The Surgeon General's Dilemma: Public Health Warnings in the Digital Age

Evaluating the Efficacy and Politics of Health Recommendations from Cigarettes to Social Media

Sometimes the US Surgeon General gets it just right. For example, the 1964 regulation, developed after an in-depth study, required cigarette makers to print health warnings on their packages. This led to a decline in smoking that saved countless lives and billions in healthcare costs.

However, sometimes the Surgeon General misses the mark. For instance, in 1993, the Surgeon General suggested legalizing drugs as a crime-reduction strategy. The idea was politically radioactive and went nowhere.

Even in healthcare, politics always plays a part in policy. This is something to consider with the latest Surgeon General’s recommendation. In an opinion column for The New York Times, General Vivek Murthy called for warning labels on social media. He linked social media to what he described as a mental health emergency among young people and argued:

“It is time to require a surgeon general’s warning label on social media platforms, stating that social media is associated with significant mental health harms for adolescents. A surgeon general’s warning label, which requires congressional action, would regularly remind parents and adolescents that social media has not been proven safe.”

No one has proven that social media is safe. However, this standard is far different from the one used to judge tobacco, which was a well-established health hazard when the warning labels were approved. In the case of platforms like Facebook, TikTok, and Instagram, how would you even design a study to certify their safety? It doesn’t seem possible.

Researchers have tried to link social media use to mental health problems among the young, but with varying results. A 2019 study compared time spent online with mental health issues reported by young people. The result? More time online equals more mental health problems. However, there’s a chicken-and-the-egg concern here. Who’s to say at-risk users don’t seek out social media for some benefit?

Contrary studies have found that many adolescents build positive support networks with contacts made online. A review of the body of research, conducted at the University of Cambridge, suggested a “very small” negative impact of social media but noted that overall, “…the link between digital technology use and well-being is still unclear…”

When studies conflict, some people blame the scientists or question their motives. In this case, everyone seems driven by two things.

First, there’s the screen-time obsession evident all around us. We see the endless scrolling, hear young people compare themselves to what they view, and our intuition tells us something is wrong. Add the occasional screaming headlines about violence and even killings linked to social media, and it feels like an evil influence.

Second, young people are suffering from a high rate of mental illness. One study found that more than half of adolescent girls feel “persistently sad or hopeless.” Boys report fewer problems, but still, 14 percent said they had considered suicide. The data over time suggests a serious trend. Major depression has increased by 60 percent in less than 20 years. Suicide rose by a similar number between 2007 and 2018.

As some have noted, the increase in mental health problems has been accompanied by a decrease in risky behaviors linked to drinking, sex, and smoking. This last one – smoking – may explain why a Surgeon General’s warning has such appeal. After all, if the tobacco warning worked so well, why not put one on social media websites?

Why not? Well, social media sites are fundamentally free speech forums. Any move to regulate them by law will face powerful legal challenges, and it’s hard to imagine the courts looking kindly on government interference.

This brings us back to politics. Washington is currently boiling with controversy over social media. It is an election year, and incumbents and challengers alike recognize a good issue when they see one. There is nothing wrong with elections forcing policymakers to focus on issues and come up with answers. The problem here may be that Murthy and others are neglecting alternatives that avoid years of litigation.

Instead of warning labels, which are unlikely to work, we should consider education projects addressing the potential risk of too much social media. Everyone should know what happens when young people scroll through content. Resources for this education, including online public service announcements, could be funded by the social media giants themselves. Surely, they’d prefer to look like good guys here. Finally, we all need to talk with the young people around us. Yes, it’s difficult. Yes, they’ll hide some of the truth. But the mere act of caring could have a huge effect. We should at least try it.