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Public relations implications for regulation of health blogs
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Content
PUBLIC RELATIONS IMPLICATIONS FOR REGULATION OF HEALTH BLOGS
by
JONATHAN FOSSLER
A Thesis Presented to the
FACULTY OF THE USC GRADUATE SCHOOL
UNIVERSITY OF SOUTHERN CALIFORNIA
In Partial Fulfillment of the
Requirements for the Degree
MASTER OF ARTS
(STRATEGIC PUBLIC RELATIONS)
August 2013
COPYRIGHT 2013 JONATHAN FOSSLER
ii
Dedication
Dedicated to my grandparents, Lita, Joe, Bob, Ruth, and Rudy
iii
Acknowledgements
For my parents, Laura Gandara and Bruce Fossler
A special thanks to Laura Min Jackson, Jennifer Floto and Jerry Swerling
I would also like to thank the following people for helping me through this process:
Melissa Roselman, Caleb Ridgway, Chine Osisioma, Mathew Davidson, Matt
McClain, Alex Hunt, Alex Bradley, Joe Lee, Ashton Shurson, Sunil Patel, Hiral
Zalavada, Ben Ellis, Misha Kokuashvili, Rubia Di Stasi, Alex Stevenson, Joe Hua,
Brandon Lee, Steve Tamjidi, Nicole Garza, Joe Garza, Justin Chen, Ankur Kheni, Mark
Posey, Stephen Ibarra, James Whittle, Alex Moore, Kathryn Brew, Yena Jeon, and
Mercedes Fossler.
Fight On!
iv
Author’s Note
The idea for the author’s thesis originated in 2009 when he was traveling through
Europe on a backpacking expedition. While having a drink in Berlin, he struck up a
conversation with several Europeans about the health policies in their countries. To his
surprise, a Dutch couple brought up the idea that Americans sell the idea of health more
than promote it. As they sipped their cocktails and indulged in a couple of cigarettes, they
told him that silly Americans are notable for coming up with quick fixes for their health
issues. To them, antioxidants, diets and alternative medicines have become commercial
constructs aimed at targeting uninformed Americans to buy health products. Americans
based this idea on the fact that these products will save them from their unhealthy lives
and make them beautiful. While the author was curious as to what these people had to say
about American health, he was more interested as to how they felt about their own health.
What had made these Europeans so confident that they had the right formula for living
the ideal healthy life?
When one goes to a country like the Netherlands, one finds a culture filled with
liberal social policies. In contrast, Germany is internationally known for its beer and
public drinking laws. In addition, with the presence of several large breweries,
Oktoberfest and world-famous beer gardens, one would have had to assume that it was
socially acceptable to consume large quantities of alcohol at any given time. For
Europeans, health seemed to have taken on a different form from that which Americans
had come up with. This led him to ask the question, “What exactly is health and why is it
such a big business in America?”
v
The author’s knowledge/expertise in health started in his undergraduate studies,
where he earned bachelor degrees, in Psychology and Social Behavior and Public Health
Policy, from the University of California, Irvine. While studying in college, he had a pre-
med roommate who worked at a successful vitamin store chain. His roommate told him
that the most popular supplements sold to customers were antioxidants and fat burners.
This prompted him to believe that many people were either buying into the idea that a pill
could make them lose weight or stay free of cancer and aging, which he found to be an
overstatement. While these supplements may have some value and work to a certain
extent, they are not regulated by any governing body, which gives the manufacturers the
power to make claims that not always entirely true. After further investigating a thesis
topic, he hypothesized an idea from his studies that companies who market these products
can make health claims as well without any regulations. He also believed that anyone
could take these company’s claims and use them to promote their own ideas of health.
When he started to study public relations for his master’s degree, he became
aware of the power of social media and the influence it has had on people’s behavior. In
particular, he found health blogs to be rather interesting, considering of the amount of
attention they receive in terms of reader impressions. Could health blogs be a
contributing factor in misleading people into buying certain unproven health products or
believing in particular health practices? While the question is very hard to answer with a
“yes” or “no”, the author is confident that he has uncovered some interesting facts that
may give consumers a reason to believe that health blogs have the power to mislead
people the same way some supplement companies may. And like health supplements,
vi
health blogs are in need of regulation and supervision. This will give health blogs the
credibility they need to remain relevant in health promotion and education.
vii
Table of Contents
Dedication ii
Acknowledgements iii
Author’s Note iv
Abstract ix
Chapter One: Introduction 1
Chapter Two: Advocacy and Patient Education 5
Chapter Three: Health Blogs and Social Media Popularity 9
Chapter Four: The American Condition 12
Chapter Five: Health Blog Regulation 21
Chapter Six: People Who Write Health Blogs 27
Chapter Seven: Research Methodology 32
Chapter Eight: Public Relations Implications 40
Chapter Nine: Conclusion 46
Bibliography 49
viii
Table of Figures
Exhibit 1. Health Blogger Survey Questions 32
Exhibit 2. Mid-Tier Blogs (10,000-100,000 visitors) Credential Break Down 33
Exhibit 3. Percentage of Credentialed Bloggers Among Mid-Tier Bloggers 34
Exhibit 4. Top-Tier Blogs (100,000+ visitors) Credential Break Down 34
Exhibit 5. Percentage of Credentialed Bloggers Among Top-Tier Bloggers 35
Exhibit 6. Types of Branding Found in Mid-Tier Blogs 37
Exhibit 7. Percentage of Branding Found in Mid-Tier Blogs 37
Exhibit 8. Top-Tier Branding Chart 38
Exhibit 9. Percentage of Top-Tier Blogs with Branding 38
Exhibit 10. SWOT Analysis of Mid-Tier and Top-Tier Health Blogs 40
ix
Abstract
Health blogs are an electronic medium in which writers create health promotion, health
advocacy, and health advice. Since the late nineties, health blogs have increased in
popularity due to several social and economic factors. Health product companies, which
once used traditional advertisements, have utilized health blogs as effective marketing
tools. In 2009, the Federal Trade Commission issued a set of regulations by which
bloggers should abide. These regulations have not been widely enforced, and further
regulations may be needed in order to insure that health blogs are not misleading people
with false claims.
1
Chapter One: Introduction
What constitutes health? Why is it important? Why are people so obsessed with
attaining good health and repelling bad health? While these are questions that are often
difficult to answer, it is important to begin an exploration of health by examining some of
its fundamental aspects to explain why this term has evolved over time and why people
find it so difficult to define. In the author’s quest, the author will start uncovering this
mystery with a simple definition of health and begin to explain its origins.
According to the Merriam-Webster dictionary, “Health is the condition of being
sound in body, mind, or spirit” (Merriam-Webster 2013). For this thesis’ purposes, this
will be a working definition of health, but it will give the author a backbone to onto
which the author will build the investigation into how the idea of health has change over
time.
The first known or recorded ideas of medicine and health emerged over 2700
years ago. While many respected scholars believe that the Greeks were the first to think
about health, there is evidence that previous civilizations such as the Egyptians also had
ideas of health. Regardless, the first truly important figure to emerge with an idea of
health was Hippocrates of Kos, the legendary Greek physician who has been called the
‘father of modern medicine’ (Yapijakis 2009).
Hippocrates was most likely born around 460 BC on the Greek Island of Kos.
