Patients are ditching vital nutrients based on Instagram advice, according to an Australian oncologist who describes a growing crisis of trust as unqualified wellness influencers replace doctors as the primary source of health information for millions.
Ranjana Srivastava, a medical professional whose patients have abandoned red meat because they believe it “dilutes chemo”, cut out all dairy, or adopted a “hand-squeezed juice only” regimen that sent blood sugars spiralling, says the problem has escalated far beyond quirky diets. “When I entered medicine, the term ‘wellness influencer’ did not exist,” she writes. “Today’s patients are watching Instagram and TikTok reels while their doctor keeps them waiting.”
In one case, a malnourished, anaemic patient told Srivastava she had stopped eating red meat after seeing advice on Instagram. “Because it dilutes my chemo,” she explained. The oncologist tried to explain that moderate red meat intake would boost haemoglobin, but the patient remained unconvinced. Another patient has turned to ivermectin, the anti-parasitic drug promoted online as a cancer cure, a phenomenon Srivastava says “every oncologist is coming across”. Despite laboratory studies suggesting potential anticancer effects, the National Cancer Institute is still undertaking preclinical research, and oncologists stress that no robust human clinical evidence exists to support its use. Srivastava’s patients have also asked about apricot kernels, a supposed cure her predecessor would warn “could kill you”.
Who are the influencers?
The scale of the shift is laid bare by a Pew Research Center study that examined nearly 7,000 health and wellness influencers, all with more than 100,000 followers. Nearly one in ten boasted a million or more. Yet the study found that only 17% of those identifying as healthcare professionals were conventional doctors, dentists or nurses. Dietitians made up just 6%, and mental health professionals a mere 4%. The vast majority of influencers are life coaches promising personal transformation (31%), business owners hawking products (28%), and a motley crew of chiropractors, authors, activists and “functional” health practitioners. A striking 16% do not offer any formal credentials at all, relying instead on “lived experience” – labelling themselves “ADHD mom” or “Cancer Warrior”.
Men are more represented among influencers with over a million followers and those who identify as doctors, but overall 64% of health and wellness influencers are women. Instagram is the dominant platform, used by 86% of them, followed by TikTok (62%) and YouTube (45%).
Who is listening?
A great many people. Half of US adults under the age of 50 now get their health and wellness information from influencers and podcasts. In Australia, two-thirds of teenagers rely on social media for health advice, and a separate study found that 97% of young Australians use social media daily, with 38% spending three or more hours per day on it. These teens are acting on the advice they see – even when they are uncertain about its accuracy. The generation with the worst mental health on record is also the one most influenced by online personalities. Research involving young adults aged 18 to 25 in the UK, US and New Zealand found that followers of health influencers reported higher levels of distress, depression, anxiety and low mood than non-followers, an effect particularly pronounced among those who followed food or diet-focused accounts.
The dangers are not hypothetical. A study of TikTok content found that 81% of purported cancer cures promoted on the platform were fake. The rise of misinformation has been linked to vaccine refusal and to tragic cases such as that of Paloma Shemirani, a 23-year-old who died from a treatable cancer after refusing chemotherapy due to anti-medicine beliefs amplified online. Others include Belle Gibson, an Australian influencer who falsely claimed to have cured her brain cancer through diet, and Brittany Miller, a UK influencer who admitted lying about having cancer to fundraise. Some influencers are accused of exploiting vulnerable people by selling overpriced supplements, detox kits and unproven medical tests, often using fearmongering tactics to drive sales.
Trust in conventional medicine, Srivastava notes, has never fully recovered after the pandemic. High medical bills, a few high-profile cases of doctors violating the doctor-patient relationship, and genuine medical errors all contribute. “But I would argue that doctors are governed by expectations and regulations from inside and outside the profession,” she writes. “The law eventually catches up to doctors behaving badly.” By contrast, an unlicensed influencer – however charismatic – faces no such accountability for advising on childbirth, depression, addiction or cancer.
What can be done?
Some governments have taken firm action. China has banned unqualified influencers from offering health advice, requiring social media creators to prove their professional credentials before discussing medicine, finance, law or education. Platforms are now responsible for verifying those credentials, with fines and content removal for non-compliance. In the UK, the NHS has issued guidance for healthcare professionals on social media use, stressing evidence-based information, professional conduct and patient confidentiality, and advising against derogatory comments or harassment. But experts argue that regulation remains patchy and that the onus should not fall solely on individuals to separate fact from fiction.
Srivastava believes doctors must meet the challenge rather than dismiss it. “As in any relationship, so in the doctor-patient relationship – taking the time to understand another perspective helps,” she writes. She advocates supporting professionally credible influencers, such as registered dietitians and doctors who provide evidence-based advice on social media. Examples include Dr Hazel Wallace, Rhiannon Lambert and Dr Megan Rossi. She also calls on institutions to stop staying silent: “They must tailor information to educate people about the hazards of influencers as advisers. Let’s start with posters in different languages in waiting rooms.”
Ultimately, Srivastava says, outrage has never changed a patient’s mind. The modest success she has had comes from “dispassionately explaining the evidence, humbly acknowledging the things medicine doesn’t know or do well, and gently offering to leave the door open”. She adds: “This may be the best way I know of being a wellness influencer.”