Pharmacy Focus: Limited Series - Celebrity Endorsements in Public Health

This episode highlights using celebrities and local advocates to promote public health initiatives and raise awareness of health topics. Experts shared examples of how Oprah Winfrey and the Ice Bucket Challenge raised awareness of issues like racial health disparities and ALS, respectively. Ensuring authentic connections between celebrities and health issues as well as coordination among stakeholders were highlighted as important factors for effective celebrity endorsements. The role of pharmacists in public health advocacy and screening efforts was also discussed.

Timestamps

0:00:11 Introduction and overview of using celebrities to promote public health

0:05:01 Discussion on using local celebrities and trusted community figures

0:10:53 Leveraging patients and peers as advocates, risks of celebrity endorsements

0:16:09 Importance of coordinating efforts between stakeholders

0:21:13 Role of pharmacists in public health advocacy and conclusion

Christina Madison, PharmD, FCCP, AAHIVP, the Public Health Pharmacist; Alfred L’Altrelli, PharmD, CFMC, MBA, the senior director of pharmacy at UPMC Presbyterian-Shadyside; Andrew Mcnab, MD, professor at the Faculty of Medicine at the University of British Columbia; Troy Trygstad, PharmD, PhD, MBA, the executive director of CPESN USA; and Sean Young, PhD, executive director of the University of California Institute for Prediction Technology

Hello, I'm Ashley Gallagher from Pharmacy Times and you're listening to the Pharmacy Focus mini-series, Star Power: Celebrity Endorsements in Pharma, a four-part series including pharmaceuticals, vaccines, Ozempic, and public health. In this final episode, we talked about celebrities as advocates for public health topics, leveraging trust centers, and using peers and health care providers as advocates for public health.

Celebrity endorsements and pharmaceuticals haven't been just limited to products. Today, we'll talk about the public health initiatives that celebrities have endorsed. For example, talk show host Oprah Winfrey released a documentary about racial and health disparities and health care and Movements, a pop rock band, created a music video in association with the Alzheimer’s Association. Dr. Alfred L'altrellifrom UPMC, Presbyterian Shadyside had this to say:

Both spreading awareness about specific causes and endorsing specific products can have benefits that are distinct and separate of each other. The choices of which one could be a benefit, I think, really depends on the nature of the message and the goals of these different, campaigns or initiatives.

So, looking at the example of Oprah. Here Oprah contributes to a broader understanding of societal issues and encourages discussions around important health care topics, discussing specific products and medication of a certain brand and type produce the benefits of that certain individual thing that potentially influence individuals to consider those options for their health needs. Awareness about a broad topic about, a societal issue, or a disease state, and then endorsement of a specific treatment that might meet an individual's health care need in my mind are kind of more commingle. I think you've actually need both. They both produce different benefits.

Dr. Christina Madison, the Public Health Pharmacist, had this to add about whether broader public health endorsements had more of an impact than pharmaceutical products.

I think both have their place. Again, for sure, I think that the documentary that Winfrey did, is incredible. I think it's great that you know, you've got people who are in creative spaces, like musicians and artists coming out around things like Alzheimer. I do think that when you have it as like a general topic, it does make it a little less sticky.

In an article published in Health Promotion International,¹ celebrity endorsements on health belief models, such as infectious disease prevention behaviors, actually influenced the target audiences’ beliefs, such as perception of severity, susceptibility, self-efficacy, and intent to perform the action for minimizing infectious disease spread.

Dr. Troy treat stat of CPESN USA, added that initiatives that are led by local celebrities can take on a life of their own to spread disease awareness.

Let's think about disease awareness. How many more Americans are familiar with [Amyotrophic Lateral Sclerosis (ALS)] now, because of the Ice Bucket Challenge? The Ice Bucket Challenge was a thing, and there was an affinity group, “oh, I'm going to do the Ice Bucket Challenge” because, first, maybe I relate to a relative that has that or somebody I know that I’m a motivated, then maybe it's the fire departments get involved, local celebrities, then the next fire department or whatever else, right? It really takes off when you get celebrities to now pitch in. It's almost like a coenzyme effect, where you can put extra gas or accelerant on to something like that. They are very powerful. Think how much money you could spend to try to get the same level of impact on awareness of ALS, versus really what amounts to earned media because you're taking advantage of people's affinities and, and it strings together.

