Simon Chapman: Sick and famous

Singer Cheryl Cole may turn out to be the most famous person to get malaria in 2010, but of course she’s not the only one. And more importantly, she’s hardly typical of malaria patients who are likely to be impoverished residents with poor access to prophylaxis living in areas with run-down public health infrastructures. While we all wish her a full recovery, has the publicity generated been useful to malaria control? And how can people working in health and medicine do more than stand back as spectators on the massive coverage that celebrity illness, injury, and death can create?

Celebrities are by definition newsworthy. We invest them with a kind of invincibility that creates compelling interest when — just like mere mortals — they get sick. We double-take that these people actually have bowels, unsightly rashes, or falls from grace with substance abuse. I lead a project that’s been monitoring all health and medical coverage on Sydney television since May 2005, with over 23,000 clips now in the TV database. Celebrity health stories today rank third highest after transport injury and “hospitals in crisis” coverage.

There have been many examples of celebrities with illnesses who have been able to focus large scale and positive attention to the conditions from which they suffer. Ervin “Magic” Johnson’s HIV, Ronald Reagan’s Alzheimers’ disease, and George Harrison’s lung cancer that cut some 17 years off the life expectancy he might have otherwise enjoyed, all generated massive discussion that assisted public health debate about these conditions.

When Kylie Minogue was diagnosed with breast cancer in 2005, the news coverage generated an unprecedented and sustained 101% increase in unscreened women in the target age range being screened for the first time. But a second study published later also showed that Minogue’s relative youth had apparently inspired a large number of very young women to see themselves at risk for breast  cancer and obtain mammograms privately. Such events can act to repudiate evidence based health policy in the minds of the public. If young Kylie has breast cancer, how wrong is it to limit screening to older women, went the chorus from lay epidemiologists with little knowledge about the risks and improbabilities involved.

When cricketer Shane Warne was given an obscene amount of money to quit smoking by a pharmaceutical company in 2001, the “story” rapidly turned into a highly moralised tale of whether it was fair that such a person should be given a fabulous incentive to quit when this was not an option for the millions around the world who try each year.  When Warne was photographed back on the gaspers soon afterwards, the story became imbued with cynicism and its news value became one of the ethics of him accepting the cash. Public health voices struggled in vain to reframe the episode by arguing that while Warne was probably the world’s best cricketer since Bradman, he was a also a terribly ordinary smoker who quickly relapsed, just like most smokers do on their way to eventual success.

An example of how well-meaning celebrities can be harnessed in the service of dubious health causes is happening today in Australia. The Prostate Cancer Foundation of Australia is running a campaign involving celebrity men urging PSA testing. Many of these men are in their 40s, with some in their 30s. They urge all men from their 50s and men with a family history who are aged over 40 to be tested. In 2007, just 10 of the 2,938 men who died of prostate cancer in Australia were aged in their 40s. While Australian male life expectancy is 79 years, the average age of death from prostate cancer in Australia is 78.6 years, and that from all cancers is 72.4 years.  77% of men who have a prostatectomy in Australia remain impotent 3 years afterwards. Of course, none of this critical information appears in the campaign.

The boost that celebrities can bring to a health cause needs very careful risk analysis. Column inches envy can mesmerise the unwary into failing to anticipate how a celebrity led campaign can backfire when the script goes wrong and the celebrity unleashes flaky advice or follows an unexpected personal agenda that can undermine important messages.

Simon Chapman is professor of public health at the University of Sydney