Who Invented the Health Influencer?

I have spent a surprising amount of my sabbatical watching TikTok health videos. Some are from physicians explaining GLP-1 medications between patient visits, and others are from lifestyle creators talking about peptides. Both kinds rack up millions of views, and as I mentioned at the end of my last post, this contrast has become one of my newest research interests: how do professional experts and "lifestyle" creators each shape our ideas about health and well-being?

So, who invented the health influencer?

Well, it was not anyone on TikTok. My vote goes to Lydia Pinkham, a homemaker from Lynn, Massachusetts, who started selling an herbal remedy out of her kitchen in 1875. The Panic of 1873 had ruined her husband Isaac's real estate dealings, and the family needed income. Lydia had long brewed a home remedy for what the era called "female complaints," the menstrual and menopausal ailments that doctors too often dismiss today. Her sons convinced her to bottle it and sell it. She did, as Lydia E. Pinkham's Vegetable Compound.

A few years later, when the family put Lydia's own face on the label and in newspaper advertisements, a kind grandmotherly face provided relatable images and credible content. Women were now being asked to trust a person instead of a corporation. Her portrait became one of the most recognized female faces in American advertising.

She also pioneered what we would now call engagement. Her ads invited women to skip their (male) doctors entirely and "write to Mrs. Pinkham," promising a personal reply about their most private health concerns. Thousands did. It was a parasocial relationship a full century before anyone coined the term.

What happened when the face outlived the person?

Lydia died in 1883. The letters kept coming, and the company kept answering them in her name, for decades. In 1905, the Ladies' Home Journal ran a photograph of her gravestone while ads were still promising her personal attention. Around the same time, analysts found the compound itself was roughly 18 to 20 percent alcohol, even as many of her loyal customers supported the temperance movement.

Why does a 150-year-old tonic matter today?

Because the mechanics have not changed, only the platforms. A relatable face stands in for a product whose quality is hard to verify, testimonials do the work that evidence should do, and direct correspondence feels personal even when a team answers it. Trust is built on likability rather than credentials. Today the newspaper ad is a vertical video, and the letters are DMs and affiliate codes.

So, what does my research have to do with this?

Quite a bit, actually. I study how people judge quality when they cannot observe it directly. In our recent work on cross-border healthcare, my co-authors and I interviewed 71 insured Americans who sought care in Mexico, and we found that the signals people trusted at home, like credentials, waiting rooms, and prices, often meant something entirely different in the new market. The people most confident that their judgment would transfer were sometimes the most vulnerable to getting it wrong.

Health content is the next version of that question. Does a white coat in a video function like a diploma on an office wall? Does follower count read as a credential? When a creator says "this worked for me," what exactly are we treating as evidence? (I have opinions, but I also have data to collect first.)

Am I telling you to unfollow your favorite wellness creator? No. Am I suggesting you look at the face on the label and ask who is actually answering the letters? Yes, and that question has been worth asking since 1875.