While the details of Hippocrates’s childhood are relativity unknown, experts believe he
became a leader in the health movement after finishing a two-decade prison sentence for
teaching subjects that went against the lessons of taught by Greek society. Hippocrates
followed his father’s footsteps into medicine but became more famous than his father by
2
claiming that good health was achieved by balancing the four “humors” of a body’s
constitution. These humors included blood, phlegm, yellow bile and black bile. This
claim, while primitive by today’s standards, set Hippocrates apart from his peers by
establishing him as one of the first individuals to separate health and religion. Many
people before Hippocrates believed that disease was caused by the supernatural or divine
intervention. His idea of balancing human fluids seemed to mark the dawn of a new age
of thought (Yapijakis 2009).
Hippocrates would go on to provide the medical community with an oath to
practice medicine honestly and ethically. While its true origins are often debated, the
“Hippocratic Oath” serves as a guideline by which doctors live. Today, it is estimated
that more than 98 percent of American doctors swear to some form of this oath (Sritharan
et al. 2001).
After Hippocrates, Galen of Rome became the predominant figure in advancing
the idea of health. Born to a successful architect, Galen spent many years receiving an
education that only a wealthy citizen could obtain. With this knowledge, Galen studied
the works of Hippocrates and other physicians to come up with health theories that are
still being used today. Over the course of his lifetime, Galen published more than 500
documents on anatomy, pharmacology and biology. One of his major contributions to
modern science was his definition of the circulatory system (Brian 1986). Using ancient
medical techniques, Galen demonstrated how the body contained several different
systems that worked together to create a homogeneous state of being (Brian 1986). He
often taught other members of the medical and philosophical communities about his
discoveries and medical practices, which gave him a reputation for being a great teacher.
3
His legendary reputation, like Hippocrates’, allowed Galen to transcend social groups and
educate thousands of Romans on the art and science of health. However, after the fall of
Rome, Europe entered the Dark Ages. This period is frequently characterized as a time of
‘ignorance’ and the Black Plague; it is also seen as a time when health advances became
rare. It was not until 1822, a year after the death of Napoleon, that a French chemist by
the name of Louis Pasteur was born and the tides of health began to shift again toward a
time of enlightenment.
Pasteur, unlike Galen, came from a humble background, having spent most of his
childhood poor. Excelling at art at a young age, Pasteur went on to study the physical
sciences, eventually becoming a professor of physics and chemistry. After the death of
several of his children to Typhoid Fever, Pasteur devoted his life to eradicating diseases
(“Louis Pasteur Biography” 2013). While researching bacteria growth, Pasteur stumbled
upon one of the greatest health discoveries in the history of mankind. Pasteur came up
with a possible theory that germs spawned through a biological method rather than a
random one (“Louis Pasteur Biography” 2013). He was able to demonstrate how
microorganisms grew through biogenesis rather than spontaneous generation. Before this
discovery, it was thought that people, randomly and without any reason, became ill.
Pasteur’s theory, later known as “germ theory,” revolutionized the idea of health.
Humans now faced an invisible foe, one that would inflict unimaginable damage onto
mankind in the upcoming decades, forcing people to figure out ways to remain free of
these diseases. Pasteur’s contribution to health brought new implications, challenging
people to combat these germs and diseases from a preventative standpoint. The invention
4
of vaccines and antibiotics would follow this discovery and change the health
environment for centuries to come.
While coming from different backgrounds and time periods, health pioneers
Hippocrates, Galen and Pasteur served as the first real advocates of health. It can be
argued that without their discoveries, the health world would not be the same as it is
today. Every year, hundreds of new health discoveries are uncovered. However, we need
to ask ourselves: is every health discovery as monumental as, say, germ theory or the
discovery of the circulatory system? When these seminal figures were alive, there was
limited monetary incentive to advocate for healthy practices. In today’s world, the health
industry has become one of the most lucrative in the world, especially in United States,
which gives the author a reason to believe that some health discoveries might be blown
out of proportion for reasons other than altruistic ones. The author will examine these
influences over the course of this dissertation and look to how advocacy has taken on a
digital format in health blogs. The author also will examine the current health
environment and regulations that the growing social media sector faces in America, and
why social media might create issues that never would have occurred to these historical
figures.
5
Chapter Two: Advocacy and Patient Education
Since the 1800s, several large health organizations have come together to serve as
the emerging voices for health advocacy. These organizations are well established and
often created by accredited health professionals. Below are descriptions of five of the
most respected organizations in the United States when it comes to medical and health
authority.
American Medical Association (AMA)
By 1847, years after medical discoveries such as Pasteur's germ theory, the
American Medical Association was formed to promote the art and science of public
health. In addition to promoting public health, the AMA serves to advance health
legislation and raise money to further advance health education. The AMA also publishes
the Journal of the American Medical Association, which has the largest circulation of any
weekly medical journal. Along with its Journal of the American Medical Association,
AMA maintains an active blog, which is written by the president of the organization, Dr.
Jeremy Lazarus (“About the American Medical Association” 2013).
American Public Health Association (APHA)
In 1872, a doctor by the name of Stephen Smith founded the American Public
Health Association to educate Americans about and protect them against preventable
health issues. With more than 30,000 members worldwide, the APHA has grown into one
of the largest health organizations in the world. Its members include doctors, health
officials, educators, students and environmentalists. APHA also contributes to the
6
promotion of health through its blog Public Health Newswire, which includes
contributions from its members as well as distinguished guest writers (“APHA:
Overview” 2013).
American Red Cross
Born from the blood of the Civil War, the American Red Cross was formed in
1881; nearly a decade after the American Public Health Association was founded. Along
with providing disaster relief to victims of the war, the American Red Cross was formed
to further educate communities on health practices. Today, the American Red Cross
serves six different sectors: blood donation, communication services for the military,
international development, health education, community services, and disaster relief. The
American Red Cross features a blog that gives its readers a chance to be ‘inspired’ by
health discussions that are relevant today (“What We Do” 2013).
United States Food and Drug Administration
Before the establishment of the U.S. Food and Drug Administration (FDA), there
were relatively few laws and regulations governing the sale and distribution of foods,
medicines and medical devices. In fact, the FDA was founded as a government
organization to investigate the misbranding and adulteration of products that were
harmful and unsafe to consumers. Starting in 1906, the FDA cracked down on food
producers by issuing mandatory pre-checks of all ingredients being put into food. Today,
the FDA enforces laws pertaining to the sale of food and drugs. These regulations affect
everything from vaccines to blood transfusions. Along with food and drug regulation, the
7
FDA also has furthered health education by creating tools such as the Food Pyramid. The
organization’s blog, FDA Voice, provides a valuable resource for people seeking
information on current health regulations, health fraud, medical devices and vaccines
(“About the FDA” 2013).
Centers for Disease Control (CDC)
Lastly, the U.S. Centers for Disease Control and Prevention, or CDC, was
established during World War II to serve as the governing agency of environmental
health and infectious diseases. The main focus of the CDC is to prevent current
epidemics and provide extensive research on health issues around the U.S. and the world.
Working with a budget of $9.2 billion dollars per year, the CDC is one the most powerful
health organizations in the world. Like the other organizations listed, the CDC provides
crucial health information to the public through a series of programs aimed at students,
adults, parents and teachers. Its main goal is to keep the public up-to-date on current
health problems. Its blog, Public Health Matters, gives readers updated information on
health related issues across the world (“About the CDC” 2013).
