The Couric-Jolie effect: When celebrities share their medical experiences

It's good when celebrities do good

The impulse to take a challenging or tragic medical experience and turn it into something that helps others is commendable. It may be easier to keep such matters private or avoid talking about them in public. But time and again, we see celebrities joining forces with health-promoting organizations, speaking out, and sharing their stories to help others avoid what they've experienced. Many have credited Katie Couric with removing the embarrassment associated with colonoscopy and showing how easy it is.

Is there a downside?

There are a number of ways celebrity pronouncements on matters of health can go wrong. For example, the information can be faulty or confusing. The forays of Jenny McCarthy (who claimed vaccines cause autism) and Gwyneth Paltrow (who recommended vaginal steams to "cleanse the uterus") into matters of health and illness are examples of influence most doctors would consider unhelpful or even dangerous.

When I heard about Katie Couric's colonoscopy, I thought it was brave and certainly a unique way to get her message across. But as well-intended as it may have been, she was 43 years old at the time. Since guidelines suggest people begin routine screening at age 50, I wondered if she was a good candidate for the test. Unless she had symptoms (such as intestinal bleeding), a strong family history of early colon cancer, or some other special circumstance that put her at higher than average risk for colon cancer, her colonoscopy could be considered unnecessary testing. And that could have led others to have unnecessary testing as well.

A recent study raises a similar concern about Angelina Jolie's BRCA testing. It found that in the weeks after her editorial was published, testing increased by more than 60% (at an estimated cost of $13.5 million). However, mastectomy rates actually fell over the next two to six months, leading the authors to suggest that most of the additional women who had testing had negative results and therefore may have been poor candidates for testing in the first place. Of note, the study did not confirm whether those having the BRCA test had risk factors (especially a family history of early breast or ovarian cancer) that would make the test appropriate. Critics of the study have suggested that mastectomy rates within six months of testing is not an adequate measure of whether the tests were appropriate. Still, the point is worth considering. When a celebrity recommends a medical test or treatment, the audience is not limited to those who are most likely to benefit.

The bottom line

For any medical test or treatment, ask whether it's likely to be helpful. The answer may be straightforward. For example, a well-studied and well-accepted screening test may be recommended based only on your age and gender. But in many cases, the answer may rely on a considerable amount of judgement based on how likely it is that you have a particular condition, the ability of the test to detect it, and the impact of the test result on treatment decisions. For example, if a person has knee pain that's mild and well-controlled with exercises, it may make little sense to have an MRI, as the results are highly unlikely to affect treatment.

If your doctor recommends a test or treatment, make sure you understand why. And if it's a celebrity making the recommendation, do yourself a favor: run it by your doctor.