Does celebrity involvement in public health campaigns deliver long term benefit? YesBMJ 2012; 345 doi: http://dx.doi.org/10.1136/bmj.e6364 (Published 25 September 2012) Cite this as: BMJ 2012;345:e6364
Celebrities seem to appear often in news reports about health and medicine. Since 2005, my research group has recorded all health related content on all five free-to-air Sydney TV channels. As of 21 August 2011, 1657/29 322 (6%) of news items have featured celebrities, which is substantially lower than the proportion featuring people experiencing disease or injury (60%), experts and health workers (50%), and politicians (49%).1 Celebrities often get involved because of personal experience with a disease or because they share the concerns of other citizens and want to help by offering the publicity magnet intrinsic to their celebrity. And like experts, some probably calculate that a public profile on good causes might also be good for their careers.
Value of publicity
Celebrities are by definition newsworthy before they embrace any subject. When they do, again just like experts, they turn in a range of performances. Those concerned about celebrities in health campaigns invariably point to examples that have gone badly wrong or that fail to change the world for ever. They hone in on celebrity endorsement of flaky complementary medicine or quack diets, ridicule incidents where celebrities have wandered off message or blundered, or point out cases where celebrity “effects” are not sustained,2 a problem not confined to campaigns using celebrities. But they are silent about the many examples of celebrity engagement that have massively amplified becalmed news coverage about important neglected problems or celebrity involvement in advocacy campaigns to promote evidence based health policy reform.
Is there anyone concerned about action to mitigate anthropogenic climate change who is not delighted when celebrities stand side-by-side with climate scientists and thereby attract attention that a phalanx of impeccably credentialed researchers could only dream of? And on the flip side, is there anyone in public health who is not appalled when celebrities speak up for smoking (the artist David Hockney and singer-songwriter Joe Jackson); promote prostate cancer screening for men, even below the age of 40 (Australian hard rocker Angry Anderson); or blather about the odious nanny state (Formula 1 driver Mark Webber after having his car impounded for driving dangerously on suburban streets)? What does it say that we can be disgusted when celebrities try to set back public health agendas but get all bothered about celebrity efforts in campaigns that could influence millions positively?
There are some uncomfortable subtexts just beneath the disdain for celebrity engagement in health. The main one seems to be an arrogant “what would they know?” reaction. Celebrities are not experts: they can use embarrassingly naive language and may have no idea about levels of evidence or all the work that has gone before. But playing to the media’s appetite for those experiencing health problems, celebrities often speak personally and bring compelling authenticity to public discourse. A leading Sydney health and medicine reporter told me once that “Experts are fine, but they are not a living thing.”3 She went on to explain a litany of problems that journalists routinely encountered in using experts, such as an inability to imagine an audience outside their often middle to high brow cliques. A recent article by Nature’s online editor, Ananyo Bhattacharya, reminds us of the tensions between science and the media and why scientists are so often hopeless news participants.4
Why do we expect perfect outcomes after celebrity engagement yet are realistic about the need to sustain public campaigns beyond their first burst? In 1999, cricketer Shane Warne accepted a six figure sum to use nicotine replacement therapy to quit smoking.5 The challenge for the paparazzi rapidly became to be first to photograph him smoking again. It didn’t take long. Warne was a world class cricketer but a very ordinary, relapsing smoker. This was an important message that many experts failed to exploit, instead climbing on a cynical populist bandwagon about his alleged motives.
Publicity about (then) 36 year old Kylie Minogue’s breast cancer led to an increase in unscreened women in the target age range having mammography6 but also to an increase in young women at very low risk seeking mammograms and thus being exposed to unnecessary radiation and false positive investigations.7 But what if such a celebrity had instead had pre-cancerous cervical lesions detected by a smear test and her story went viral generating increased awareness of the importance of smear testing (as Big Brother star Jade Goody’s experience did in the UK)? The ambivalence about “the Kylie effect” reflects enduring debate about the wisdom of breast screening, but it should not blind us to the potential value of celebrity engagement in important causes.
Cite this as: BMJ 2012;345:e6364
Competing interests: The author has completed the ICMJE unified disclosure form at www.icmje.org/coi_disclosure.pdf (available on request from the corresponding author) and declares no support from any organisation for the submitted work; no financial relationships with any organisation that might have an interest in the submitted work in the previous three years; and no other relationships or activities that could appear to have influenced the submitted work.
Provenance and peer review: Commissioned; not externally peer reviewed.