Each one of these organizations plays a pivotal role in furthering health education
in America. Most importantly, these organizations have established credible reputations
among health practitioners and the public, which allows them to have a voice in the
discussion of health. Every one of these organizations maintains a social media website
as well as a blog that serves as a medium for communicating the group’s core messages.
These blogs, like the organization, can be trusted to give audience unadulterated and
8
unbiased health information. However, that not can be said about all health blogs. To
further investigate what role personal, or non-institutional health blogs play in
communicating health information, it will be important to take the next step and identify
what health blogs are, why people choose to start them, and how the American society
may directly and indirectly be influencing their evolution.
9
Chapter Three: Health Blogs and Social Media Popularity
In the late 1990s, a series of online diaries emerged on the Internet, resembling
opinion articles from newspapers (Carvin 2007). Short for weblogs, “blogs” started
catering to niche audiences, and grew in popularity due to the help of free software
offered by websites like LiveJournal and Xanga (Carvin 2007). While many of these
blogs were dedicated to personal interests, several devoted to health education emerged.
For the purposes of this research, the author defines “health blogs” as being comprised of
several different facets of health promotion and education. Whether they provide recipes
for healthy cooking, promote physical fitness, or sell new health products, health blogs
have become one of the most popular methods of teaching best health practices. In fact,
there are so many health blogs in existence that counting them all would be a difficult
task. Like other blogs, health blogs can be created by anyone; the difference is these have
the potential to directly transform the way health education is used, assembled and
presented. These bloggers (people who record and keep daily diaries) have helped move
the flow of health information into the digital sector by posting health information, often
from their own personal experiences. Because of this, many health blogs range in content.
While some blogs might take a serious stance on a particular health issue, others might be
light-hearted and cordial.
In contrast to traditional medicine, which is closely regulated, health blogs allow
people to share health practices as well as personal information that were once private.
Their blogs also give health bloggers the opportunity to review and make
recommendations on company brands and products, thereby creating an environment ripe
for companies to perform outreach and influence these bloggers.
10
According to Erik Qualman, author of the Socialnomics, “Social media isn’t a fad,
it’s a fundamental shift in the way we communicate” (Qualman 2009). He goes on to
state that 78 percent of consumers trust peer recommendations. Needless to say, this
means that readers could take health information and health recommendations on blogs
very seriously. This also means that blog contributors may be becoming an increasingly
important marketing tool for healthcare companies. A traditional marketing campaign can
cost a company upwards several million dollars. For example, a single one-page ad in
USA Today may cost around $150,000 dollars, whereas a 30-second TV commercial can
average $350,000 to produce (Buchanan 2013). Advertising, while effective in the past,
has become a pricey tactic when promoting products. And, while it is estimated that 34
percent of bloggers post opinions about products and brands (Qualman 2009), in the
future, it can be argued that consumers will be the main factor in marketing consumer
health products. Unlike traditional marketing, which focuses on print, media and
television, social marketing remains interactive and personal, which consumers are
starting to prefer over the cold and impersonal advertisements of the past (“Global Trust”
2012). According to the Nielsen’s report, “Global Trust in Advertising and Brand
Messages”, 92 percent of consumers trust word-of-mouth advertising above all other
forms of marketing. In addition, the same survey shows that 82 percent of small
businesses say word-of-mouth marketing is the most effective way to market their
business and is essential in finding new customers. With outlets such as Facebook and
Twitter, there is 50 percent chance that a person will buy or try a product that was
mentioned on one of these websites by their friends, making social media one of the
largest advertisement platforms in the marketing business (Qualman 2009). In
11
conclusion, it is estimated that companies spent $1.59 billion on word-of-mouth
marketing in 2008, which gives an indication of how prominent this method of
advertisement has become (Qualman 2009). Health blogs, which make a portion of word-
of-mouth marketing, are more important than ever.
12
Chapter Four: The American Condition
America has seen a rise in health-related issues over the past century. With a
population numbering a little over 315,000,000 people (“State and Country” 2012), we
have grown to be the third most populated country in the world. However, our obesity
rate has also grown to unacceptable rate by world standards. Currently 35 percent of
Americans suffer from obesity, which is the highest percentage rate in the world (Ogden
et al. 2012). In addition to obesity, Americans suffer from the 7th highest rate of all types
of cancer (Mann 2011). According to Eileen Crimmins, holder of the AARP Chair in
Gerontology at the USC Davis School of Gerontology and a member of the National
Research Council panel that compiled the report, “U.S. Health in International
Perspective: Shorter Lives, Poorer Health”, Americans are not as healthy as they should
be. In the report, she claims that “Even Americans with health insurance, higher incomes,
college education and healthy behaviors, such as not smoking, seem to be sicker than
their counterparts in other countries” (Woolf et al. 2013). One would expect Americans
to be the healthiest due to the availability of our health resources and ranking as a world
economic power, however, this isn’t true. U.S. males currently rank 17th in life
expectancy when compared to other developed countries around the world (Woolf at el.
2013). In contrast, U.S. Females rank 16th in life expectancy. But what is the root of
these alarming statistics? Is it poor dieting habits? Is it a lack of national healthcare? Or is
there another factor that contributes to United States being an unhealthy nation? Does it
have anything to do with the growth of health blogs as one the most popular forms of
health education? One must look into the current state of health in this country and
13
identify the external and internal factors potentially contributing to the rise in popularity
for health blogs.
External Factors
National Healthcare System
While the current state of U.S. healthcare is undergoing widespread revision,
America is still one of the few developed nations without a reliable national healthcare
system. According to the author Arthur Kellermann, the average family healthcare
insurance policy costs $13,000 dollars a year (Kellermann 2012). Even though this is just
an estimate, most families are projected to spend nearly one-fourth of their earnings on
healthcare insurance. In addition, the average price for healthcare is expected to cost
Americans another $5,400 by the end of 2013, which indicates a growing trend in rising
healthcare costs (Kellermann 2012). This rise in costs has led many families to eliminate
healthcare coverage for their families. Without proper healthcare, some people have
chosen to self-diagnose and treat some of their ailments through the use of alternative
medicines. By using the Internet, people have found reading health blogs to be one of the
most effective ways for receiving health information. In a 2012 survey, 65 percent of
1,000 adult respondents claimed they avoided going to a doctor by instead seeking
medical information online (Treasure 2012). And while health blogs cannot diagnose or
treat diseases, the Internet is free and full of information on diseases, health practices,
diets, and alternative medicines and many people find the information on blogs to be
helpful.
14
Work Hours
Americans on average work more hours than any other developed nation. In fact,
134 nations across the world have set mandatory laws that require employers to set a
limit on the amount of hours a person can work. The United States is one of the few
countries that does not set such a limit (Miller 2010). In addition to having long work
hours, the United States is the only country in the Americas that does not require
companies to provide working mothers extended parental leave. In contrast, European
Union nations require all mothers receive three months of paid leave when having a baby
(Miller 2010). Do Americans like working more or are there societal pressures placed on
Americans to work more hours? In addition to having less time for exercising and
preparing healthy food, women might find it hard to fit in time to go to the hospital and
wait to see a doctor. Health blogs cater well to the working class by providing 24-hour
medical and health advice. These sites do not get in the way of a person’s profession and
parental duties and may provide online communities in which peer groups can meet.
American Doctors and Medical Talk Shows
In general, physicians in America have the highest salaries when compared to
their peers in other countries. The average general practitioner in America is expected to
make $161,000 dollars a year (Rampell 2009). In contrast, general practitioners in
Australia are expected to make $91,000 dollars, whereas in Sweden, one of the most
developed countries in the world, general practitioners are expected to earn $66,000
dollars a year (Rampell 2009). How are doctors in America making so much money?
