Empowered Health


Ep. 55: Influencer Mania: The unregulated business practice that you’re friends with, featuring Dr. Sophie Boerman and Suzanne Zuppello

Influencers aren’t just promoting beauty, lifestyle, and fashion products anymore, they’re posting #ads with medical devices, pharmaceuticals, and even testimonials on surgical techniques. But is this ethical? Dr. Sophie Boerman, who studies consumers’ understanding of sponsored content, helps us understand why these posts are so influential. Suzanne Zuppello, who has been reporting on the trends in health sponcon, breaks down the ways the government has failed at regulating these ads.

Show Notes + Transcript

Emily Kumler: I’m Emily Kumler and this is Empowered Health. If you’re listening to this in real time, you are probably at home isolated because of the coronavirus. I am at my house with my family where I am learning to become a teacher and giving me all new respect for kindergarten and second grade teachers, which I’m finding I am not very good at. But I’m also realizing that I’ve spent a ton of time on social media and I became way more aware of who was targeting me and what the ads were that were targeted me, which I thought I was already pretty aware of. But I think the ads started to change around this virus. So now I get lots of things about how to keep your house clean and things about how to keep your kids occupied for like 20 minutes, many of which I’ve actually purchased. And I’ve realized we’ve been working on this episode that we’re going to share with you guys this week, that’s all about influencers for a while now. Like these interviews have been taped, but just like last week’s episode, which was on solo moms, which ended up having a really sort of, I feel like it took on a new, more poignant message because of this virus. I also feel like this episode kind of takes on a little bit more of a serious tone given that we’re all sort of stuck at home and maybe a little bit more vulnerable to what we’re seeing online. So, I mean, I don’t think I need to explain what an influencer is too much. I think there is some confusion both legally and just the way we observe it, that people who are influencers are not always people who have a million followers. They can be people who only have 5,000 followers and they’re just sent free products and they promote those products. And you may not always be able to tell that they’re getting the products for free, but they are. And in sort of more worst case scenarios, they’re really pushing products like supplements that may be dangerous and they’re acting as if they’ve taken them. And we’re going to get into all of that because I think from the perspective of women’s health and of women’s experiences, it’s really interesting to think about the sort of safety nets that we have as a culture, especially sort of fairness in advertising laws and that companies are not allowed to advertise products and make claims about them that are like basically lies or inaccurate. Now there’s one exception to that, which is the lottery, which was a totally different story, which I’ve researched extensively and it’s kind of unbelievable that the lottery is exempt from fairness and advertising laws, but nobody else is. So if you’re a healthcare company and you’re trying to sell some sort of device or vitamin or whatever, if it’s not been approved by the FDA, you have to say that. And when I was a kid, if something wasn’t approved by the FDA, my mom would probably not have bought it. But now there are so many supplements and there are so products that aren’t approved by the FDA that that’s become, I think less of a warning sign. But even more so now if you have an individual who is anecdotally saying, I took this thing and it made my hair really shiny or I lost 20 pounds, is the company responsible if that’s not true or if somebody dies because they take that supplement or is that influencer responsible? And that is something that we do not know. That is a gray area in the law. And from my perspective it’s something that a lot of these companies are kind of taking advantage of right now because it hasn’t been figured out. So when you see people promoting products, whether it’s you know, the latest person to be kicked off the Bachelor or it’s one of the Kardashians or it’s like the soccer mom who lives next door, you kind of have to take it with a grain of salt. There’s a real science which we’re going to get into about the way that we feel connected to people when they share stories with us online and how that sort of creates an affinity relationship of trust. And then when they share a product with us, we sort of assume that that product, you know, is really what they say it is or that it’s really had that effect. And maybe it really has had that effect on that one person. But it doesn’t mean it’s safe for you or it doesn’t mean that you’ll have the same thing. So when I was a newspaper reporter, I launched a style section for the biggest newspaper in Nevada, which was called the Las Vegas Review Journal. It’s still there, but it’s a much smaller paper now. When we launched that section for the newspaper, I had a column and it was sort of like an around town column called ‘Vegas Girl’, which was really fun. But I wrote a lot of beauty stories and nightlife stories and stuff like that. So I got sent tons of free products. Now the newspaper had a policy, I could not accept anything that was more than $20, but I was sent products that were hundreds of dollars and I didn’t know what to do because honestly they wanted me to write about these products. Was I supposed to go out and spend my own money on them? If I couldn’t accept them, it really created this sort of conflict of interest for me. So I remember