Pharmacy Focus : Episode 77

Pharmacy Focus: Limited Series - Celebrity Endorsements in Pharmaceuticals

Commentary
Podcast

The podcast highlights addressing misinformation, the impact of celebrity endorsements in pharmaceuticals, and the important role of pharmacists in educating patients.

The podcast discussed the impact and effectiveness of celebrity endorsements in the pharmaceutical industry, covering how health care professionals are working to address misinformation through community outreach and multicomponent interventions. Regulation differences between prescription drugs, OTC medications, and dietary supplements were also highlighted. Celebrity endorsements were said to potentially contribute to misinformation if claims aren't verified, and while endorsements can raise awareness, medical experts cautioned that popularity doesn't equal scientific merit.

Timestamps

0:00:09 - Introduction to the podcast series on celebrity endorsements in pharmaceuticals
0:01:14 - Dr. Alfred L’altrelli discusses multicomponent interventions to address vaccine hesitancy through connecting with communities
0:03:27 - Dr. Christina Madison emphasizes the importance of differentiating between misinformation and disinformation
0:05:00 - Dr. Christina Madison discusses regulation differences between OTC supplements/vitamins and prescription drugs
0:10:00 - Dr. Christina Madison discusses pros and cons of celebrity endorsements, and importance of verifying claims
0:12:41 - Dr. Troy Trygstad discusses how personal endorsement of conditions can impact effectiveness
0:14:34 - Dr. Alfred L’altrelli discusses how media choice can impact message effectiveness
0:17:18 - Music videos as a health promotion tool used by students in Africa is discussed
0:22:23 - Pharmacists serving as medical experts and gatekeepers in rural communities is discussed
0:24:53 - Dr. Troy Trygstad concludes that celebrity endorsements can start conversations for pharmacists to provide care

Experts Include:

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; and Troy Trygstad, PharmD, PhD, MBA, the executive director of CPESN USA.

Key Takeaways

1. Multicomponent interventions like addressing specific populations, increasing knowledge, and engaging community leaders can effectively address vaccine misinformation.

2. It's important to differentiate between unintentional misinformation and intentional disinformation.

3. OTC supplements and vitamins are less regulated than prescription drugs and claims may not be evidence-based.

4. Celebrity endorsements can raise awareness, but claims should be verified, and patients need guidance from medical professionals.

5. Personal endorsements from celebrities affected by conditions may be more effective than endorsements unrelated to health.

6. Different media types impact message effectiveness. TV is broad but social media allows targeted messaging.

7. Music videos using repetition and visuals can be an effective health promotion tool.

8. Pharmacists serve as trusted medical sources and should educate patients, especially on OTC products.

Ashley Gallagher

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 4-part series, including pharmaceuticals, vaccines, Ozempic, and public health. In this episode, we talked about advertising, multicomponent interventions, and awareness initiatives, as well as the impact of celebrity endorsements in various pharmaceutical products.

In a review published in the International Journal of Nursing Studies,1 the author stated that multicomponent interventions, including addressing specific populations, increasing knowledge and awareness, addressing mistrust in information and engaging community leaders can be an effective strategy for addressing misinformation. In an interview for Pharmacy Focus, Dr. Alfred L’Altrelli, the senior director of pharmacy at UPMC Presbyterian-Shadyside, discuss the use of these interventions, saying that they were effectively used to address vaccine hesitancy and foster positive impacts on vaccination rates.

Alfred L'Altrelli

So it's actually like a great source of pride that we've all had here as pharmacists and other health care providers, because we're all pulling together pharmacists, pharmacy technicians, pharmacy students, nurses, nursing students, physicians, residents, non-clinical team members, and so on, coming together, and we're addressing that mistrust and that misinformation, we're working together across the spectrum, to meet the community where they are, and have a relatable person for them to talk to. It might be a pharmacist, maybe it's a student, maybe it's someone non-clinical, maybe it's a nurse, etc. So together, as health care discipline, we're all coming together and doing that.