Some doctors in America have found outlets via the media to further advance their career
15
and earnings potential. These include writing blogs, giving medical advice on television,
publishing books, and establishing personal brands. Some of the most successful doctors
have even become household names. According to the Journal of Medical Internet
Research, up to 46 percent of doctors contribute information to health blogs at least once
per week (McGowan et al. 2012). In the same report, 58 percent of doctors perceived
social media as a reliable source for health information (McGowan et al. 2012). One
wonders whether the remaining 42 percent might have issues when it comes to getting
health information on blogs and social media, because doctors walk a fine line when
extending their influence into the digital and media realms. While some doctors offer
their medical advice based off our their beliefs, others choose to also promote products
and endorse companies because there of the monetary incentives. One of the most
successful doctors to recently become famous by doing this is Doctor Oz, of television
fame.
In 2008, Dr. Mehmet Oz, famous for appearing on the Oprah Winfrey Show,
started his own syndicated show, which is shown in 16 different countries. On his show,
Dr. Oz informs and educates viewers on health-related products, diets and proper health
practices. While Dr. Oz is a medically trained cardiothoracic surgeon from Harvard, he
does not take the place of a primary care doctor. In addition to his health education
segments, Dr. Oz has been found to use words like “holy grail” and “magic” when
describing some of the products he has promoted (Belluz and Hoffman 2013). In fact, it
is estimated that the show receives over 200 pitches a month, which may give one an
indication of how much his program emphasizes product placement. According to an
investigation by Slate Magazine, Dr. Oz has had an extreme effect on the purchase
16
intentions of the American population. It is estimated that products that Dr. Oz mentions
on his show can have spikes in sales and online searches of up to 12,000 percent (Belluz
and Hoffman 2013). However, the news about Dr. Oz is not always as glamorous as his
public reputation. He has been attacked by many of his colleagues, who claim he is
nothing more than a salesman. According to Dr. Edzard Ernst, criticizing his advocacy
for the substance, Garcinia cambogia, “Dr. Oz's promotion of this and other unproven or
disproven alternative treatments is irresponsible and borders on quackery” (Belluz and
Hoffman 2013). And yet, it is pretty hard to argue the impact of his medical advice
against the success of his show. There have been other medical shows, including The
Doctors, which was created by Dr. Phil McGraw, another medical practitioner whose
success is also owed to Oprah Winfrey.
So the question becomes: are people being influenced by these TV doctors more
than by their own personal doctors? Or even more concerning, are people turning toward
these TV shows as a substitute for receiving primary healthcare guidance? The sales and
Internet search data seems to serve as some is evidence that people are listening to these
television practitioners and acting upon their advice. To what degree do viewers trust
these TV doctors, and could it be misleading people into forgetting that they are just
watching television shows? Even though Dr. Oz claims, “I don’t sell the stuff. I don’t
make any money on this. I’m not going to mention any brands to you, either. I don’t want
you conned,”(Belluz and Hoffman 2013) he does not mention the any of publicity and
compensation he receives from companies who claim that their products are endorsed by
him. For Dr. Oz and others like him, television programs are another way to build a
personal brand, which seems to be an ongoing issue in the health industry. Doctors who
17
use the media to garner attention and build their businesses are clearly interested in
publicity. According to a measurement taken on Compete, Dr. Oz’s blog, The OZ Blog,
recorded over four million impressions in a month -- more the Harvard Health Blog and
New York Times Health blog combined during the month of December 2012. Dr. Oz’s
blog success is a prime example of how personal branding leads to success. In later
chapters, the author will investigate 15 blogs and their use of personal and commercial
branding.
Internal Factors
The Facebook Effect
In 2004, the social media site, Facebook, launched the world into a new era of
connectivity. The website, which is devoted to building social networks, has become the
one of the biggest companies in the world in under a decade by attracting more than a
billion users (O’Keeffe and Clarke-Pearson 2011). Fueled by the human need to
socialize, Facebook has given individuals the ability to stay connected to their friends and
families with the ease of clicking a button. However, Facebook also has caused many
people to suffer from a new phenomenon called “Facebook depression” (O’Keeffe and
Clarke-Pearson 2011). With the help of the News Feed on Facebook, individuals are
constantly bombarded with social updates, photos and news on all of the members of
their network. This tool, while useful for staying connected, has put pressure on people to
look and sound their best when presenting images to the rest of their peers. Even though
this might seem harmless, Facebook may in fact be exerting pressure on individuals to
seek out shallow methods of getting attention, such as posting flattering self-portraits and
18
having the largest amounts of friends. In fact, according to a 2012 German research
study, “One in three people felt worse after visiting the site and more dissatisfied with
their lives, while people who browsed without contributing were affected the most”
(Krasnova et al. 2013). Most importantly, researchers found that women were more likely
to envy others’ physical attractiveness. So, while it might seem harmless on the surface,
Facebook might be one of the contributing factors prompting people to want to look and
feel better about their health. People who are in shape and display how healthy they are
on Facebook tend to get more attention from their peers than people who are out of shape
and ‘unattractive’ (Krasnova et al. 2013). Even though this study was conducted in
Germany, its authors claim this issue can be applied internationally. In fact, one could
suggest that in America, the matter could be worse because of the general appearance-
conscious social pressures that Americans face.
Another European study has shown that having attractive friends on Facebook is a
good indicator of one’s level of social influence (Crandall et al. 2008). Keeping with this
same idea, it could be argued that the more attractive someone is on this website, the
greater the chance he or she has at building a network and becoming successfully
influential. So, how does this relate to health? Thanks to social media, people today have
more individual exposure than their predecessors, and thus they may be experiencing
greater pressure to look good for their peers, and even to show off. While there are no
current data as to why people start health blogs, the author theorizes that some people
may feel the need to create blogs to seek attention from their peer groups and gain
validation. This could provide one explanation as to why many bloggers use health blogs
to track their own personal fitness progress.
19
Cosmetic Appeal
The United States is undeniably one of the most affluent countries in the world
when it comes to healthcare spending, but it also is one of the most progressive countries
when it comes to investing in personal beautification. According to The Economist, the
U.S. has the 5th highest rate of plastic surgery in the world, with an estimated 3.3 million
procedures being performed annually (“Prescription For Change” 2012). This leads one
to ask: are Americans obsessed with being healthy, or with looking good?
Looking good appears to be an important value in America. According to a
European study entitled, “A Study of the European Cosmetic Industry”, the U.S. cosmetic
industry was valued at ∈38.2 billion in 2006. Compared to China, which has a national
population of more than 1 billion people, U.S. consumers have spent more than ∈30
billion on the makeup industry alone (“A Study of European Cosmetic” 2007). However,
spending on cosmetics is only a fraction of what Americans spend annually on health
supplements, including protein supplements, fat burners, pre-workout supplements and
vitamins. In 2010, the U.S. supplement markets sold more than $60 billion in products,
making it one of the largest supplement markets in the world (“Dietary Supplement
Industry” 2010). Although many supplements may be used to boost exercise efficiency,
one has to wonder how many of these products might be used to bolster consumers’ sense
of beautification. In addition, the supplements industry provides nearly a half a million
jobs to the American economy (“Dietary Supplement Industry” 2010), creating a
significant number of stakeholders in the industry. Since these people have a vested
interested in promoting their products, many of them may be starting health blogs to
promote the company they work for.