going in and talking to the editor of the newspaper who was this sort of old time Western guy, literally worn boots and a cowboy hat. And I remember trying to explain to him that, you know, these products were being sent and that I could try them but that it would be breaking, you know, the company policy and that I could get fired for it. And I didn’t know what to do. And he basically was like, well how much are these products? And I think there was like a jar of La Mer or something that I had brought in and I was like, well I think this is like $400. And he literally almost fell backwards in his chair because he was like, what? Like that jar of skin cream. Like what does it do? It was like totally blew his mind. And then he sort of came up with this idea, well, we’re like, why don’t you try it? And then send the remaining part back. So don’t keep it for yourself. So basically like we could justify you didn’t use this for any like sort of personal reasons. And I was like, no PR person slash beauty company is going to want my half used jar of moisturizer sent back. Right. So like that’s a no go. And so I sort of tried to suggest to him that like what the big beauty magazines do is they have a free table and if they don’t use the products in the story or if there’s extra, whatever, they put it out and then employees can take it. And he sort of didn’t like that idea but it was the best we could come up with. And so that’s sort of what we did. It made us both very uncomfortable. It sort of created the situation where it’s like if you want to be writing about products, how do you handle it? Because you don’t want to ever seem like you’re bias towards the products that are being sent to you. But we certainly didn’t have a budget whereby I could go out and spend $400 on skin cream. When we’re looking at this influencer market today, that’s the background or the context that I’m sort of overlaying with this, which is that that was really hard for me when that was my job was to sort of review these things. When I think about people who are on Instagram who are reviewing these things, but they’re not disclosing that they’re reviewing them, that feels incredibly unethical to me. I think the most important thing is that they should absolutely be saying like, I got this product for free. I tested it. You know I think most people know that when you are trying to promote a product, it is much better to spend the money on PR, meaning like you get a publicist to help place the product for you rather than finding, you know, spending a ton of money on advertising because when you have a reporter write about it, it ends up sounding more credible than when it just looks like a paid ad. Now that is all becoming murky because you have all kinds of things like even at newspapers now have huge ad divisions where they have reporters writing stories that are advertisements. I don’t, I don’t think that’s good. I think that that’s bad. I think there should be a very clear separation between what is news and what is advertising. But here we are. So I want to get into all of that and you know, just really sort of be honest about like this is where we are and I think there’s no going back because it becomes very clear when you look at how big this market is. Like I think the industry spent, you know, brands sort of like collectively it was approximately $8 billion that was spent in 2019 on paying influencers to promote products. I guess it’s estimated to double by 2022 so that’s a lot of money. And it’s a lot of money. That’s a little bit squishy in terms of like those aren’t credible sources. Those are people who have conflicts of interest now in what they’re promoting. And I think this idea of like how does it make you feel when somebody that you’ve come to trust online is recommending the product is really important to keep in the back of your mind and be critical of because some of these products truly are dangerous and have not been tested. And I don’t think the influencers are thinking of that sense of responsibility for themselves when they’re taking on products. One of the reasons that we have not done that on this podcast and we’re taking donations instead is because I don’t want to be responsible for fully vetting every product that’s wanting to advertise on here. It’s just too much. So instead what we’ve decided to do is just take donations from listeners. And so if you haven’t donated yet, this is a good plug to go ahead and do that. You can do it on Patreon or you can do it right on our site. And so without further ado, I’m gonna turn it over to Dr. Sophie Boerman, who’s an assistant professor of persuasive communications at the University of Amsterdam. And she has studied how people respond to sponsored content. And she really has done a good job explaining to us sort of how this kind of communication can be recognized as advertising and still be effective. But that how, when it’s done sort of subversively it’s harmful to both the brand as well as to the influencer and to the consumer. We’re so excited to have you on for this episode where we’re talking about influencer power and what people kind of may infer but may not fully understand. And you’ve done a lot of research into this and studies, one of which had David Beckham in it. And my, so my first question is, when you got into this research, did you have the idea of trying to sort of sess up if women in particular were being taken advantage of? Or was it more a matter of like how does our brain respond to communication?

Dr. Boerman: Yeah, so what I really try to understand this when people recognize advertising. So I’m focusing mostly on this idea of persuasion knowledge. And this is some knowledge that people should develop throughout their lives.

