Kim Kardashian Has a Cold

Health issues are the new frontier in celebrity PR.

We know more about these stars’ ailments today than ever before. Clockwise from top left: Selena Gomez, Angelina Jolie, Charlie Sheen, Miley Cyrus, and Hayden Panettiere.

Photos by David McNew/Reuters, Mario Anzuoni/Reuters, Peter Kramer/NBC/Reuters, Danny Moloshok/Reuters, Kai Pfaffenbach/Reuters

The dramatic fire on Bravo’s Real Housewives franchise tends to be lit by very small sparks: Someone drank too much white wine at a boutique opening; someone else was rude at a dinner party. But the just-ended season of The Real Housewives of Orange County featured a plotline worthy of a good old-fashioned soap opera: Brooks Ayers, the sketchy now-ex-boyfriend of longtime cast member Vicki Gunvalson, was apparently pretending to have cancer all season long.

Ayers’ claim on air that he was being treated for non-Hodgkin lymphoma quickly aroused doubts among cast members. Their suspicions were at one point confirmed on camera by a psychic. (Bravo to Bravo for that one.) Last month, Ayers presented medical bills to an E! reporter; hilariously, the documents included what turned out to be a barely doctored copy of the first Google image search result for “chemotherapy bill.” Gunvalson said recently she suspects Ayers purposefully made himself sick by swallowing eye drops to mimic the symptoms of chemotherapy treatment.

Ayers’ apparent lies are bizarre and brazen, and they make for great TV; Bravo has been milking the drama for all it’s worth. But they’re also an extreme example of the fact that health issues big and small are the new frontier of celebrity publicity opportunities. Traditionally, a star might deploy news of a major illness in, say, a carefully pre-negotiated interview with People magazine. But increasingly, sickness is the stuff of Instagram posts and Twitter rants along with soft-focus prime-time interviews and magazine covers. The net result is that the public knows more about stars’ medical histories and ailments today than ever before. If being sick was once something to be managed, PR-wise, today it’s often something to be promoted. A 21st-century Frank Sinatra would Instagram his cold medicine.

Let’s take a look at just the past month or two of headlines:

It wasn’t that long ago that many stars went to great lengths to conceal their health issues, and sometimes they still do. Sheen said he had paid $10 million in hush money to keep his diagnosis secret until now. Jackie Collins, who died in September, kept her breast cancer secret until almost the end. “I didn’t want to make it public and I didn’t want people’s sympathy,” she told People in an interview six days before her death. “I like to be in control and so I took control of the situation.” Nora Ephron, too, kept her cancer diagnosis a secret. And who knows how many have kept their struggles totally private—if they do it successfully, the whole point is that we’ll never know.

It’s no mystery why a celebrity would want to keep an ailment private; more interesting is why they so often do the opposite. In the upper echelons of the fame hierarchy, talking about health issues is a time-honored way to burnish a reputation for selflessness and authenticity. Take Angelina Jolie, who announced that she had undergone a prophylactic double mastectomy in a New York Times op-ed titled “My Medical Choice” in 2013. Jolie used the op-ed to describe the monthslong series of medical procedures, to inform readers about genetic mutations that lead to higher cancer risks, and to press for cheaper genetic testing options. “Life comes with many challenges,” she concluded. “The ones that should not scare us are the ones we can take on and take control of.” In March, she followed up with an op-ed about having her ovaries and fallopian tubes removed in another preventative surgery.

At the A-list level, this kind of controlled disclosure is a way for stars to shape stories about recovery and resilience, and to be viewed as both strong and sympathetic. It also seems to have a measurable effect on the public. A study published in September in the journal Cancer confirmed an “Angelina Jolie effect”: Women were significantly more aware of reconstructive surgery options after Jolie’s first announcement. Previous research in Britain found that referrals and inquiries about genetic testing rose dramatically, too. This is not unprecedented: Researchers described an uptick in colonoscopies after Katie Couric underwent the procedure on Today in 2000 as the “Katie Couric effect.”

The secure A-lister raising awareness about a public health issue is an old phenomenon. Shirley Temple Black and Betty Ford went public with mastectomies in the 1970s, for example; Black conducted a news conference from her hospital bed and wrote an essay titled “Don’t Sit Home and Be Afraid” for McCall’s magazine. Jolie, for what it’s worth, is in many ways a guarded megastar of the traditional type, in perfect control of her image even when revealing a physical vulnerability, and framing that revelation as an opportunity to educate and encourage the public. 

But the level of granular medical detail to be seen on the lower rungs of the fame ladder—that’s something new. Teen-focused publications cover minor health traumas like they cover dating woes, leading to breathless sentences like this one about Miley Cyrus: “In addition to having a gluten allergy, MiCy found out she has hypoglycemia almost 10 years ago.” The “hospital selfie” has become something of a phenomenon, with practitioners including Sam Smith, Kim Zolciak-Biermann, Lindsey Vonn, and Tori Spelling. Jimmy Fallon has documented his recent series of weird minor accidents—a mangled finger, a chipped tooth—on Instagram, too. On The Real Housewives of Beverly Hills, Yolanda Foster has expertly turned her struggle with chronic Lyme disease into part of her brand. (Fellow cast members, and plenty of doctors, are skeptical.)

It’s all fun and games when Miley Cyrus has a gluten allergy. But in the case of serious illness, the sharing can take on a darker tone that makes cynicism hard to resist. Over the course of the past few months, a Nashville singer-songwriter named Rory Feek has been sharing stories and photos online of his wife’s experience with terminal cancer. Thanks to Rory’s blog, the couple have rocketed to greater fame than they ever achieved as the country duo Joey + Rory. Macabre and manipulative headlines such as “Rory Feek Reveals Wife Joey Can No Longer Get Out of Bed, Shares New Emotional Family Photos” regularly top the most-read lists on gossip websites; recently published a story titled “Joey + Rory Share a Last Dance as She Battles Stage 4 Cancer.” Rory also recently announced the couple is releasing an album of hymns on Valentine’s Day next year.

It’s impossible to untangle the desire to “raise awareness” and to self-promote in cases like this, and it would be crass for an outsider to try. It’s commonplace for ordinary people to share their experiences with serious illness online, too—so why would we expect celebrities, whose livelihood depends on our care and curiosity, to be more withholding than the rest of us? In a landscape like this, it’s a bit easier to imagine why someone like Brooks Ayers would think it wise to (apparently) conjure a life-threatening diagnosis from thin air. On one level, at least, his instincts were right on: Bravo reported that the most recent season of The Real Housewives of Orange County was the series’ most-watched.