20
External and Internal Factors Conclusion
Experts agree that health issues in the United States are at alarming high levels.
(Woolf et al. 2013), and several factors may be contributing to poor health habits. Given
the increased influence of social media, it is worth considering whether health blogs,
which can fill an informational void for many Americans and provide an outlet for self-
expression, product endorsement, and the dispensing of health-related information, might
be playing a contrary role, inadvertently deriding the overall quality of the nation’s
health.
Americans already look to health blogs to find answers for their medical
questions. They look to health blogs to find the latest trends or to learn about and
possibly buy products that promise them health and beauty. For health bloggers, their
regular posts may help garner attention and enhance their feelings of self-worth. Authors
of health blogs may be viewed as having greater credibility and authority than their peers,
which can be highly valued, both socially as well as monetarily. But who is responsible
for questioning a health blogger’s credibility or credentials? To their followers, these
bloggers may look the healthiest when they are promoting health products and dietary
approaches, when in fact, they may be merely engaged in self-marketing. In the United
States, we applaud individual success; it is the capitalist way. So, while blogs may allow
people to only voice their opinions, they also may allow the transformation of those
opinions into a lucrative operation. Concerns may arise, however, if there are sufficient
regulations to ensure that bloggers are not allowed to over-promise and mislead their
readers into believing unsupported claims.
21
Chapter Five: Health Blog Regulation
Currently, several U.S. organizations oversee the regulatory processes related to
health promotion, including health blogs. Along with overseeing the regulatory process
of these blogs, these organizations have oversight over the advertising and marketing of
supplements, prescription and over-the-counter drugs, cosmetics, and medical devices, as
well as some forms of alternative medicine.
Food and Drug Administration
The Food and Drug Administration (FDA) is the primary governing body of
health supplements in the United States. According to the FDA, “A dietary supplement is
a product taken by mouth that contains a "dietary ingredient" intended to supplement the
diet.” (“Dietary Supplements” 2013). In addition, the FDA classifies health supplements
as a type of “food,” rather than as a “drug,” and that “dietary ingredients" in supplements
may include “vitamins, minerals, herbs or other botanicals, amino acids, and substances
such as enzymes, organ tissues, glandulars, and metabolites.”
By classifying supplements as “food,” FDA notes that they do not need approval
before they are marketed, and that “under the Dietary Supplement Health and Education
Act of 1994 (“Dietary Supplements” 2013), the dietary supplement or dietary ingredient
manufacturer is responsible for ensuring that a dietary supplement or ingredient is safe
before it is marketed. (“Dietary Supplements” 2013)”
22
Federal Trade Commission
In 2009, the U.S. Federal Trade Commission (FTC) recognized the growing issue
of needing to assess sponsored blog postings with essentially the same criteria as
advertising products. The Federal Trade Commission was one of the first organizations to
use the term “word-of-mouth marketing,” which is deployed in a wide variety of
marketing media, including social media sites and blogs. Word-of-mouth marketing is
often associated with marketing “buzz,” an approach typically used to amplify or bring
attention to the original marketing message.
Unlike more traditional marketing approaches, word-of-mouth marketing works
by having consumers promote products to their peers, largely using their own word
choice and tonality. Without proper laws, any blogger could post incorrect information
about product without the threat of legal action. In 2009, the FTC released its preliminary
recommendations to bloggers and companies proposing sponsored blog postings,
requiring bloggers to disclose any payments they received based on the paid promotion of
products featured on their websites. These materials were later amended in 2013. The
“.com Disclosures” document published by the FTC in 2013 includes the following
guidelines (“.com Disclosures” 2013):
* The same consumer protection laws that apply to commercial activities in other media
apply online, including activities in the mobile marketplace. The FTC Act’s prohibition
on “unfair or deceptive acts or practices” encompasses online advertising, marketing, and
sales. In addition, many Commission rules and guides are not limited to any particular
23
medium used to disseminate claims or advertising, and therefore, apply to the wide
spectrum of online activities.
* When practical, advertisers should incorporate relevant limitations and qualifying
information into the underlying claim, rather than having a separate disclosure qualifying
the claim.
* Required disclosures must be clear and conspicuous. In evaluating whether a disclosure
is likely to be clear and conspicuous, advertisers should consider its placement in the ad
and its proximity to the relevant claim. The closer the disclosure is to the claim to which
it relates, the better.
Media websites have released information that bloggers who do not abide by the
new rule will face a fine of up to $11,000 (“FTC’s Revised Guidelines” 2010). According
to the FTC, this information is misleading, and the organization does not issue fines to
bloggers. To further complicated matters, the FTC also stated that “[they are] not
monitoring bloggers and [they] have no plans to” (“FTC’s Revised Guidelines” 2010). As
of 2013, the FTC mainly focuses on the advertisers and not the endorsers.
WOMMA
WOMMA, or the Word of Mouth Marketing Association, is a voluntary
membership organization that has developed a series of ethical guidelines geared toward
regulating blogs in observance of the FTC guidelines. While this organization does not
24
have the governing authority of a body like the FTC, WOMMA presents bloggers with a
set of rules by which they should abide. These rules are not strictly enforced by the
organization and only serve as a recommendation as to how bloggers should
acknowledge sponsored posts. Currently, members of WOMMA may get access to
training and education to ensure that they are up-to-date on the most recent guidelines. In
addition to its connection to the FTC, WOMMA has formed relationships with industry
leaders, academic professors and consumers to construct these guidelines. According to
their WOMMA guideline handbook, “testimonials and endorsements delivered to
consumers through social media—whether by consumer, experts, celebrities, or
organizations” must disclose all material connections (“Social Media Marketing
Disclosure” 2012). These material connections may include:
* Benefits or incentives such as monetary compensation, loaner products, free
products or services, in-kind gifts, special access privileges, affiliate commissions,
discounts, gift cards, sweepstakes entries or non-monetary incentives provided by a
marketer to an advocate
*A relationship between a marketer and an advocate (such as an employment
relationship)
* Along with the bloggers’ responsibility to disclose their relationships, marketers
also are encouraged to ‘adequately disclose’ their relationships with the advocates of their
company.
According to the WOMMA guidelines, appropriate disclosure is supposed to
happen in five ways (Manue 2013):
25
1.) Companies must educate the advocates (including vendors, agencies and partners) on
disclosure and inform them when it is necessary.
2.) Companies must monitor their own campaigns to ensure that the advocates of their
product are making the required discourses and that the recommendation and promotion
of the product is not false and misleading.
3.) If the advocates do not comply with the first two steps, it is the job of the company to
address the situation with reasonable effort. WOMMA suggests that companies create
their own set of regulations and protocols in order to deal with advocates who do not
comply.
4.) Companies must educate and inform the advocates of their compliance guidelines
5.) Companies must educate and inform their employees on the compliance guidelines to
ensure that they do not falsely represent themselves as ordinary customers when
promoting a product or brand.
In addition to providing these guidelines, WOMMA warns bloggers that
disclosure of their relationships must be clear and easy to understand. The display of this
disclosure should not be hidden and must use language that is universally acceptable.
26
Advertising Regulations
In the past, companies controlled their brands when it came to reputation,
including nearly full control over the content they promoted through advertisements.