Emily Kumler: So with the research that you have done, one of the things that when I was reading through some of your work that I was struck by is that in like traditional newspaper kind of printing, you’ll sometimes see things where there’s like a black box and it’ll say like sponsored story or something. And I feel like in the last like 10 years or so, that’s become harder and harder to pick out. And so things are actually looking more and more like news stories that are actually paid content, but newspapers still have to follow, you know, sort of the right guidelines. You get over to social media and Facebook in particular, Instagram, it becomes very tricky to try to figure out if somebody has been paid to promote a product. So like we know that there is this bar that shows up that says, you know, sponsored content or partnerships. Right. But can you talk a little bit about why that’s important, like why is it important for the viewer, we could say consumer, but in some cases it’s like somebody might just be on there trying to be social with friends, not really thinking about shopping so much or you know, being influenced, why is it important to have this de-marking of what has been paid for and what has not?

Dr. Boerman: This is especially important because it’s really difficult right now to understand when something is advertising and when it is not. Because the social media posts look very similar to any other posts. So commercial posts are not different with regard to what they look like in color or anything else. So they need some kind of label. As soon as the celebrity is asked to post a picture of a brand, this picture will be very similar to the other pictures that he or she will post. So it’s becoming very unclear what social media content is advertising. And what social media content is not. So we need some kind of label to recognize advertising in scientific languages means we need a label to activate our persuasion knowledge to activate knowledge about persuasion and how to cope with this.

Emily Kumler: You mean, so it’s not just taken as, oh, Emily really loves this product genuinely and isn’t benefiting from the sale of it. In any way versus, oh, okay. So this is a partnership that she’s decided to go into for financial reasons.

Dr. Boerman: Yeah. So, it’s really difficult to understand when a celebrity or any other person is just posting something about a brand or a product because he or she wanted to do that from, from themselves. So it’s just word of mouth. I really liked this, this product, I enjoy it. Or whether they are paid for and this has a commercial intent and is trying to persuade you, therefore we need a label or we need to understand what is going on.

Emily Kumler: And in your research, you found that when brands use the label that it’s not a negative, it doesn’t sort of negatively impact the viewers, like sort of idea of the product in any way. Right?

Dr. Boerman: Yeah, that’s true. Because what we found is that the level of ad recognition is a similar to posts that are sent by a brands with and without a label. So it doesn’t really matter if a brand says that it’s sponsored or not because the brand itself already is a cue for people to understand that this might be advertising in some way.

Emily Kumler: Whereas when it’s an influencer, like an individual sort of celebrity type person, the viewer ends up finding out that it was a paid sponsorship that does have a negative impact on that person. Can you talk a little bit about that?

Dr. Boerman: Yeah, so what we usually find in many different studies about disclosures of sponsored content and especially influencer marketing on social media is as soon as you do use a disclosure like sponsored or hashtag based ads or any other type of sponsorship disclosure, people will recognize it’s advertising. And because of this, they will be more critical about it so that they process this ad more critically and therefore also are less important to share it for instance, or comment on it or like it because they are made aware of this commercial intent. Whereas if you don’t include a disclosure, just persuasion knowledge is not activated. So people do not understand what is going on and therefore do not cope with this by becoming more critical towards it.

Emily Kumler: The criticism is really, I mean in some ways I sort of feel like we need to back out and talk a little bit about like the psychological impact of this because it’s a little bit like being manipulated, right? So like you have an understanding of something from somebody that you look up to or you trust in some way and you feel a certain way and then you come to find out that it was designed to make you feel that way and then that makes you feel resentful or manipulated or angry or annoyed or you know, probably a myriad of different reasons. Is that an accurate sort of explanation of that interchange?

Dr. Boerman: So the whole idea of influencer marketing, celebrity endorsements on social media is that people may be persuaded by them, first of all, because it’s a credible source, it’s a likable source. It’s someone that people appreciate and find trustworthy. So this is very useful for, for any, yeah, any commercial message. But also because it is so difficult to spot when something is advertising, you might be persuaded by it unconsciously without being aware of it. And as we find it, as soon as you add a disclosure and people become aware of this, they understand that they were trying to manipulate you and try to perhaps even persuade you without being aware of it. And this makes people usually more critical towards this type of advertising as soon as they recognize it.