I know that I personally had several patients who needed more information to decrease their anxiety, some who just wanted a little extra personalized support. I think, personally, I view it as my job to provide the accurate information provide the human connection, and the support, so people can make the decision that's right for them as to if they get vaccinated or not. So that's a strategy that I know many other disciplinary colleagues of mine had, that really allowed that multicomponent type of intervention to come together over connecting with different types of people and different types of settings and getting to them with the information that's necessary for them to make an informed decision.

We also did a lot of partnering with different community groups and leaders during the height of the pandemic, these community influencers, whether they were religious leaders, local figures, etc., they champion vaccine efforts throughout our region, their endorsements, their support helped build trust within our communities because they're from that community and a trusted member within it. These are the communities that we as health care professionals serve, and encourage, individuals to take part in vaccination campaigns, as members of those communities ourselves. Being being from those communities, partnering with people also in those communities, really led to a much stronger showing than it would have been if it's just us as health care providers out there on our own. This is something that we really need to continue doing as a health care profession. Because you know, there is power and connecting people to accurate information.

Ashley Gallagher

But vaccine misinformation isn't the only incorrect information out there. As Dr. Christina Madison, the public health pharmacist reminds us. She said that it is essential for patients to be able to differentiate between misinformation, which she defined as unintentionally false information, and disinformation, which she defined as intentionally misleading information.

Christina Madison

The one thing that I would like the audience to understand, specifically around this topic is that there's a difference between misinformation and disinformation. Understanding that there could be an intent to mislead people versus telling a falsehood, and not realizing that that is something that could be harmful to someone, so just making sure that you're checking to see if whoever you're with, and whoever you're listening to, is using a reputable source. You really do have to kind of take everything from a standpoint of it could be false, right? When you look at it as it might be false, then you can make sure that you're digging in and seeing: is this a reputable source? Is this something that I can believe? And when in doubt, do your own research, look into it yourself. I always say you can always ask Brother Google. He is there for you and then you can always look to see: is that a government email? Is it a government website is that edu at the end associated with a university or an academic institution? That's usually going to be a reputable source.

If you do your due diligence, and you look into things or go to your local pharmacist, you're likely going to be able to make a good decision.

Ashley Gallagher

One such example she gave us is how OTC herbal, dietary supplements, and vitamins are regulated and marketed.

Christina Madison

I think the biggest thing is understanding that it's kind of a wild west when you think about like herbal supplements, and dietary supplements, vitamins, and those kinds of things in the market, which by the way are not held to the same rigorous standards that drugs that are approved by the FDA are. I think, first and foremost, it's understanding that there is a very distinct difference between the two groups. Things that are OTC, things that are overly counter, herbal products, those are not held to the same standards versus say like your OTC cough medication or your OTC pain reliever. They've gone through the FDA process and found to be safe in order to allow for someone who is a layperson to use that product without the recommendation of a health care professional versus pharmaceutical products that have been FDA approved, those typically need to be counseled upon by a pharmacist, they are prescribed by a health care professional. So those are so those are the differences.

When you think about sort of this, proprietary blends that they put on the label. I mean, they're basically hiding what's in the product, and then unfortunately, because of the way that our structure is it allows for that. So again, you have to do your own due diligence, you have to look into what those products are, you should be investigating the ingredients that are inside that product.

Ashley Gallagher

In fact, in a study published by student pharmacists in Currents of Pharmacy Teaching and Learning,2 the authors concluded that approximately 30% of celebrity endorsements of over the counter medications violated the laws, and nearly 35% made claims that were not supported by evidence. So how do celebrity endorsements affect the patient's perception? What do pharmacists think about this? Dr Madison tells us that there are pros and cons to celebrity endorsements.

Christina Madison

The big thing that I think that I would start off with is that there's good and there's bad to this, right. So the good thing is that we have people that have basically instant credibility because of their celebrity status, talking about medications, talking about vaccinations, talking about public health initiatives, and that brings awareness to the space and helps people to be able to feel like they have that know, like, and trust factor in order to make an informed decision about their health care. So that's the good part, right?