So What does that have to do with sort of health promotion? I would probably say the greatest effect is probably just awareness and education. Again, I go back to Katie Couric and colonoscopies. John Kruk and testicular cancer, destigmatizing things. What better a person than apparently John Kruk, a very, very nice person, but he comes across as gruff, he comes across as, not the person that you'd say is going to show up to that primary care visit every year for their annual wellness visit. He's talking openly about, “here's this thing that happened to me” and that can be really, really powerful, and you'd say, “Oh, well but John Kruk is not, a 20 time All Star Hall of Famer,” you name it, etc. But that's not the objective that you're trying to get to here when we're talking about these trust centers in these audiences.

John Kruk was likely a very effective celebrity, health promotion and awareness person for a subset of the population that would know who John Kruk is, and would listen to John Kruk over maybe a surgeon or other types of health care professionals or other types of celebrities that might say, “hey, heads up, there's testicular cancer is this and here's how you check for it” whatever else right, so I think we've got lots of examples of celebrities, helping stimulate conversations that otherwise people would feel uncomfortable talking about, except that a celebrity has a disease state or was affected by a disease state.

In another article published in Health Promotion International,² Dr. Andrew McNab from the University of British Columbia, and colleagues identified a genre of music videos, educational entertainment, that can help spread messages and promote awareness about health care topics that are specific to communities. He said,

We've gained considerable benefits from this research because we've, as others have, identified this education entertainment genre as an innovative way of promoting health, but have gone on to use it, most recently, as a way to promote awareness about sexual and gender-related violence against girls and women in Africa. Type 2 diabetes is an epidemic. very sadly, within African culture. Harsh treatment of girls and women, sexual abuse is very much front and center of the daily life for girls and young mothers. Almost half of women in Africa in their lifetime will report some kind of adverse sexual or gender-related event involving violence.

So here we went to again, young people that are in high schools, and said, “Look, tell us about aspects of your life, hat are a problem in terms of this kind of treatment.” In order to again, find out from them issues that were of immediate relevance, often these things when we're trying to teach about health, or medicines, or behaviors that top-down committee gets together, and a group of old people like me say “right, we should tell him about this, and this is important that we do it this way.” And often, again, coming back to what I was saying about the dialogue with young people, you miss something that is relevant, you approach it in a way which doesn't resonate, doesn't interest them doesn't age them, doesn't lead to dialogue, so doesn't help.

He added the text, repetition, and imaging are important when it comes to health topic promotions and music videos.

We included the phone number for a helpline in our sexual and gender-related violence music video in Uganda, which dramatically increase the number of calls to that helpline. And it isn't just included in the song. Usually these are put out as a text message like a subtitle across the screen. So even if you've not got the volume on, you're watching it on the screen, you actually see the health message or the phone number highlighted in that way.

So again, coming back to further explanation about education entertainment video or documentary has is it gives you the information in different ways. It's there, as a scenario, as an illustration acted out a flash image, but it's there as a text. It's there as a statement, it's sung in the song, there's a comment about it by the celebrity. It's kind of given to you in different ways and different layers. So that, if you like different parts of the brain actually take in the same information, which makes the impact of the education process and the promotion of the facts or the concept that you're trying to get over that much more powerful, great benefit of the YouTube music video concept is that it is listened to or seen multiple times. So, you get repetition, which leads to A. much greater chance of a retention, and B. discussion.

But what celebrities will drive these discussions, Dr. Trystad stated that everyone has a different trust center. So, it's not a one size fits all method. He said that local trust centers can be leveraged more to spread awareness pertaining to specific communities.

I believe that different strata of the population in different geographies, different generations, different ethnicities, different exposures, and worldviews have different trust centers. Much of what we've found, particularly with the advent of social media, is that trust centers are varied. The idea of tapping into local trust centers, it can certainly be powerful. It might be more powerful in some areas of the country than others. I grew up in a town of 4200, folks, and, in a small town in northern Idaho, where the nearest major airport is 2 hours away. There's a lot of trust centers locally, and particularly in rural areas, I would argue underserved areas as well, we've seen that with sort of the barbershop trials and where is it that you sort of let down your guard and turn your ears on and listen, right? You're not on guard, you're not in defense mode, but you're in listening mode, is different for different communities, and certainly the rural communities, I relate to quite a bit having grown up around rural areas, and quite oftentimes, the health care providers are the most highly educated folks in town. It's your teachers in the local school district, you might have a lawyer or 2, and you have health care providers, and so health care providers speaking in their own voice, particularly if they live in that community, I believe is very powerful. It's one of the reasons that those encounters between local providers and local patients tend to be effective trust-based interactions as well. So yes, local folks, local churches, local health care providers, again at different trust centers for different folks.

Dr. Sean Young from the University of California Institute for prediction technology, added that these trust centers don't necessarily have to be celebrities, or even local celebrities. He said that sometimes even a peer can be more powerful that a health care physician or pharmacist.