However, recently the Federal Trade Commission has taken over the regulatory process
in corporate advertisement. Among the responsibilities of the FTC is “ensuring that
unfair and deceptive acts or practices in commerce do not occur and that violators are
fined for deceiving or misleading costumers into believing things about products that are
just not true” (“Federal Trade Commission Act 5” 2008). However, the true purpose of
the FTC, according to its policy, is not to punish violators in a criminal manner (“Federal
Trade Commission Act 5” 2008). The main goal of the FTC is to prevent companies from
creating misleading messages, which leads to the question: what happens when
companies do not comply with the FTC recommendations?
Currently, each country has laws against “misleading” advertisements. In the
United States, for example, the “Unfair Competition Law” prohibits companies from
gaining an advantage over other companies through the use of unjust and false claims.
However, this law, along with those in several other countries, only aims at targeting
companies that violate the FTC rules for a financial gain. There is little mention in these
laws of protecting the consumer from false health recommendations, given by a third
party such as a health blogger, which is a huge issue in the case of health products that
may mislead consumers.
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Chapter Six: People Who Write Health Blogs
A health blog may be started by anyone. It does not take a medical degree or
credential to write about health issues. For this essay, the author looked at blogs whose
creators had several different certifications, which are listed and described below:
Personal Trainer, Registered Dietitian, and Medical Doctor. Blog authors’ other
credentials, such as collegiate degrees in journalism or related fields, were not listed.
Health credentials may be important for establishing a medical practitioner’s credibility,
but they do not necessarily mean success in the social media sector. More than half of the
bloggers who were investigated in this thesis study had no medical-related credentials.
Personal Trainers
Personal trainers are generally professional exercise advisors and coaches. These
individuals specialize in assessing the fitness of their clients and giving personal
recommendations about health and exercise routines. Members of this profession are
typically not medically trained professionals, and may provide sets of guidelines that
clients are able to use at their discretion. Currently, there are five different organizations
offering professional Personal Trainer certifications in the United States:
-The American College of Sports Medicine (ACSM)
-The International Sports Science Association (ISSA)
-The National Strength and Conditioning Association (NSCA)
-The American Council on Exercise (ACE)
-National Commission for Verifying Agencies (NCCA)
28
Personal training certifications can require a person receive up to 500 hours of
classes and education in order to become certified. According to a 2002 study entitled,
“Importance of Health Science Education For Personal Fitness Trainers,” 70 percent of
the certified trainers who were surveyed did not have a college degree in any field related
to health or exercise science (Malek et al. 2002). In addition, the study’s authors were
unable to conclude if years of experience increased or decreased a personal trainer’s
knowledge regarding health and fitness.
In 2006, the International Health, Racquet & Sportsclub Association (IHRSA
2006) issued a recommendation that health facilities accept only National Commission
for Certifying Agencies (NCCA) accredited certification. However, there is no national
regulation of the industry.
Registered Dietitian (RD)
Dietitians are nutrition experts who advise and coach people on proper food
consumption in order to live healthier lifestyles. The LiveStrong organization has
identified are 4 different types of specialized practices: Clinical, Community,
Foodservice, and Business (“Information on Dietitians” 2013).
In the U.S., dietitians must be registered by the Commission of Dietetic
Registration if they are to use the title of Registered Dietitian (RD). In order to become
registered, a dietitian must complete a bachelor’s degree from a Western Association of
Schools & Colleges (WASC)-accredited university, serve as an intern for a minimum of
29
900 hours, and pass an exam administered by a State Department of Health Services
agency. In addition to RD certification, people may obtain a Dietary Manager (DMA)
accreditation by completing similar coursework and passing an exam (“ANFP Mission
and Background” 2013).
People also may serve as Dietary Assistants or Clerks. Clerks and assistants often
prepare specialized food for clients or assist RDs in giving recommendations. However,
these professionals are not subjected to the same qualifications as RDs and DMAs.
Medical Doctors (MD) and Doctors of Osteopathic Medicine (DO)
Medical Doctors (MDs) are professionals who practice medicine and work to
diagnose, treat, and assess health. A Doctor of Medicine is a medical professional who
has obtained his or her credentials from an accredited medical school. In the U.S., the
American Medical Association (AMA) or the Association of American Medical
Colleges’ Liaison Committee on Medical Education (LCME) must accredit medical
schools (Cooper 2003).
In order to attend medical school in the U.S., applicants must complete a four-
year bachelor’s degree and take the Medical College Admission Test (MCAT). Upon
completion of medical school from an accredited program, students are expected to
complete an internship and some form of residency if they are to practice medicine
independently. In order for a person to be board certificated, he or she must pass the
United States Medical Licensing Examination (Cooper 2003).
30
As an alternative to an MD degree, a Doctor of Osteopathic Medicine (DO)
degree can be obtained through a similar process. Professional DOs, like MDs, must earn
a bachelor’s degree and graduate from an accredited medical school before entering into
residency programs if they wish to practice independently. DO students are required to
learn the same medical practices and standards for surgery as MD students. While not to
discredit DO degrees, it is estimated that, on average, most DO students have lower
MCAT scores than their MD peers. In addition, it is estimated that one out of three DO
applicants were not accepted into MD programs that they had applied to (Cooper 2003).
Conclusion
Why is credibility important? Credibility gives content its merit. The Internet is
filled with information, and it can often be difficult to find material that one can take
seriously. According to a 2010 study by Yifeng Hu and S. Shyam Sundar, distinguished
professor of communications and co-director of the Media Effects Research Laboratory
at Penn State University, college students are actually able to distinguish different types
of sources and credibility (Hu and Sundar 2010). The study showed that they were “More
likely to act on the advice they received, and recommend it to others or forward it to
friends online if the advice was sourced from a website than from a blog or a personal
homepage” (Hu and Sundar 2010). However, the authors indicated this was not
necessarily true for older adults, who might not be as Internet savvy. In fact, the lead
researcher came up with the idea for the study due to the fact that her mother had been
contacting her regarding health information she had found over the Internet. People like
31
the researcher’s mother sue the Internet to look up health information that they use in
their daily lives. If this information is false, it could be harmful.
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Chapter Seven: Research Methodology
For this essay, primary research consisted of quantitative surveys distributed to
fifteen different health bloggers divided into two separate categories: Mid-Tier blogs that
had received more than 10,000 but less than 100,000 unique visitors while Top-Tier
blogs received more than 100,000 unique visitors. This traffic assessment was made by
using compete.com, a traffic measurement website, during the month of December 2012.
In total, the Mid-Tier blogs had a readership over 100,000, and the Top-Tier blogs had a
readership of over 500,000 during the December 2012 timeframe. The survey consisted
of seven different questions regarding bloggers’ involvement with health companies and
their health backgrounds.
1. What was your motivation for starting this blog?
2. Do you have any particular brands or products you currently endorse?
3. What information, if any, do you typically require to support or endorse a brand
or product?
4. How do you define health?
5. What’s your academic background? Do you have any specific
credentials/qualifications related to the health field?
6. Have you ever corrected a mistake on your blog concerning misleading
information? What was the source for the correction?
7. Has there ever been a time when your readers have provided corrections to your
blog in their comments/e-mail?
Exhibit 1. Health Blogger Survey Questions
33
Content Analysis
Only one blogger returned the survey, which left the author to do secondary
research through the “About Me” sections on the fourteen other blogs. While it is
unclear why only one blogger returned the survey, the author was able to draw several
conclusions about the other bloggers from the content on their blogs. The author
constructed a mini-bio for each blogger containing his or her credentials, the amount of
branded or sponsored articles within the specified timeframe, and whether the blogger
promoted any of his or her own personal material. Branded material, by definition, was
any mention or promotion of a particular brand, whether it was of a personal or
corporate nature.