The bad part is that direct to consumer advertising is one of the biggest challenges that we have within pharmacy. Direct to consumer advertising, for pharmaceutical medications, as well as supplements, and, dietary products, are really kind of separate. With pharmaceutical products, there does, there is regulation there. There is a little bit of a gatekeeper, but with a lot of these supplements and dietary things, vitamin, those are not regulated. I think having sort of these claims of being healthier, having better skin, losing weight, all of these things may or may not be true. So we really just have to do our due diligence to make sure that the information is coming from a reputable source. So yes, we may have a celebrity endorsement, but we do have to remember that these people are being paid for their time, and that that may cloud some of the judgment or some of the information that they could be telling us and taking that celebrity endorsement with a grain of salt, understanding that the claims that they're making are the company's claim, and that those claims do not necessarily have to have the same rigorous testing and research and that those claims have to be proven before that product goes to market.

So the way that I think of it is it, unfortunately, it does harm whether or not people believe other future celebrity endorsements and that it does make it really challenging for the average consumer because they don't know whether or not the information that they're getting is false. They don't know if it's partially true. Or if they can take it and they can run with it and they can go and get the product and feel safe that they're taking something that is going to be beneficial to them.

Ashley Gallagher

So will celebrity endorsements actually drive patients to the pharmacy? One example of a celebrity endorsement in pharmaceuticals would be Pfizer's Nurtec commercial, featuring reality TV star, Khloe Kardashian, and another featuring Popstar Lady Gaga. Dr. L’altrelli said,

Alfred L'altrelli

Yeah, I do think it will drive more people because these endorsements really do align with the other component inventions that we were discussing, including targeting specific populations, which are, in this case, fans of the celebrities, increasing knowledge and awareness about the medications, addressing mistrust through the credibility of the celebrity, and so on. Celebrities endorsing medications for specific conditions, such as, like migraine in the case of Nurtec can raise awareness among their fans that are affected by those conditions. You've got two subsets right there fans, and then the fans that are affected by the migraine, so they might get missed by people that see that message, and are unaffected by migraine. But that's not who uses these medications. So that's not our target.

Then there's the people that don't relate to the celebrity, and the message might be missed with them, because they might not relate to the message, because they don't relate to the celebrity. What is interesting about all of this, to me is we have to remember that patients can't just take these medications without a physician and a pharmacist. So it brings them in to talk to us, if you're looking at a choice between 2 medications, and I saw Lady Gaga that takes this, I would like to take this too, because I have whatever condition and the conversations being held with a health care professional that can balance the influence of the endorsement with more comprehensive medical information that we know about the patient's condition the medication itself, its efficacy and safety, sustainability, compliance, adherence for individual patients, and say, “Yes, that's the right medication for you” or “no, we have something similar to what Lady Gaga takes, but this is really what's going to be the right medication for you.” So I think that there's a benefit, even if it does get the idea of a specific brand or a specific medication in somebody's mind, because there's a gatekeeper, right, to make sure that we're doing what's right for the patient.

Ashley Gallagher

Dr. Troy Trygstad, executive director of CPESN USA had this to add:

Troy Trygstad

My own personal belief which is not found in any data points that the type of product and condition and whether or not how the endorser is affected by that can be really important, right? George Foreman endorsing the George Foreman Grill is a different thing than celebrity that might have breast cancer and is using a certain oncologic agent. They might be in the same neighborhood, but they're not on the same block, so to speak, right? I think the more serious the condition, the more effective it is, if the celebrity is either affected their son, daughter, Mom, themselves has it's affecting them, and they're speaking to an audience and saying, “I am you, you are me. Here's what I do. Here's what I've done. Here's how I view the world” versus Gatorade is an electrolyte. Gatorlight is sort of competitive to Pedialyte. There's that sort of brackish water in the middle there that you don't really see as a medical intervention, might be more of a food product or an OTC that's kind of a medical intervention or a supplement.

There's a whole world out there the murky middle, where I think celebrity endorsements are likely to be more conventional. It's just a name that's associated with something. It's not a name associated with the condition. Yes, athletes we sweat, we need nourishment, go Gatorade, sure. But when we're talking about our world of pharmaceuticals, that celebrity being affected by the condition, and speaking to the audience that also is affected by the condition feels to me like it would be a much more effective speaker and audience engagement.