Emily Kumler: And just so I understand that correctly, that’s in hindsight. So that’s like you show somebody an ad and you don’t tell them that it’s a sponsored post and then you go back later and you say, oh, by the way, that was a sponsored post, right? Not when the influencer has the label that says sponsored post in real time? Or both.

Dr. Boerman: So it is, when you add this label, it is when you say sponsored. So it’s not afterwards.

Emily Kumler: And so what’s interesting to me is that like celebrities didn’t face that kind of scrutiny when it was like a TV commercial. Right?

Dr. Boerman: No. But it’s because the TV commercial is very clearly a commercial. So it’s usually in a commercial break and people understand that this is all short videos trying to persuade you to have some kind of brands or service or anything else.

Emily Kumler: Uh huh.

Dr. Boerman: The [?] itself already signals to people that this is advertising and this is trying to persuade you, but because social media content is so similar and there’s no clear division between what is commercial and what is not, it gets more difficult to understand. And this is why we need these labels.

Emily Kumler: As a sort of thought experiment or you know, just like thinking this through. If somebody, if there was a social media influencer who did an advertisement and it was clear that like, you know, it was like sort of a different feeling than their regular posts. Do you think that that would have a different outcome?

Dr. Boerman: Yeah. So if the post is very different from what they usually post and perhaps the post itself might signal to people that this is advertising. Yes, that could be true. But still I would say always disclose it. So you transparently communicate what you are doing.

Emily Kumler: So if there are influencers who are listening and they’re like, well that’s ridiculous. Like this is how I make money. Like I am always honest that I’m getting a sponsorship. Like what am I supposed to do? What is the correction to this?

Dr. Boerman: Well, if they’re honest and they use a hashtag or a paid partnership tool, that the label that is placed on top of your Instagram posts for instance, then you’re doing it the right way. You are telling people that you are being paid to do so.

Emily Kumler: And so in terms of this sort of idea of advertising versus influencing, which I think is a little slippery, like it sort of feels to me like when you advertise in a, like let’s say a women’s magazine, it’s clearly an advertisement, but when you hire a publicist to push a story that influences people, that’s not marked as advertising, right? Because it’s really up to the journalist to sort of have, be the gatekeeper and say like, oh, this is a worthy story or it’s not. But even so, most big companies or even small companies have people who manage their public relations and are getting stories sort of regularly published for them. And that’s not advertising. And so when I look at the social media landscape, I feel like that’s sort of where this falls is like is this a sponsorship? Is it PR? Like if people are getting products for free versus getting paid, like there’s some gray area there. Right. And it seems like anytime the person like benefits in some way that it should be acknowledged. But if the person is a reviewer and they review skin cream, right, and they get tons of skin green sent to them and sometimes they write good reviews and sometimes they write bad reviews, that’s not necessarily a sponsorship. Right? But they are getting the products for free. So how do you kind of negotiate or like work some of that out?

Dr. Boerman: Yeah, that’s a very good question. I am not sure about the regulations with regard to when you get a product for free. But, uh, usually what they say is that you should be transparent about those things as well. So you should be just transparent about any relationship you have with a brand or a product or a service just to make sure that people understand where this is coming from. And you often also see on blogs and product review videos that people say, well I got this from this and this brand. But my, it’s all my honest opinion. Research has also found that this is actually really good, that people really appreciate this transparency and this only increases the effectiveness of these product reviews and makes people actually appreciate the influencer as well

Emily Kumler: Because it’s more credible that way.

Dr. Boerman: Yeah, it’s more credible. People appreciate your transparency.

Emily Kumler: And then will you talk a little bit about the sort of following that influencers have? And so I know you’ve looked closely at this idea of like people who have followers that are less than 10,000 versus more than 10,000. And that that actually doesn’t make as much of a difference as we might have thought.

Dr. Boerman: Yeah. What I think is really interesting is this development in influencer marketing where smaller nano or micro influencers are also a very useful spokesperson for some brands and products because while they do not reach a very large network of people, but they are seen as experts in some kind of fields or very credible sources and therefore can be very useful influencers to use in your campaign. I expected that as soon as you use a large influencer, people will understand that this person is, well probably paid to post products. Whereas the smaller influencers are usually not paid. So I would have expected that people respond differently to micro and the so-called mezzo influencers. But I didn’t find that in the study that was published. But I did some new studies in which I compare to very nano influencers that with less than 5,000 followers to a macro influencer with millions of followers. And this is where we did find differences. The big celebrity influencers with more than a million followers. People actually always understand that this person doesn’t just post branded content because of their own personal liking. This is always based on some kind of commercial relationship. Whereas this is more difficult to understand when you have less than a thousand followers. But this is still being done right now. So even influencers with a thousand followers can be very useful and can be paid to post advertising.