I would even take it to a more scalable level even than pharmacists and physicians. We had a recent study around patients with opioid use disorder where there's also a lot, but a lot of hesitancy and stigma, and in distrust around that treatment. And very surprising, we found that patients with opioid use disorder said they would prefer to receive health information and treatment information from other peers with opioid use disorder rather than from health care providers.

This was surprising to us as scientists and health care providers, but important information. It means that true celebrities may be other patients and often are other patients because of their experiences with being patients. So that makes it both more scalable and empowering to support patients because there's so many patients and these patients are often the most passionate also about sharing information. I think it's really helpful and important that we, as scientists in the public health community, invest more time and effort, educating. in gaining the support of patients, because these are the ones who are often most passionate and often the most received by others.

If we want campaigns against misinformation or in promotion of vaccination, we need to empower other patients with the knowledge and support tools for them to be able to do it themselves. Of course, having pharmacists and physicians, health care providers, is important as well as celebrities, we're all in it together. It's a big effort coming together. But I think it's really promising and exciting the power of the patient voice and being able to help empower them.

For celebrity endorsements. Dr. Trygstad mentioned, one risk in celebrity endorsements is that celebrity status and celebrity interest are not static over time. There are a variety of factors that can come into play for celebrity endorsements.

To me, the 2 risk corridors is again, assuming that somebody's cachet with a particular audience is static, over time, could get better, could get worse ending on lots of factors. If I was a person in this space, I wouldn't be signing any long term deals in other words, right? But the other is that it's the nature of the relationship between the person on that screen, that person on the Tik Tok, and that person that is on the other end of whatever that celebrity is doing, and even though it's not a relationship in a traditional sense, it is a relationship.

Not only is that person's cache potentially change over time, some people are more Swifties now, some people are less Swifties, now that that can be in flux, there's some people that will be Swifties for life. But it's also if , I have a health economics degree and did econometrics, if I was run a with our to run a really fancy statistical model. My guess is one of the predictive factors of the strength of that connection between that audience and that celebrity has to do with authenticity, and that the more that audience believes that person is authentic, and is really speaking to them, the more likely it is that it's going the message is going to sink in. And we see that this is literally political science. How am I connecting with somebody, and what is fake to some people is very authentic to others. But you want to be able to measure that authenticity and optimize that authenticity. To me, it's just easier if that celebrity can personally speak to the disease state.

Dr. Young said that collaboration and communication between patients, key stakeholders, health care providers and scientists are essential to ensure authenticity of the celebrity endorsement.

Communication and planning and a coordinated discussion and marketing approach is really important for ensuring buy in from as many people as possible and making it feel like it's a joint effort.

Dr. L'altrelli added that celebrity endorsements have come up in national pharmacists meetings, and how it is an interesting topic among pharmacists and other health care professionals.

I think this is a really interesting topic. I think it's something that comes up more frequently from time to time, even at some of our national meetings, we talked about different celebrity endorsements and how bringing awareness to certain things could be helpful. No one wants to sell out their profession. We're not saying that the celebrity or anybody that isn't part of the profession replaces the profession. It's more of a spokesperson. So I think this is an important topic, and I think it's something that is picking up, more discussion worth hearing about.

I'm hoping if I had the ability to speak to pharmaceutical manufacturers, generally, policy folks up at CMS or in DC or even at the state level. There is an army of more than a quarter million licensed health care professionals out there called pharmacists, who are celebrities in their own right to certain populations across the country, and that when we talk about public health measures, health prevention, screenings, a big one, screenings, that there's a gigantic, untapped opportunity to work with pharmacists as endorsers, celebrities, etc. Just as we have with primary care, rightly so for a long time and others to be population health management and screening just juggernauts because there is a lot of trusted relationships, particularly with the patients that have the most challenging issues going on.

We need to use that front door to the health care system to do a lot more screening and education and counseling, not just counseling for the drug when it's there at the counter at the end of the counter, but screening for conditions screening for whether or not regimens are working, etcetera, etcetera, and that they may not end up on a manufacturer's commercial on broadcast television, but they are celebrity to a lot of people in their community.

I hope you enjoyed this episode of the Pharmacy Times Pharmacy Focus mini-series, Star Power: Celebrity Endorsements in Pharma, as well as the whole series. If you haven't listened to the rest of the series, episodes 1 through 3 are available now, wherever you get your podcasts. Thank you for tuning in.

Pharmacy Focus: Limited Series - Celebrity Endorsements in Public Health

Timestamps

Macnab AJ, Mukisa R. Celebrity endorsed music videos: innovation to foster youth health promotion. Health Promot Int. 2019;34(4):716-725. doi:10.1093/heapro/day042