WTF is up with dermfluencers? Roundtable Recap
“Dermfluencer” - Dermatologists as social media influencers
Due to their credibility, dermatologists have become sought-after influencers. A common marketer’s recommendation to brands is to use these influencers, over others, to help build consumer trust. As a result, compared to other influencers, dermfluencers can earn exorbitant amounts per sponsored post. E.g. I’m aware of one dermfluencer who makes 60k USD for single TikTok posts.
The rise, and stickiness, of dermfluencer misinformation
While many dermatologists provide accurate information, a small but prominent group spreads misinformation. While they are a minority, they represent a majority of the information the public sees.
Factors that contribute to this:
Attention Economy: Sensational information (that’s generally incorrect) does best on social media - accounts get paid more when they have ↑ engagement
Money’s Too Good: 60k for a single post is a pretty good incentive to turn a blind eye.
Lack of Critical Appraisal Skills: Unlike scientists, most dermatologists are not trained to evaluate scientific literature rigorously - rather, rote memorization is more important in medical school (which is fine, it’s just not a PhD scientist’s training. Disclaimer, non PhD scientists and MDs can certainly learn how to do this.). This may lead to the spread of flawed conclusions (e.g. rosemary oil addresses hair loss)
Stickiness of Misinformation from Doctors: Thanks to the white coat bias, misinformation from perceived “experts” is much harder to address.
What advertisement disclosure?
Many dermfluencers do not disclose that they are getting paid for a post or have received the products they’re promoting as brand PR. A common dishonest practice is to wait 24 hours to add disclosures (which is illegal) so the post can get better engagement. Disclosures are also hidden at the bottom of the caption, or unclear words are used like #partner. The brands AND influencers are liable for this behaviour, with risks of lawsuits & fines.
By law, disclosures should be upfront and obvious, using clear words like “advertisement”. All material connections, by law, must be disclosed and it must be obvious to viewers (every time they talk about a product!)
Issue: Dermfluencers are in essence working as salespeople and marketers when they advertise online (even if it’s just sharing products they like that includes products they were gifted) and therefore, often, are ignorant to advertisement regulations (at least I’d like to give them the benefit of the doubt and think this)
Issues: 1) No material connection disclosure for products shown on video. 2) Recommending treatment for a medical condition. See 3 slides from here as what the ethical and legal issues are with that. 3) These claims also are illegal drug claims when associated with cosmetic products (which the brands may now be liable for depending on the contracts in place)
Dermfluencers have a second legal responsibility as an expert compart to non-expert influencers - it is their responsibility to ensure their claims are supported by rigorous scientific evidence (not just one bad study). This is required BY LAW. Issue: The groups who regulate this (e.g. FTC, NAD) are resource limited and may have a hard time catching all of this behaviour...
One of the solutions here: Lawyers.
Once more consumer attorneys see this behaviour (which is already starting), they will take action and sue both the brands and the influencers. Their incentive: they can also make A LOT of money doing this. (At least in the USA; most of the bad behaviour from dermfluencers seem to come from here, perhaps because of how accepting this region has been historically to pharma advertisement). Consumer lawyer trends follow beauty industry trends. When there are new beauty trends, it’s only a matter of time before lawsuits related to that trend follow.
Conflicts of Interest?
Selling products: Many dermatologists promote products, including questionable supplements, potentially delaying consumers from seeking proper medical care. Promoting products isn’t necessarily a bad thing, but the ethics behind it matter. Dermfluencers peddling snake oil is probably problematic... In the Nutrofol example, this product is sold in many dermatologists’ offices, and was recently reported to cause liver damage.
Brand influence: Some dermfluencers are deeply entangled with brands, leading to ethical concerns about objectivity and consumer trust erosion. E.g. some brands have seemingly partnered with ALL the dermfluencers, seemingly buying up all the dermfluence...
The Problem with Online Diagnoses
Ethical concerns: Diagnosing strangers on social media raises privacy, medical, and professional ethics issues.
Legal risks: Publicly diagnosing someone based on a social media post wouldn’t hold up in a court setting and could invite liability.
Related trend: Medfluencers analyzing celebrities and speculating on the procedures they have gotten... this takes a BIG step over the ethical line that physicians should toe.
Broader Impact on Dermatology
Erosion of credibility: The rise of misinformation from dermfluencers has led some consumers to view "board-certified dermatologist" as a red flag for questionable information.
Influencer over expertise: Many leading influencers are not actual thought leaders in dermatology but gain traction due to social media popularity. Since these individuals get the majority of the public attention, while representing on the minority of the derm space, they have a disproportionate impact on public perception.
Addressing the Problem: What Can Be Done?
Dermatologists addressing this themselves seems to be an uphill battle - the top reason I’ve heard is collegiality in a small field. Regulating medical misinformation is also a huge challenge for medical boards. Many derms also don’t realize this is an issue (because I’m sure they don’t spend enough time online to really see this issue)
Industry self-regulation: Brands should ensure that influencers comply with disclosure and claims rules.
Education: Increasing awareness among dermatologists about advertising regulations and critical scientific evaluation can help mitigate misinformation.
Fact-checking efforts: While science communicators have taken on the role of debunking misinformation, this is highly unsustainable since we don’t get paid to do this. This also reduces our own income opportunities, and on top of this, we’re often called bullies, or worse. We are not the solution, but in any case, more support is needed for this type of work that generally has a big toll on the people doing it.
Legal repercussions: Consumer attorneys are increasingly monitoring influencer claims, meaning legal action against misleading content may become more common.