The Attention Economy of Menopause Medicine

Why unsupported brain fog "cures" keep going viral

Natalya Kosarevich/Getty Images

How did we get to a place where there have been three “miracle cures” for brain fog in menopause in the past twelve months? Last year, it was ADHD medications, then about 6 months was creatine, and now it is the antihistamines H1 and H2 blockers (read more about this latest claim in this post).

The first part of the equation is clearly the gaps in the system. Menopause brain fog is poorly understood, and the whole structure of the medical visit doesn’t allow for the exploration of poorly researched symptoms. What makes brain fog even trickier than most symptoms is that it’s non-specific, so it can be seen with a variety of medical conditions as well as a side effect from medications, including, paradoxically, antihistamines. I understand that people are desperate for answers, so when they don’t get them from their medical professionals, they turn to the internet. And unfortunately, the internet is filled with misinformation that is packaged far more attractively than the truth could ever be.

The second part of the equation is that we are in an attention economy, where your attention is a valuable resource that creators (including doctors), companies, and platforms compete for, measure, and monetize. We are in a content glut, but there are only so many hours in the day, so the limiting factor is your attention. This is why we are faced with platforms, advertisements, and content designed to capture our attention, which can then be turned into money. It is also designed to get us to participate with likes and shares, which further feeds the beast.

Clickbait headlines draw you in, fear-based content gets you to read or share, and platforms keep you scrolling to show more ads. And the algorithms are designed to maximize engagement (likes, shares, watch time). With social media, you are either paying with your money or your time (or often both).

With the H1 and H2 blocker claims, we witnessed a perfect storm: a gap in medicine exploited by creators and the algorithm. It doesn’t seem like anyone is selling bougie versions of Pepcid. The likely trajectory is there were a couple of index posts where people reported their experiences, and then this was amplified by large accounts, either because they had low-histamine diets to sell, could repurpose products they already sell for this reason, or simply to feed and profit from the attention economy. And of course, when more people are discussing brain fog, it’s a perfect time to push other products for brain fog. While I was working on this post, I was served the following ad on Facebook. (I often go to Facebook when I am researching something, and if I get a targeted ad about the topic, it’s a decent sign that the attention economy has been engaged).

There are no trials specifically studying “brain fog” as a clinical endpoint, which is why there are little asterisks about the claims in the above ad. The current evidence does not support recommending creatine as a treatment for cognitive complaints for women navigating brain fog in menopause. When other brain fog content gets pushed out, likely to capitalize on the discourse, it only adds fuel to the fire.

Social media algorithms amplify content by prioritizing emotionally salient, sensational health claims over facts. Studies consistently show that posts with misinformation often get more engagement than accurate information. And then confirmation bias and expectation effects take over. Did you know that observing someone else report relief from a treatment can trigger a placebo response in you that is just as strong as if you had personally experienced that relief , and this effect is linked to empathy? This means people who try H1 and H2 blockers for brain fog expecting improvement because of what they have seen online are primed to perceive that improvement. And so the cycle self-reinforces; each new testimonial becomes “evidence” for the next person.

In addition, repeated online health searching paradoxically increases health anxiety, rather than helping to reduce it, and people who have a harder time “not knowing” search more and emerge more anxious. Tapping into health anxiety is useful as it is associated with both acceptance and sharing of health misinformation.

Think about claims from health influencers about “women can’t wait for the science,” it directly taps into this kind of anxiety about not knowing. This is urgency framing combined with intolerance-of-uncertainty exploitation, and it is particularly effective precisely because it weaponizes a legitimate frustration.

How Can We Disengage from the Attention Economy?

The symptoms (brain fog, fatigue) are real. What social media provides is a causal narrative, “your brain fog is caused by histamine intolerance,” and a solution, “take H1 and H2 blockers.” The narrative feels empowering because it offers an easy explanation and an easy action. And so people share the posts suggesting there is benefit because they typically believe they are sharing accurate information.

Because there is so much money to be made in menopause by selling products or services, or by jumping on viral moments to capitalize on the attention economy, we need to be extra careful about what we share and why. The problem is, it’s hard, because the algorithms are built to trick us. Here, I want to discuss how these viral moments of misinformation are not a failure of anyone’s ability to understand a post or to tell what is science from scam, but a structural feature of social media platforms’ design, because the algorithms are designed to reward engagement (including sharing), not accuracy.