Blog Blogger(s) Credential(s)
eatliverun.com 1 (1) Certified Yoga Instructor
fitbottomedgirls.com 2 (2) Journalist
ohsheglows.com 1 (1) Health Degree
nerdfitness.com 1 (1) Certified Personal Trainer
diseaseproof.com 1 (1) Medical Doctor
greatist.com 48 N/A
blackgirlsguidetoweightloss.com 1 (1) Certified Personal Trainer
diet-blog.com 3 (2) Dietitians, (1) Personal Trainer
zenhabits.net 1 (2) Journalist
fourhourworkweek.com/blog 1 (1) Health Degree
Exhibit 2. Mid-Tier Blogs (10,000-100,000 visitors) Credential Break Down
34
Exhibit 3. Percentage of Credentialed Bloggers Among Mid-Tier Bloggers
Mid-Tier blogs were defined as blogs that had more than 10,000 but fewer than
100,000 visitors during the month of December 2012. These blogs were selected by
looking up health blogs using the search engine Google. The credentials listed were
obtained by searching the blogs for any mentions of the bloggers’ health-related
background and/or credentials. Out of the ten Mid-Tier blogs examined, 31 percent of
bloggers were journalists, with personal trainers coming in a close second (Exhibit 3). To
the author’s surprise there were fewer medical doctors than he expected.
Blog Blogger(s) Credential(s)
well.blogs.nytimes.com/ 6 (2) Medical Doctors, (4)
Journalists
fitsugar.com/ N/A N/A
health.harvard.edu/blog/ 20 (5) Medical Doctors, (15)
Journalists
foodpolitics.com 1 (1) Health Degree
marksdailyapple.com 1 (1) Health Degree
Exhibit 4. Top-Tier Blogs (100,000+ visitors) Credential Break Down
15%
31%
15%
8%
31%
Journalist Medical Doctor Health Degree Personal Trainer & Yoga Diet
35
Exhibit 5. Percentage of Credentialed Bloggers Among Top-Tier Bloggers
Top-Tier blogs were defined as blogs that had more than 100,000 visitors during the
month of December 2012. These blogs also were obtained by using the search engine
Google. Interestingly, the presence of medical doctors was slightly higher in these types
of blogs, but “journalist” was still the most predominant credential, representing 63
percent of the 28 contributors (Exhibit 4).
Branding
Both Mid-Tier and Top-Tier blogs were checked for mentions of either personal
branding and corporate branding during December 2012. This means that each entry was
checked to see if there were any mention of brands or sponsorship. Below is the
definition that was created for each category:
Personal Branding - Any brand created by an individual as self-commoditization. These
brands had been created by an individual or designed, constructed or produced by an
individual. These brands might have taken on several aspects of an individual's likeness,
68%
25%
7%
Journalist Medical Doctor Health Degree
36
including his or her physical appearance, personality, academic/professional background
or social group.
Examples:
* Personal Supplement products such as Primal Blueprint created by Mark’s Daily Apple
blog
* Personal books such as The Power of Less: The Fine Art of Limiting Yourself to the
Essential, in Business and in Life written by Zen-Habits blog
* Personal fitness gear created by Nerd Fitness blog
* Personal diet plans created FourHourWorkWeek blog
(Corporate) Branding - Any brand or product that had been created by a company,
corporation or entity, including by the individual who was blogging. These brands and
products were mentioned or promoted by individual bloggers to establish creditability for
products or brands, or conversely, to discredit them.
Examples:
* Supplement products created by Nature Bounty Vitamin Company
* Health Food products created by Sambazon Acai Company
* Corporate diet plans created by South Beach
* Fitness products created by Nautilus
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Mid-Tier Branding
Blogs Branding Personal Branding
www.eatliverun.com
X X
www.fitbottomedgirls.com
X
www.ohsheglows.com
X
www.nerdfitness.com
X
www.diseaseproof.com
www.greatist.com
X
www.blackgirlsguidetoweightloss.com
www.diet-blog.com
X
www.zenhabits.net
X
www.fourhourworkweek.com/blog
X X
Exhibit 6. Types of Branding Found in Mid-Tier Blogs
Exhibit 7. Percentage of Branding Found in Mid-Tier Blogs
41%
42%
17%
Personal Branding Branding None
38
Top-Tier Branding
Blogs Branding Personal Branding
www.well.blogs.nytimes.com
www.fitsugar.com
www.health.harvard.edu/blog/
www.foodpolitics.com
X X
www.marksdailyapple.com
X X
Exhibit 8. Top-Tier Branding Chart
Exhibit 9. Percentage of Top-Tier Blogs with Branding
While branding and personal branding are present in Top-Tier blogs, their presence is
less observable. 33 percent of Top-Tier bloggers had personal branding, branding or
none. The only top-tier blogs that had branding were those operated by individuals rather
than groups.
34%
33%
33%
Personal Branding Branding None
39
Conclusion
Personal branding and branding appeared in both Top-Tier and Mid-Tier blogs. In
fact, there was an abundance of branding examples in the Mid-Tiered blogs. Half of the
Mid-Tier bloggers had written a book or started a health company upon which they based
their blogs. While the overall samples for this study were small, there was some evidence
suggesting that Mid-Tier blogs featured more personal as well as sponsored or corporate
branding than the Top-Tier blogs. However, since both Mid-Tier blogs and Top-Tier
blogs contained branding, it can be concluded that both types of blogs are susceptible to
corporate influences.
Given these results, it could be assumed, in this author’s opinion, that Mid-Tier
blogs are more likely to contain blogs with product placement than Top-Tier Blogs.
While a larger content analysis may be needed to generalize these findings, Mid-Tier
bloggers might use sponsorships and product promoting to establish credibility and
attract readership.
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Chapter Eight: Public Relations Implications
The ease by which health blogs can be created without requiring authors’
credentials represents a potential risk and weakness. The author’s influence, as well as
potentially different motivations for creating these blogs, may create issues with content.
Here is a more detailed SWOT analysis, from performed for this thesis.
Strengths Opportunities
* Blogs provide easy access to health
content
* A variety of different audiences can
be addressed using word-of-mouth
marketing
*Content Variety (health advice,
nutrition, exercise, alternative medicine,
etc.)
*Always available to anyone who has
internet access
* Current health information due the ability
to change and add content
* Risk of Inconsistent/False Information
* Risk of Non-credible advice
* Risk of Potentially misleading health
information
* Rarely regulated unless the blog has
high visibility.
Opportunities Threats
*Doctors could potentially dispense advice
to patients
* FTC issue stricter guidelines followed
by implementing regulations
* A universal seal of accreditation and
oath for which bloggers can use.
* Corporate influence on content which
can establish credibility
*Potential for sponsored posts/ corporate
influence on content which could create
bias toward a particular product or company
Exhibit 10: SWOT Analysis of Mid-Tier and Top-Tier Health Blogs
41
Drawing from the SWOT analysis, here are some examples and suggestions for blog
improvement. These suggestions are based on current and future work being done to fix
some of the issues associated with health blog credibility:
Universal Seal
Developing a universal seal of approval would help establishing credibility in
health blogs. Hotels, restaurants, businesses and respectable websites already have rating
systems that they use to show their customers that they can be trusted. For instance, the
Zagat Guide for restaurants not only rates the quality of the food being served but also
rates other factors like cost, service quality and decor. A similar rating system could be
established for health blogs using guidelines that have been established by organizations
like the National Network of Libraries of Medicine and the National Center for
Complementary and Alternative Medicine (NCCAM). These guidelines, outlined on
these organization websites, would be an excellent model to follow. This new rating
system could include the rating of academic credibility and health information quality.
