THE POWER OF THE PODCAST, AND OTHER SOCIAL MEDIA
A colleague recently asked my advice about a hostile interaction with a patient. The patient, a 74-year-old woman, previously had undergone a coronary CT angiogram that showed mild to moderate, non-obstructive coronary artery disease. Because she wanted to treat it aggressively, my colleague prescribed a high-intensity statin and ezetimibe. On that regimen, her LDL cholesterol was 60 mg/dL, her apoB was 66 mg/dL, and her triglycerides were below 100 mg/dL.
The patient then called into a YouTube live session featuring a well-known lipidologist. According to the patient, the lipidologist told her, “I can’t believe you haven’t been tested for lipoprotein(a),” and “You absolutely need to be put on Drug X to get your LDL cholesterol as low as possible. Lower is better and this is a novel medicine.” Worried, the health-conscious patient sent a MyChart message to my colleague asking to start the new drug, and my colleague responded clearly: "You already are at goal on two lipid-lowering medications. I don't think measuring lipoprotein(a) is going to change our management, and [Drug X] isn't indicated by guidelines given your lab tests and level of risk."
The patient was very upset. She asked my colleague whether they had watched the broadcast and knew how famous the lipidologist was. After several exchanges in the electronic medical record and then a phone call, she yelled at my colleague, who told me she said: "You're an idiot. Dr. X is a world-famous preventive cardiologist who was invited to this live broadcast, and he said I absolutely need this test and this medicine. You don't know anything!" Then she hung up.
This situation, sadly, is increasingly common. I discussed it previously in my essay about the physician-podcaster-patient triangle (1), and more recently I was quoted about it in the New York Times (2). A health blogger, podcaster, or influencer builds an audience, and often a business, on the premise that your doctor is withholding something from you, whether out of stupidity, laziness, or capture by the "industry." That internet personality often is a physician. The pitch almost always is the same: some marker your doctor didn't check, some risk your doctor never identified, or some drug your doctor is too conventional or too uninformed to prescribe. Fear is the hook, the physician’s credentials make it credible, and the product is whatever resolves the fear. The dynamic does not require bad intent; a well-meaning expert who gives confident advice to a stranger without her records can produce the same result. Either way, the doctor becomes the obstacle in a narrative that casts the influencer as the hero, undermining the patient’s trust in their doctor.
The doctor becomes the obstacle in a narrative that casts the influencer as the hero, undermining the patient’s trust in their doctor.
The frightened patient demands an off-guideline medication, and the visit, or in this case the phone call and MyChart exchange, becomes a negotiation over a stranger’s authority instead of a conversation about the patient’s actual risk and health needs. Rebuilding that relationship takes time and trust, and both are scarce in clinical practice these days.
To make matters worse, there often is another layer: conflict of interest. Many physicians, podcasters, and influencers are paid by companies whose products they discuss. According to the federal Open Payments database, the lipidologist on this broadcast received more than $200,000 last year from the company making the drug he recommended, mostly for promotional speaking rather than for research or service on a data and safety monitoring board. A conflict of interest does not make advice wrong, but it is a reason to scrutinize confident advice given to a stranger. Often the conflict involves a supplement or a device, and the pitch is the same: your doctor was too stupid to know about it or too dismissive to take it seriously. You need it if you want to live longer, avoid a heart attack, avoid dementia, be ripped, or be rejuvenated in the sack.
In addition to the harm to patients, I am especially frustrated by the accountability asymmetry. At the end of the broadcast, the influencer signs off and collects a fee, supplement sales, or future bookings. But the clinician gets the anxious clinic visit, the unnecessary workup, and the combative fallout if they refuse the recommendations or if the drug causes a problem. The costs of what the influencer says land on other people. The clinician is left looking like the bad guy, and an untrustworthy one at that. The patient is stuck in the middle, a product whose attention and money enrich someone else.
I am not arguing that we should shut down internet health content. It meets a demand for explanation that brief clinic visits often cannot, and I write a Substack blog myself. The distinction is between people who build an audience by undermining trust in order to sell something and people who build one in order to inform it. Content that helps an audience understand evidence and health information is worth having. Advice that tells a stranger what to demand from her doctor, without her records and at her doctor’s expense, is not.
I also want to be clear that “idiot” is a pejorative that should not be applied to any clinician or any patient. Some clinicians have more expertise, more insight, a better track record, or better interpersonal skills than others, but that does not make the rest idiots. The vast majority of clinicians and patients are thoughtful people trying to do the right thing. We need to extend grace to one another, including to the physician on the broadcast, who may have thought he was being helpful. But medicine should not be used as a weapon to build reputations and sell products by undermining the people it is meant to serve, patients and clinicians alike.
References:
Stein JH. The Physician-Podcaster-Patient Triangle. JAMA Cardiology 2026;11:9–10. doi:10.1001/jamacardio.2025.4109. Published online November 5, 2025.
Ducharme J. Podcasts are Changing the Doctor-Patient Dynamic. Is That a Good Thing? The New York Times, June 24, 2026. Updated July 9, 2026. https://www.nytimes.com/2026/06/24/well/podcasts-patients-doctors-health.html?smid=url-share.
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