing which information can be trusted. The trick is knowing the difference.

Based on the Pew report and my conversations with doctors who do some influencing themselves, here are some good rules of thumb about how to approach these accounts and their content.

You should know who you’re listening to. Be aware that sometimes influencers will mask their credentials, claiming to have a medical degree when in fact they have a certification from a notorious degree farm. You might look at their content differently if you know the full story.

“It sometimes is very difficult to tell. Like if someone comes on and says, ‘Hey, I’m Dr. Chris,’ and you have to click several links to find out what kind of doctor these people are,” Wallace said. “And then you get all the way there and you realize they got an online chiropractic degree or something. But they don’t say that, and you have to really dig to find out what their credentials are.”

2) Be careful about conflicts of interest

If somebody is selling you something, they probably stand to make money off it — and knowing that might change how you internalize their advice. Such sponsorships are ubiquitous: Wallace told me she has a dedicated email inbox for Instagram, and every day it is filled with offers of trips, money, and other perks in exchange for promoting a company’s product.

Wallace told me she once attended a meeting that brought together science communicators and MAHA-affiliated influencers, an attempt to bridge the gap between two groups that are often at odds in this influencer ecosystem. They were shocked she wasn’t monetizing her content, she said. It is common practice among the influencer crowd.

“This is literally their job,” Wallace said. “People aren’t going to necessarily go see why they’re saying to take this supplement — because they’re getting like 20 percent on every bottle that they sell. Of course they’re going to say that it’s great and that it helps people.”

It’s one thing to start sardine-maxxing because you hope it’ll have manifold health benefits. (Sardines are good for you, but you need a balanced diet.) It’s another thing to inject untested peptides into your body because an influencer told you to.

Finally, remember that lived experience and a sense of emotional connection can mean a lot, but it’s not everything. Somebody without conventional credentials can still offer valuable advice on day-to-day living with a certain medical condition or a sense of camaraderie; 21 percent of respondents in the Pew survey said “a major reason” they sought out this content was to hear from people who share their beliefs and another 43 percent said it was a minor reason.

That is totally valid, Dark said. But, as the report makes clear, most of these influencers aren’t actually physicians — and you shouldn’t listen to them as if they are. If you have serious medical concerns, please: Ask your doctor.