Do celebrities influence our health?
We look at three examples of celebrity star power influencing health behaviors.
Celebrities seem to be able influence all kinds of decisions we make. Some of these decisions are minor, like how we style our hair (“The Rachel” seems to have made a comeback with the popularity of Friends on today’s streaming platforms). Other decisions that carry more consequences, such the purchases we make both big and small, can also be swayed by celebrities—to the point that companies spend millions on celebrity endorsements to sell their products.
But can celebrities influence our life-and-death health decisions, too? Yes, according to a growing body of research.
Angelina Jolie and BRCA gene testing
In 2013, the actress Angelina Jolie wrote a highly publicized essay in the New York Times about her decision to undergo a preventive double mastectomy to reduce her risk of breast cancer, for which she was at increased genetic risk. In the essay, she endorsed genetic testing for BRCA1 and BRCA2 genetic mutations that place women at increased risk of breast and ovarian cancer, stating:
I choose not to keep my story private because there are many women who do not know that they might be living under the shadow of cancer. It is my hope that they, too, will be able to get gene tested, and that if they have a high risk they, too, will know that they have strong options.
In a study published in 2017, Bapu and economist Sunita Desai took a look at insurance claims data to see what effect Jolie’s announcement might have had. Since the timing of her essay was as good as random with respect to everyone else’s risk of breast cancer, any differences occurring just after the publication of her essay could reasonably be attributed to Jolie’s message. Here’s what the data showed:
Following the May 14th, 2013 publication of Jolie’s essay, there was a sudden increase in the rate of BRCA genetic testing. Looking at the same time period in 2012, which served as a “control” year where there was no essay published on that same day, there was no such jump. The best explanation for this increase in testing was Jolie’s essay.
The next question is whether this increased testing led to any more women finding genetic mutations and taking the next step, as Jolie did, of a preventive mastectomy. The analyses showed that mastectomy rates didn’t change in the subsequent months, suggesting that the additional tests brought on by Jolie’s essay might have been spurring women who were already at low risk of mutations—and thus unlikely to ultimately need preventive mastectomy—to get tested shortly after her essay. Subsequent research, however, suggests that the years-long duration of the “Angelina Jolie effect,” led, over time, to preventive mastectomies (and thus, hopefully, lives saved).
Nevertheless, it’s hard to deny that a movie star was able to motivate health behaviors. Jolie’s essay was shared around the world, and similar increases in genetic testing were seen in the UK as well. She went on to pen another essay about her decision to have her ovaries removed because of her increased risk of ovarian cancer.
Katie Couric and Colonoscopy
Two years after her husband passed away from colon cancer, television journalist Katie Couric chose to broadcast her experience undergoing a screening colonoscopy live on the Today show (clip below) in the year 2000.
As with Jolie’s essay, the timing of Couric’s televised colonoscopy (on one of the most watched shows in the country) was as good as random as far as everyone else was concerned—any changes in colonoscopy rates from before and after the televised procedure could be attributed to the increased awareness she was trying to spread. Here’s what a 2003 study of the “Katie Couric effect” found:
In the months following Couric’s televised procedure, there was a sudden increase in colonoscopies performed. The researchers estimated that after accounting for a general trend in increased awareness of colonoscopies, the effect lasted for about 9 months—particularly among women.
Because colon cancers tend to take a long time to grow and cause problems—which is why we can get away with waiting 5 or 10 years between screening colonoscopies—the study wasn’t able to determine the extent to which the effect led to a reduction in diagnosed cancers or lives saved (but there’s a good chance that it did, since unlike breast cancer genetic testing, colonoscopy is recommended for everyone at a certain age).
Again, we see a celebrity able to influence health behaviors in the larger population (although it’s unclear if her accompanying Jimmy Kimmel on his televised colonoscopy in 2018 had a similar effect).
Charlie Sheen and HIV testing
In 2015, actor Charlie Sheen revealed in a television interview that he had been HIV-positive for four years. Unlike Jolie’s and Couric’s, this publicized announcement was not intended to promote preventive health behaviors. Nevertheless, one study showed that after this announcement, internet searches for symptoms of HIV, HIV testing, and condoms spiked in the 24 hours or so following his announcement.
A subsequent study examined sales of the OraQuick at-home rapid HIV test around the time of Sheen’s announcement. Sales of the test were 95% higher the week of his announcement—a record high—and remained elevated for about a month. The researchers estimated over 8,000 additional sales of this test alone attributable to Sheen’s announcement, about 7 times the number of additional tests sold on a typical World AIDS Day.
These are a few very high profile examples with compelling data to suggest a celebrity effect on health behaviors. We imagine that with the right data, it wouldn’t be hard to find other examples of celebrities motivating people to do things they know they “should” do, like get screened for diseases.
We of course didn’t talk about celebrities motivating unhealthy behaviors—perhaps that’s a post for a different day. But it’s important to remember that a celebrity is going to be more likely to motivate someone to do something they were already inclined to do—whether it’s trying out a new restaurant, switching car insurance companies, or finally scheduling that colonoscopy—than they are to completely change someone’s mind.
Great analysis! I think it gets murky when the celebrity believes strongly in the appropriateness of the intervention but this isn't in line with the evidence base or standard of care-- pandemic examples abound. In these cases, they aren't trying to motivate unhealthy behavior, but they have a powerful influence on behavior that isn't driven from anything beyond personal experience.
Food for thought for non-celebrities in the current media landscape where getting a platform for yourself is easier.
On a related note, are people following the John Green/Tuberculosis story? It's a crazy one about celebrity impact, and one that really instills hope in the idea of a well-informed community getting to work.