Emily Kumler: And then will you also talk a little bit about the parasocial relationships, like that sort of relationship that happens between an influencer and his or her audience?

Dr. Boerman: Influencers are very interesting spokespersons because they are usually very credible, easy to relate to people, but also because they can create this, you can create the parasocial interaction or parasocial relationship with this person because you have the feeling that you can connect to them, you can interact with them in some way at least by commenting or liking. And perhaps you even get a response of this person. And because you can follow them over some time, yeah, you really can develop this strong relationship or this feeling of friendship with this influencer and this makes them very, yeah, powerful spokespersons because yeah, you really feel that this is your friend telling you this is a product that you should really try out for instance.

Emily Kumler: And so how do you measure that? Or like when you’re studying that, how do you identify that?

Dr. Boerman: That’s a good question. I don’t know the items by heart, but usually we ask people whether they feel that this person is, feels like a friend and whether you connect to them on the, on a daily basis basis for instance, these types of questions.

Emily Kumler: So right now with the coronavirus and with everybody at home and with people pretty nervous, there are certainly people who are trying to sort of take advantage of this crisis and are advertising things like this tea will prevent you from getting the coronavirus or this cream will help you get over the symptoms of the coronavirus faster. So as I was recording this transition, I was joined by a special guest, my daughter. And I thought maybe I could ask her if somebody told you that they had a special tea that they made that could prevent you from getting the coronavirus, would you buy it?

Camilla: Uh… yes.

Emily Kumler: How would you know if it was real or not?

Camilla: I would look it up online, but if it wasn’t, then I would just protect myself.

Emily Kumler: How?

Camilla: I would protect myself by not getting any germs and saying at home.

Emily Kumler: Yeah. But what if somebody said, okay Millie, we have this really special moisturizer. If you get a cold and you put it on the cold will go away. Would you try it?

Camilla: Uh, I would try a little bit cause I don’t know if it actually will work. If it would, I would use it

Emily Kumler: When you try a little and say like, oh yeah, it worked. Okay, great. I’ll try some more.

Camilla: No, I’d say, oh yeah, it works. And then I would like, you know, use it.

Emily Kumler: And then what would happen if like one of your friends, like what if Paige was like, oh my gosh, I love this tea. It makes me feel so happy and excited. Would you want to try it?

Camilla: Uh huh.

Emily Kumler: Okay. And so what if you had friends who were saying like, Oh my gosh, if you take this vitamin, you won’t get the coronavirus. Would you believe it?

Camilla: No.

Emily Kumler: Why?

Camilla: Because if you ate it, they don’t, they don’t actually know. They might like say like you might get the coronavirus, but you actually don’t get the ground of ours. But they’re like, I feel much better. But it actually means that they were already better so it might not work. So I would say no.

Emily Kumler: You mean like they’re attributing their improved symptoms to the vitamin, but really it was like they were just getting better on their own.

Camilla: No, no. Yeah. So wait. It’s like they’re like, I’m feeling good. And then they said, you want to try this coronavirus vitamin that will not make you have the coronavirus. But they were just actually all better

Emily Kumler: So you mean there was no clinical trial to prove what they were saying.

Camilla: Mhm.

Emily Kumler: Yeah. So you need to have clinical trials, right? Because that will prove that what people are saying is true and who’s going to protect you. If people say, oh, you got to try this.

Camilla: I will say that. I don’t want to try but thanks for asking and then if they say it again, then I’ll say, don’t ask me again. And if, and then if they asked me again then I’ll just ignore them.