Most importantly, the rating system could identify if a blogger had been sponsored by
any brand or company, including his or her own. This way, readers would have a clear
idea of what type of blog they are reading. It would then be up to the reader to make a
judgment on how credible the blog was. For instance, readers might think: Is this a blog
created by an amateur gym fanatic trying to sell their new fitness book, or is this a blog
created by a medical doctor who is trying give good health advice? The rating system
would give the reader clear indication of how reliable the source of information is.
42
Second, this new rating system would most likely have to be established by a
third party organization like the NCCAM. While the FTC might seem like a great
candidate for this position, it would be better suited for an organization like World Health
Organization (WHO) to champion the project. WHO has an advantage over the FTC
because WHO is a international organization that has a very established community of
health experts who actively try to promote best practices. This rating system should fit in
with their objectives and goals as an organization. However, there are also several other
opportunities for another organization to create a respectable and reliable rating system.
New businesses could be established through this rating system. It would be up to
organization to develop a method for which it will establish credibility throughout the
online blog community.
Implementation
Key Audiences that could potentially create a rating system and universal seal:
*Current Healthcare bloggers
*World Health Organization
*Healthcare Officials
*WOMMA
*Federal Trade Commission
*Food and Drug Administration
*American Medical Association
*American Public Health Association
43
Key Audiences in this tactic include organizations that have an established
credibility attached their name. Other health organizations could possibly get involved
with the rating system, however, it will be important to have a well-known organization
There are two ways in which WHO or another third party organization could go about
rating blogs. First, the organization could start rating Top-Tier and Mid-Tier blogs that
have the most readers. There are several websites including Compete and Technorati that
monitor website traffic. Other websites like Klout and Kred offer the opportunity to track
individuals and score the amount of influence they have on their networks. Blogs that
have high traffic rates would be the first to check. In addition, highly influential bloggers
could be an excellent place to start the vetting process.
Another method could be an application process. This could be accomplished on a
case-by case basis. Many rating systems establish credibility within their industries.
Bloggers who wish to gain this accreditation could apply to this process, which will give
them a chance to be reviewed. This could work if a rating system became well known as
an industry standard. For example, having a Zagat rating on a restaurant is a token of
merit, even if the rating itself may not be as distinguished. Even though some of the
bloggers might be reluctant to have their credentials and credibility questioned, it would
allow some of the more established blogs to gain notoriety. These blogs would receive a
rating that they would have to post somewhere on the homepage of their blog.
Hippocratic Oath for Bloggers
If bloggers use their blog to promote health information, then it would be important to
create an oath similar to the one taken by physicians, to which bloggers can abide that
44
would create a sense of respect, trust and unity among the community. An oath would
establish a sense of purpose behind the messages that these bloggers were delivering. A
possible public relations campaign could be formed by WOMMA and WHO to promote
and encourage health bloggers to take the ‘oath‘ to promote better health messaging. This
will also serve as an extra opportunity to remind members of the online community of
best practices in health blogging. As mentioned earlier, WOMMA has already published
a set of guidelines by which bloggers should abide. By creating a campaign centered on
taking an oath created by the WHO, the author predicts that bloggers could feel a greater
sense of obligation to abide by these rules.
Implementation
Key Audiences that could create a Hippocratic Oath:
*Current Healthcare bloggers
*World Health Organization
*World Health Organization
*WOMMA
*Federal Trade Commission
*Food and Drug Administration
*American Medical Association
*American Public Health Association
The WHO should first start with its members who currently publish health blogs.
This would give the program exposure and create a foundation from which the
organization could build. The WHO has an international presence, which will allow the
45
program to have universal appeal. In addition, since WHO could reach out to multiply
stakeholders to increase the visibility of the oath. Some of these organizations are
outlined in the key audience. Some organizations like WOMMA requires all members to
complete an application process, it would be easy to implement a program.
46
Chapter Nine: Conclusion
Today, Americans living past 50 years old are expected to have more illnesses in
their life compared to their peers in other developed countries (Woolf at el. 2013). While
many Americans enjoy long and healthy lives, there are several factors believed to
contribute to our overall poor health status when compared to other developed nations.
Health insurance, work hours, and dietary habits are some of the biggest predictors of a
person’s life expectancy (Woolf at el. 2013). In response, many health practitioners have
looked for ways to provide health information to the public at a low cost. With the advent
of the Internet, health information and health promotion can be provided by virtually
anyone who has the will and means to do so. In particular, health blogs have served as an
excellent and growing medium for health practitioners to use to reach out and educate the
public. However, because health blogs require no health accreditation and can be started
by virtually anyone, they are susceptible to authors’ personal bias as well as the potential
for corporate influence. People who read these blogs may not appreciate the absence of
health accreditations, leading some to fall victim to companies and brands that may be
using health blogs as a marketing device. Many of dietary supplements, for example, are
loosely regulated, which gives bloggers greater opportunity to promote these product in
the ways they see fit. Herein lies the potential consumer risk of health blogs. While some
blogs may be credible sources of health, others might be business tools designed to
merely sell product. Even though the FTC and WOMMA recommend special interests
and sponsorships be disclosed, there is no way to be hundred percent certain that all
bloggers are abiding by these recommendations.
47
In addition, in the research collected in this report, there is evidence to suggest
that many bloggers associated with high-volume health blogs are using these as vehicles
to promote their own health brands and products. Many bloggers have created their own
dietary systems or health recommendations, which they promote on their blog. While this
a generally acceptable practice, it also gives people that opportunity to look at health as a
commodity rather than a humanistic need that everyone deserves. Instead of giving
objective health information, the research for this thesis indicated that bloggers at some
of the most popular health blogs were choosing to promote lifestyle products from which
they presumably profit, as well as health information generally. While they may have the
right to sell their branded health products, how does the average health blog-reader
distinguish between this kind of content, and the content from other health blogs that are
dispensing advice for more altruistic reasons? Enacting a new rating system could help
address this problem by establishing a method of differentiating blogs. It would allow
bloggers with either business or altruistic motives, to continue operating, as long as they
were more transparent in display their motives to their audience. It also would give health
bloggers with established health credentials the credit and credibility they deserve. With
a rating system, people would be better informed about whether to embrace or disabuse
the gifts of information and community-building offered by some of the most popular
health blogs. Consumers must remember that not all health information is created equal,
and they would do well to consider the external and internal pressures that are shaping
the environment in which health blogs are created.
It is important to remember that health should be a universal community that all
human beings deserve to have. With out health, our society’s goals and aspirations could
48
be compromised. It is important to remember that our goal as a society should be to help
one another and not take advantage of the people who are not as well informed.
49
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Asset Metadata
Creator
Fossler, Jonathan
(author)
Core Title
Public relations implications for regulation of health blogs
School
Annenberg School for Communication
Degree
Master of Arts
Degree Program
Strategic Public Relations
Publication Date
08/01/2013
Defense Date
08/01/2013
Publisher
University of Southern California
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