Ashley Gallagher

Dr. Laltrelli added that the form of the endorsement and the presentation might be just as meaningful to patients as the endorser themselves.

Alfred L'altrelli

We have a large variety of different ages and generations of people on our workforce that have different familiarity and comfort with technology. I know with my kids, they're constantly on these apps and that's how are connecting with society. Whenever you look at all of those differences, I do believe that the choice of media type for promoting information, especially in pharmaceuticals and health care can impact the effectiveness of a message. Whenever you think about it, there's a perception in different generations, right? But then there's also the media source for television is something that's broad. It's effective for reaching more diverse, more spread out audiences, more age groups, more demographics, the production values are typically higher, there's more of a cost to entry into putting something on TV, the contents, usually more visually appealing professional content. It seems that there's a tendency where people may perceive that information is more trustworthy. We're always affected fully by some regulatory body. Because some commercials have that subscript information about what it does and what it doesn't do. So yes, I know that there's a public perception about what is on television, versus social media, but social media does allow for targeted advertising.

We're reaching specifically into specific demographics or niche audiences that you can have people engage directly with the content, they can share it, they can post their comments and thoughts and likes and participate in discussions, and it fosters a sense of community. It's 2 way; it's not 1 way like the TV. Social media is also again, more cost effective, and allows for more frequent touch points with those targeted groups, because of cost, other things like that. There definitely is a difference in the audience that you reach with each of them, as well as the amount of times you're able to reach them to have a message stick. I really think that both have unique benefits and drawbacks the differences really to which can be more effective in which situation. You've got to consider the target audiences, message tones, what amount of money you have, cost, constraints, budget, etc, he desired level of interactivity and engagement. Are you really trying to set up a culture around this? Or are you trying to be more informational? So yeah, I definitely see the differences. I see benefits and drawbacks to both in all honesty.

Ashley Gallagher

But are these the only media that can be used? Logic, A rapper, has a song called 1-800-273-8255, which at the time was the National Suicide Prevention Lifeline number. In a study published in Health Promotion International,3 the authors found that when asked about different health topics and health information, the students in Africa actually quoted health advice from popular music videos. Dr. Andrew McNab, a professor from the University of British Columbia said,

Andrew Mcnab

Music is very much part of their everyday life, and the use of cell phones is very widespread. So YouTube, downloading mp3 files of songs, is almost universal. They're constantly listening to music. What you have in a music video, which contains health information and health advice, is ideal health promotion material that provides the information. But because the song is listened to again and again and again, and listened to as well as seen as a video, very often on television, you get repetition of the message, so that it imprints and those facts are retain. Because the celebrities are recommending those behaviors, they are in many ways endorsing them, and the young people want to follow suit. What we found was that there were a number of videos, the facts, that these youngsters were relating to us came from.

Ashley Gallagher

The authors downloaded the videos from YouTube printed out the words, translating them were necessary from the local languages, to examine the content for the health facts they provided, and looked at the style of the video to see if they fell into educational entertainment. Dr. McNab added:

Andrew Mcnab

The ones that had the most impact included scenes that illustrated the health messages, they contained text, which gave specific advice. There were words in the song which set the scene and again gave examples. This was news to us. This is why we wrote the paper to explain the relevance of these music videos as a health promotion tool. and the potential value of using both music, as a medium, and celebrities as the health messengers.

Ashley Gallagher

Though celebrity endorsements can be useful, Celebrities aren't health care providers, and because of that, some claims can be made that qualifies misinformation, Dr. L’altrelli said in the interview. He added that patients could be influenced more by the celebrity’s popularity than the scientific merit of a product or the health information.

Alfred L'altrelli

In a more extreme case could lead them to exhibit a pursuit of something against what the health care data or the health care recommendations are. It could lead them down to a path, that isn’t data backed, the right choice for them, and something that the medical community wouldn't support. I think that celebrity endorsements can inadvertently contribute to misinformation or misleading claims, because to your point earlier, they aren't health care experts. So if they make a statement about a product, they think they know the information, but they substitute a word or trip up over something, or don't have accurate information, it can lead to public confusion, and it can lead to even potentially harmful decisions, because now, the celebrity that's endorsing something could have misrepresented it to create potentially harmful decisions without even knowing it.