Emily Kumler: Oh okay. Great, thanks so much Millie. And that dilemma that my six-year-old just presented to us, I think pretty well. It’s the same thing that’s basically Facebook and Google and everybody else is now facing, which is that all of these people are trying to peddle products online that are making claims about the coronavirus being, you know, a treatment for the coronavirus or a prevention for the coronavirus, taking advantage of this crisis essentially. And there’s no validity behind any of that. Right. I mean, we definitely don’t have any sort of homeopathic remedies for any of this. And yet it spreads like wildfire or people because they’re scared sort of think, well, why not five bucks? Why not just try it? Maybe I’ll try it. Why would I not? And you know, it becomes a little bit confusing because the FTC does have rules about this stuff, but because they’re understaffed, overwhelmed, they are very reliant on people to sort of get in touch with them and complaint and point out that these things are happening. It’s much less about them, sort of have been a police force and going out and finding things and more of them responding to the most concerning complaints that are brought up. And our next guest is the expert on all of this. She’s a journalist who’s been covering this for years and has been able to sort of look at the spread of this across all social platforms. And she’s going to explain this to us and really how the government has sort of failed to properly regulate how influencers are an extension of a corporation. Like they really are a part of the marketing department and yet they don’t fall under that category in terms of regulations and how that leaves consumers in a vulnerable position.

Suzanne Zuppell…: I don’t think the FDA ever expected us to be where we are. I mean, first of all, we’re one of two countries in the entire world that allows direct to consumer pharmaceutical advertising, us and New Zealand, which I find really interesting. But the FDA has said themselves in, you know, so many conversations on background that they haven’t kept up with social media and just social media is advancing at such a pace where they’re not able to regulate what content is coming out there for patients. But to back up a little, I think why we’re seeing this rise in wellness and supplements and you know, jade eggs to put inside your vagina for whatever Gwyneth Paltrow says they’re curing is because women are notoriously forgotten by doctors. Or if they’re not forgotten, they’re dismissed or their concerns aren’t taken seriously. You know, we see that with women who suffer from endometriosis. They suffer for years until they get a diagnosis or women with ovarian cancer; it’s often diagnosed in late stages. And that’s because we’ve written women off as hysterical. And so I think women are now trying to take their health in their own hands and obviously they can’t write a prescription for themselves. So if they’re reading online that Gwenyth Paltrow or Kourtney Kardashian is telling you that chlorophyll water is gonna detox your body and keep you healthy and keep you away from that doctor that makes you feel bad about, you know, speaking up, then they’re going to do that and they’re going to buy into this. So, you know, I understand where women are coming from.

Emily Kumler: But you know, there used to be a really hard line about like sort of fairness in advertising laws and like this idea of like you can’t say something that’s not true. How are they getting around that?

Suzanne Zuppell…: Well, social media is interesting because again, back to the FTC and the FDA, they’re not able to regulate all the content that is out there. Because even though they consider, let’s take FitTea for example, they consider that company’s Instagram page and Twitter feed and Facebook page, all marketing materials. So anything under there should presumably follow regulations that are set forth by the federal government. But there are so many posts that they can do it and there’s no way to possibly filter all of it. So it really is just sheer luck that our government doesn’t have the capacity to regulate it. And then when it comes down to actual paid advertising on these sites, you know, and when I say paid, I mean we’re paying Instagram to promote a post or paying Facebook. They have some regulations but supplements do not fall under that. It’s really pharmaceutical drugs. And even still there’s so much leeway with how you can talk about a pharmaceutical drug and a paid advertisement where if you never mentioned the drug, Twitter and Instagram and Facebook are going to let you talk about it.

Emily Kumler: So will you explain that a little more? Cause I know you’ve written about that and I think that’s really interesting because this is like a nuance, right? That like a lot of people who are just, you know, using Instagram for fun or whatever may not realize, but it’s a very, very strategic move.

