Gena Norris and gadolinium deposition disease-the impact of celebrity health disclosure on public awareness.

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This year marks the 30th anniversary since the approval of gadolinium-based contrast agents (GBCAs) for diagnostic use in MRI. To date, well over 300 million doses of GBCAs have been administered to patients and have repeatedly been shown to be safe for use. However, a recent high profile celebrity case of what is being colloquially termed “gadolinium poisoning” has thrust the safety profile of GBCAs into the media spotlight and patient awareness. Gena Norris, wife of retired Hollywood actor and mixed martial artist Chuck Norris, spoke candidly in an interview with CBS news on November 2, 2017 about the symptoms she developed following a contrast-enhanced MRI performed over 5 years ago.1 Both she and her husband have been vocal about GBCAs and addressed the Food and Drug Administration (FDA) in an open letter that was read out before the FDA's vote on gadolinium warning labels in September 2017.2 We would like to take this opportunity to extend our sympathy and support to Mrs. Norris, who, as a patient has undoubtedly experienced distressing symptoms. Previously, high profile celebrity cases have increased the public's awareness of certain health issues. This was most famously demonstrated by what has been dubbed as the “The Angelina Effect” by Time magazine. Hollywood actress, Angelina Jolie, underwent a bilateral prophylactic mastectomy and eventual completion oophorectomy after discovering that she was positive for the BRCA1 gene. A paper published in 2014 found that public demand for BRCA gene testing almost doubled as a result.3 We aimed to ascertain whether the Gena Norris case had an effect on the public's awareness of GBCAs and gadolinium retention by examining recent trends in internet searches. The software Google Trends (Google, Inc.) was used to examine internet trends over the past 5 years for the search terms “gadolinium,” “gadolinium deposition disease,” and the more colloquial term, “gadolinium poisoning.” Google trends provide information on the relative popularity of an internet search term over time. A score of 100 indicates the peak popularity for that search term over the time period selected by the user. A score of 50 indicates a relative popularity equating to 50% of the value for the most popular time for that particular search term. Google trends from January 2013 to January 2018 were examined. The peak popularity for the search terms “gadolinium poisoning” and “gadolinium deposition disease” occurred over the week of October 29–November 4, 2017 (Figure 1). This was the week of the Gena and Chuck Norris interview with CBS about gadolinium agents. The peak popularity for the term “gadolinium” was over the week of November 5–11, 2017, the week after the aforementioned interview, by which time it had been reported on by media outlets worldwide (Figure 1). Combined Google trends graph for search terms “Gadolinium,” “Gadolinium Poisoning,” and “Gadolinium Deposition Disease” from January 2013 to January 2018. The peak search term popularity occurred between the dates October 29–November 11 High profile celebrity health disclosures can cause significant increases in the public health awareness of disease. It is clear from internet search activity that the public are becoming increasingly aware of GBCAs and the perceived risks. This is most likely due, in a large part, to the widely publicized case of Gena Norris. As professionals concerned with the public's perception of MRI, it is of utmost importance to be mindful of this when answering the questions that will inevitably be raised by future patients requiring gadolinium-based contrast-enhanced MRI. We feel that there is a growing need for more readily available patient appropriate information regarding the safety and potential risks associated with gadolinium deposition.