Does celebrity involvement in public health campaigns deliver long-term benefit? Yes

Celebrities 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, 1,657 of 29,322 (6 percent) news items have featured celebrities, a rate substantially below those experiencing disease or injury (60 percent), experts and health workers (50 percent) and politicians (49 percent).1 They often get involved because of personal experience with a disease or because they share the concerns of other citizens about an issue 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.

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 forever. They hone in on celebrity endorsement of flaky complementary medicine or quack diets, or ridicule feet-in-mouth incidents where celebrities have wandered off message or blundered, or point out cases where celebrity “effects” are not sustained,2 a problem of course 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 issues 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 flipside, is there anyone in public health who is not appalled when celebrities speak up for smoking (David Hockney, Joe Jackson); promote prostate cancer screening for men even younger than 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 in advocating for an issue. But just as the media have an 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, like a common inability to imagine an audience outside their own often middle- to high-brow cliques. Nature’s online editor, Ananyo Bhattacharya, has just reminded us of all the ways that scientists can be hopeless news participants.4

Why do we expect perfect outcomes following 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 rapidly became a paparazzi sport: who would 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 the then 36-year-old Kylie Minogue’s breast cancer, meanwhile, led to an increase in unscreened women in the target age-range having mammograms,6 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 precancerous cervical lesions detected by a pap smear and her story went viral, generating increased awareness of the importance of pap smears? 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.