Suzanne Zuppell…: Yeah, there’s a lot of nuance to it and from the marketing professionals I’ve talked about who specifically work in healthcare marketing, they see selling a pillow as no different than selling a supplement that’s going to tell you you can sleep better and the average consumer isn’t aware that those things are, you know, a supplement is not regulated by the government. It’s regulated in the sense that there can be recalls on it, but it’s not something that requires FDA approval. And so it doesn’t need to actually do what they say it’ll do. When you bring in, you know, influencers for instance, into the mix where you’re, where a company is paying a person, say Kim Kardashian, to sell their product and promote it. There’s no cut and dry way that Kim Kardashian has to acknowledge that she is being paid to talk about that. Bigger celebrities now will be more obvious in using different hashtags that say sponsored or ad at the start because they’re the people who are going to come under fire the most. Kim Kardashian was, you know, did receive a letter from the FDA because of a prescription drug that she advertised on Instagram without noting that there are some serious risks to that drug. But you know, then you have all the people who are coming off their season of the Bachelor and the Bachelorette who are advertising, for instance, on a surgical technique or a, again, a diet tea or something that they’re not really following those rules. They’re not looking at the FTC’s website and the FDA’s website, which says that it needs to be fair and balanced. What they’re saying about a product that they should have experience with it and that they need to note that there is a, they need to make a financial disclosure. Instagram doesn’t care about that. And Instagram also doesn’t make it very easy for the federal government to filter to find those posts, to search a bunch of different hashtags that might be used. So influencers get very creative and that’s because they want their content to look organic or natural and want us as consumers to not realize, you know, as you’ve mentioned, people who are using Instagram for fun thinking that somebody out of the goodness of their heart is telling us about an experience they had with something and it might help us too.

Emily Kumler: Well, and you know, I think what’s so interesting about all of this too is that there is this like it’s, there’s a disingenuousness about the whole thing, which I mean, I guess sounds naive, right? Because like that’s the basis of advertising is like trying to people into needing or what they need that they need your product. But you know, like from a old lady perspective, there’s a part of me that feels like if you’re being paid to speak on behalf of a company, then you are a spokesperson, right? Like you are no and therefore you are part of their marketing budget. And therefore you need to fall in line with all the rest of the rules about advertising and marketing.

Suzanne Zuppell…: Absolutely. I couldn’t agree with you more. And the people that I’ve interviewed for various pieces that I’ve written on this, people who are just consumers, they do see a really clear distinction too between being advertised to when it comes to health care and being advertised to when it comes to, you know, socks or shoes or clothing or something for their home. And there should be a really clear distinction there. But I think the other point to make is that again, that the regulations are so far behind that if you were to go on and look at the different articles that have been published by the FDA and the FTC, Instagram doesn’t come up once really. They’re still talking about, you know, somebody being a spokesperson for a company by using their own website to write a blog post. So they’re still stuck in like blogger days where everybody and anybody is an influencer on Instagram right now. And they acknowledge that they’re behind and they, you know, say that where they say blog or where they say social media, Instagram and Facebook and Twitter all fall within that. But it’s not explicit. And so until you know, we’re super, and by we, I mean the federal government is super explicit about how this needs to be disclosed, then we’re never going to be able to filter it in a way that’s made it, makes it safer for consumers.

Emily Kumler: I feel like, I’m thinking about Elizabeth Holmes while you’re talking about all of this, who had Theranos right. And like in some ways, I don’t know if anybody who’s listening who has read the book or the documentary is fantastic, but she started this company that was basically gonna be this wonder company that was going to do all this medical testing in like one blood sample and she kind of got over her skis, right? Like she had this great idea, maybe it was possible and then she started sort of making up stuff. And they started making machines that weren’t really working properly and selling them and raising money. And you know, I have a couple of, obviously there’s some big issues with what she did, but I also feel like you look at Jeff Bezos and like he was promising stuff before he had a product, right? Or like before he was profitable. So like some of that stuff is a little bit more tricky. But the line for me always with Theranos was this is a medical company, right? Like this is totally different than like saying I’m going to sell, you know, 20,000 books this year. I hope. Right? Like that’s the plan. That’s totally different than saying like, we tested your blood and you don’t have diabetes. Right? And so that to me is where they’re like, what, why don’t we have more protection in this medical area? And even like when it comes to taking supplements, like I feel like you go to Whole Foods, right, and you can find all of these probably pretty benign probiotics or whatever that are, you know, say right on them, like not regulated by the FDA. And so I think we’ve become numb to that. Right? It’s like that might have been 20 years ago a warning. We don’t really know what this is. It hasn’t been tested in a doubly blind clinical trial that’s been in peer reviewed or that’s been approved by the FDA like so we don’t really know. You might be being sold snake oil, but we don’t know. And like I bet my mom wouldn’t have bought that stuff. Right. Cause she would have wanted to know that it had been rigorously tested. But today it feels like everything has that label on it. And so it’s a little bit, I dunno, we’re more pacified by that. Right? Like it’s not setting off an alarm bell the way it used to. Like I always think of taking vitamins or supplements as sort of like an insurance policy. Like maybe they’re great, maybe they’re not probably better to take them. But some of the stuff, I mean you look at some of the diet stuff out there, like all of these energy drinks that are supposed to like burn calories and you’re sort of like, huh, what about your heart? Right? Like what about your liver? What are these things actually doing? And so you’ve done a lot of research into all this stuff. Do you have things that you personally look for or that you recommend people listening who are like, yeah, you know, I really like this shake or whatever. And it does seem sort of like medical food because of what it’s saying it does. Or the teas that you mentioned, like are there things that you think people should be aware of or like really great places that people can go to check products?