I do think those endorsements in the form that they're presented to people are pretty meaningful. We discussed earlier TV ads versus social media, obviously, a TV ad with the production crew more rehearsed, probably backed by the company, or somebody else who's, helping with this scripting is very different than a social media post randomly where somebody says something that gets out and hits a lot of people.

Ashley Gallagher

But celebrities come in many forms a celebrity and one isn't necessarily a celebrity do another, as Dr. Trygstad put it, tapping into local trust centers are powerful and could be more powerful in smaller, more rural areas of the United States. He added that the health care provider can sometimes be one of the most educated ones there. Dr. Christina Madison echoed this response, and said:

Christina M. Madison

Shout out to all of my community pharmacists, colleagues ,that are on the front lines answering these questions. We are the gatekeeper, right. Ultimately, when people have questions, especially for things that are over the counter, I would highly recommend for pharmacists to get comfortable being in that OTC aisle and to see what's out there. Because that's really going to help when you have people come and ask you for questions or just even go walk out of the pharmacy and go down the self-care aisle and ask people if they have questions. Because a lot of times people may feel embarrassed, or they may not feel comfortable going and talking to a pharmacist because they feel like “oh, the information’s on the bottle. I can figure this out for myself.” Right?

When I was working in the community pharmacy space, this was many years ago, full disclosure. It's been since about 2008, since I've worked in the community pharmacy setting, but I used to do that I used to go in the self-care aisle. I used to ask people if they had questions because I felt like that was me providing good patient care. Because I think that we all need to have that confidence that when we take something home and we put it in our mouth, it's going to do what it says it's supposed to do. So I think that’s where we can really shine as a profession is by being that gatekeeper, by being that educator, by being that patient advocate, to allow people to feel like they have the most accurate information possible in order to make a good decision regarding whether or not they should take a product or if they shouldn't take a product. If they tell you “well, you know if it's good enough for Khloe Kardashian, it's good enough for me.” That's fine too. But we do want to make sure that we tell them about the alternatives as well.

Ashley Gallagher

In conclusion, Dr. Trygstad said that celebrity endorsements are useful to start the conversation, but pharmacist serve as the medical liaison to patients.

Troy Trygstad

It's an entree to a conversation. So, most health care professionals get into health care because they believe they can acquire, or they have innately an ability to connect with someone to help improve their life. If they believe in the medical, pharmaceutical, cognitive behavioral, whatever the modality of information that the intervention or the intervention is, they believe they can help somebody. And if Travis Kelce, and Anthony Fauci and the Kardashians and name a celebrity can help them start the conversation, the assumption then is that the health care professional takes it from there. Right?

You don't end the conversation with Travis Kelce, you start the conversation with Travis Kelce. Travis Kelce helps them get to you. If there's interventions or pharmaceuticals out there that the pharmacist doesn't necessarily believe in that can work the other way.

I also think it's a good thing that not all of our medical experts, and pharmacists agree on everything at all times. We all swear an oath to evidence and science and in the scientific process and so on and so forth. But that doesn't mean that there can't be rational disagreements about between health care providers. That's fine.

Ashley Gallagher

I hope you enjoyed this episode of the Pharmacy Times Pharmacy Focus miniseries, Star Power: Celebrity Endorsements in Pharma. Tune in next week as we discussed celebrity endorsements in vaccines.

References

  1. Peters MDJ. Addressing vaccine hesitancy and resistance for COVID-19 vaccines. Int J Nurs Stud. 2022;131:104241. doi:10.1016/j.ijnurstu.2022.104241
  2. Mospan CM, Alexander KM. Utilizing celebrity endorsements to teach over-the-counter medication and dietary supplement regulations. Curr Pharm Teach Learn. 2018;10(11):1507-1511. doi:10.1016/j.cptl.2018.08.001
  3. 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
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