Today we are joined by Dr. Christopher Worsham from Harvard Medical School. He explains why healthcare professionals should utilize publicly available data to better understand how popular culture influences patient behaviors.

Dr. Worsham?

My name is Chris Worsham. I am a pulmonary and critical care physician at Mass General Hospital and a health services researcher at the Harvard Medical School Department of Healthcare Policy. I think that pop culture plays an underappreciated role in public health, and it’s one that is sort of intuitive and common sense in a lot of ways, but it’s not one that’s well studied. There are some examples of how popular culture and celebrities can influence health behaviors. This was about 10 or 20 years ago. Katie Couric live streamed her colonoscopy on television, and that led to a transient increase in colonoscopies when Angelina Jolie wrote an op-ed in the New York Times about her experience with breast cancer prevention and the BRCA gene mutations that led to an increase in genetic testing. And then we had this example from the Netflix show, 13 Reasons Why, which seemed to increase rates of suicide and suicide attempt. It was a show about suicide.

There are examples of this, and we decided that with Barbie being this massive movie last year that sort of focused on issues related to womanhood, and there was this final scene where she sort of enthusiastically shows up at the gynecologist. We were wondering if, because the movie was so popular, might that have actually influenced healthcare behaviors. What we found looking at Google search data was that the week that Barbie came out and that opening weekend, I want to say maybe 10 or 15 million tickets were sold, there was a big spike in Google searches for the word gynecologist and then another smaller spike for searches for gynecologist definition. And I think this is probably the case because at the end of the movie, Barbie enthusiastically shows up at her gynecologist and we were wondering, well, did this spike in search gynecologists represent just interest in gynecologists as sort of what is a gynecologist? Or was it translating into people actually looking for gynecological care?

We looked at all of these different searches and we found the spikes in searches for gynecologists and information about gynecologists, but we didn’t see any increases in searches for people looking to make an appointment with a gynecologist, find a gynecologist near me, those kinds of searches. Nor did we see searches or spikes in searches for other things like women’s healthcare in general or medical care more broadly. So what we think happened was that the movie led to a lot of people trying to figure out what a gynecologist was, even though we didn’t see, at least in the Google search data, it translating into gynecological care from a public health standpoint, this is still something really important. We saw that thousands of people were looking up gynecologists because they went and saw the Barbie movie, and we don’t know who those people are. It could be that a good chunk of them are maybe teenage boys who don’t know what a gynecologist is, but as a result of the movie, they looked it up and now they know.

As far as what should healthcare providers do with this information, or how should public health practitioners try to translate interest and increased health literacy into actual changes in healthcare behaviors is a complicated question. And I think if we knew the answer to it, we’d have a much healthier population of how do we get people to do things that are good for their health that they might not otherwise be inclined to do. One of these things is recognizing just how complex and widespread our public health system is. I think the biggest takeaway here is that movies, TV shows, celebrities are part of our public health system. What happens there and these things that are sort of in our daily national conversation are part of our public health system, and we need to recognize that and try to find ways to harness it.

I think there are a handful of studies looking at how popular culture can influence public health. There’s not a lot of studies looking at specific interventions and other sort of outside of the box ways we might be able to influence health behaviors for the better. So I think the most important takeaway here is recognition of the role of popular culture in public health with an eye towards what else should we be looking into and what kinds of things should we be trying in the future. Figuring out the long-term effects of these pop culture and other cultural events on public health is really challenging because so much of this is transient. We have transient increases in colonoscopies after Katie Couric livestreamed hers. We had transient increases in HIV testing after Charlie Sheen disclosed his diagnosis. So there does seem to be a little bit of short-lived measurable effects, but then the longer term effects are much harder to measure because they play out over such long periods of time over many, many years where individual cultural phenomena start to add up and start to demonstrate broader shifts in behavior.

If we were to ask ourselves what the effect of having a lot fewer people smoking cigarettes in TV shows and movies on smoking rates, well that was something that gradually happened over a long period of time that coincided with a lot of other interventions we’ve taken to decrease smoking. So how do we tease out the effect of less cigarette smoking in the movies from tobacco taxes and advertising regulations? That kind of thing is really hard to figure out, but just because it’s hard to measure doesn’t mean we shouldn’t try to, or that we should discount the role that popular culture is playing. Using internet searches as a tool to understand sort of interest in health topics or actual changes in health behavior is obviously not ideal. It’s sort of a proxy for what someone might actually be doing. So the better ways to measure these types of things are to look at how many gynecologist appointments got made as a result of the Barbie movie.

We weren’t able to measure that because we didn’t have the data available yet, but one day we will. But in the event that it doesn’t directly translate into something that’s easy to measure, things like Google search results can give us a sense of the process by which popular culture and influence health behaviors. But figuring out exactly how to measure these things is a challenge. We have immense amounts of data that are being generated every second of every day by every single one of us who picks up a smartphone or goes on the internet. Figuring out how to harness the potential of that data in a way that actually can tell us about cause and effect is really challenging. And we’re constantly on the lookout for opportunities to study cause and effect. In this case, we take advantage of the fact that the release of the Barbie movie is timed pretty randomly with respect to general interest in gynecology as sort of a topic of Google searching. But we don’t always have those sorts of randomizing events that let us understand cause and effect. So I think moving forward, as we do try to understand how popular culture is influencing health behaviors and public health, it means we need to take advantage of the data. I don’t know who is watching what on Netflix and therefore I am not able to link that to their health outcomes. But one day that would be a nice study to be able to do, to look at differences in outcomes on people who perhaps happen to have a certain show or movie on a streaming platform released to them randomly compared to another group that was randomized to not have that show released to them.

There’s a lot of things we could do, but it relies on collaborations with various aspects of this cultural public health system with the sort of traditional public health system. And that’s collaborations I hope we get to see in the future. I think if there’s one takeaway from this study, it’s that this really is in my mind pretty convincing evidence that movies, even lighthearted comedy movies are contributing to public health literacy in some form or another. But we saw thousands of people searching for information about gynecologists from a single joke in this movie. And so my hope is that we can recognize this in the future. We can look for ways to measure it in the future, and we can find creative ways to combine our sort of broader cultural data with our traditional health data to glean some new insights.