Suzanne Zuppell…: First and foremost, I’m not a doctor so I can give advice on what I like, but what I always tell people is, you know, this isn’t a substitute for a doctor. And if you want to take a supplement, you should be talking to a doctor about it. You should get your blood checked. Because, for instance, you know, you’re seeing on so many websites now that women should be taking more B12 because it’s going to help with energy and it’s going to help with focus or you know, vitamin D or whatever is being peddled to you. But you might not have a deficiency in either of those vitamins. And so what you’re essentially doing is spending 20, 30, $50 on a bottle of pills and it’s running through your liver. It’s running through your body and you’re peeing it out is when I tell people like, you’re wasting your money because you might not need those things. And so you are, what you’re trying to fix, there might be a more serious or totally benign underlying cause. So I never really want to recommend to anybody, you know, what different things I take or where I like to go. I mean, I do recommend finding studies on it. So if you’re looking on a website and it could be, you know, there’s tons of wellness sites out there that are reputable, look at who’s saying it, look at what their credentials are. I just wrote a piece on Kourtney Kardashian’s website Poosh and I was looking at all the different health claims that they make on the website. And there are a lot of people who are being credentialed as doctors, but they’re doctors, they’re naturopaths or they’re doctors of pharmacy or their doctors, you know, they’re chiropractors.

Emily Kumler: You mean they’re not endocrinologists or people who…

Suzanne Zuppell…: Exactly. Exactly. They’re not specialists in the regard that they should be giving the types of advice that they’re giving. And so, you know, I think you really need to look at–supplements aren’t bad in the grand scheme of things. You need to look at the brand, if the reputable, you know. You don’t always want to go for the cheapest option. Sometimes there are cheaper options that are great quality, but you want to look for a study that’s saying that and also figure out what the cause is that you’re, you know, you’re trying to treat. And I think we’re preying on a lot of people’s vulnerabilities and insecurities when it comes to this, whether you’re selling, you know, I see a lot of sponsored content for like psoriasis medication and your skin condition could be psoriasis, it could not, but a skin condition is going to make somebody feel insecure. It’s going to make somebody want to stay at home and it’s going to make them want to do anything they can to feel better and to look better. And so when you see that beautiful person on social media saying, I tried this and it worked for me, you’re going to do what you can to get that same exact thing that they tried because you want to look like them and you want the life that they have, but that might not actually work for you or you might be allergic to it or you might not have psoriasis or whatever condition the person has. 

Emily Kumler: We’re going to stop there for now. Next week we’re going to come back to this idea of sort of influencer marketing and the power of influencers, but we’re going to take a slightly different look at it. I was really curious because of the amount of attention that we pay in this podcast to people who are sort of influencers within the medical community as patient advocates. So what happens if you have a medical condition and you end up sort of developing a following because of that medical condition that then makes you an influencer and then what happens if you start getting paid for it? Does that then somehow change your credibility? And there’s actually a company in Boston, where I’m based, that is a talent agency for people who have these kinds of medical conditions that become influencers and they link them up with medical companies but then pay them to share their experiences. That becomes really complex. So next week we’re going to dive into that and talk a little bit more about sort of the regulations behind influencers and how this is really a gray area in terms of the regulations, the protections, and us as consumers of this kind of information. What do we need to know when we’re feeling like we’re sharing in somebody’s experience and yet that experience might be slightly marginalized because we’re being manipulated. If not by anything other than that there’s a conflict of interest that the person’s getting paid to share that story. So I hope you’ll join me next week for the second part of this influencer series. I’m Emily Kumler and that was Empowered Health. Thanks for joining us. Don’t forget to check out our website at empoweredhealthshow.com. For all the show notes, links to everything that was mentioned in the episode, as well as a chance to sign up for our newsletter and get some extra fun tidbits. See you next week.


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