The Habit of Sharing

Some people are super-sharers (for lack of a better term) on social media. A key study found that 30–40% of all false news shared came from just 15% of users. This is not because these people are lazy or have bad intentions; it is because social media platforms train us all through likes, shares, and engagement metrics to amplify content that attracts attention, and we are creatures of habit, so once we start doing it, sharing becomes automatic. It is fascinating that habitual users even share content that contradicts their own beliefs because sharing is rewarded with positive reinforcement in the form of likes and replies. This is genuinely reflexive behavior.

The answer is not to expect the platforms to do anything to fix this. They won’t. The answer is to pause before you share (or engage). Ask yourself if the content is worthy of your sharing?

The Accuracy-Attention Gap

When faced with information that may or may not be true, we do a far better job distinguishing what is factual and when someone asks us, and we have to reply ourselves than when we read content and decide to simply share on social media. It seems the brain systems that activate sharing on social media don’t activate accuracy evaluation in the same way that discussing something does.

Interestingly, when users are prompted to consider the accuracy of content before sharing, it dramatically improves their ability to determine whether what they are about to share is true. Just don’t expect any new features to show up on Instagram where you go to share something and get a pop-up that says, “Have you validated the accuracy of the article you are about to share?” That is never happening as it slows down engagement, page views, and the opportunity to fill ad space.

The answer? Challenge yourself to consider the validity of the content before you share it. Are you sharing someone’s personal experience that cannot be verified, or is this from a health care professional who has provided compelling data, or are they relying on rodent studies, and does their content have lots of asterisks with FDA disclaimers?

Confirmation Bias

This is a big one. We are all predisposed to favor belief-consistent information and rate it as more credible, useful, and convincing. And here is something that is even more fascinating: people with higher health literacy show stronger biased selection, not weaker. This means that health-literate individuals who already hold a belief (e.g., “antihistamines help menopause brain fog” or “testosterone treats all symptoms of menopause”) will preferentially seek, select, and share content that confirms their pre-existing bias while dismissing contradictory evidence.

As Mark Twain famously said, “A lie will travel halfway around the world while the truth is putting on its pants.” Except… oops, there is no record of Twain actually saying or writing that. I know, right? But hey, since Twain was known for pithy, clever quotes, reading that likely triggers confirmation bias.

When you read something on social media, ask yourself, does this content reinforce what I already believe? If so, do some lateral reading (step outside of social media to verify) before hitting like or share.

Emotional Content Spreads Faster

This also gets to another fascinating aspect of false information. Misinformation spreads faster than information. A lot faster. Basically, because the truth and nuance are boring.

If I make a true claim about hormone therapy and dementia, I might say something like, “There is no evidence supporting the claim that menopause hormone therapy prevents dementia.” However, false claims usually include some pretty big emotional triggers, so it would be rare to see people who make false claims about menopause hormone therapy use boring language, as I just did, like “Menopause hormone therapy prevents dementia.” Instead, we get attention-grabbing claims like, “Without menopause hormone therapy, the brain literally eats itself,” and yes, this is a real soundbite from a conversation between two health influencers, one a doctor and one who is working on a PhD, and they have 1.8 million followers on Instagram combined.

Heightened emotions, both positive and negative, increase the likelihood of sharing content regardless of the accuracy. If the content really fired you up, reconsider sharing, and also maybe reconsider if people who use that type of emotional hook messaging really have your best interests at heart.

The Echo Chamber Effect

Most of us have accounts we engage with frequently, so we are potentially exposed to echo chambers where the same narrative is repeatedly reinforced. Remember the illusory truth effect, the fact that we all mistake repetition for accuracy. So a claim seen multiple times within a community begins to feel like the truth.

When I see these silos of misinformation scroll by on my feed, I do my best to ignore them (although, admittedly, it’s hard). In the early days of my social media use, I would engage, but it would just result in pile-ons from true believers. In addition to being soul-sucking for me, there is data that shows that trying to debunk false information in these silos can paradoxically backfire, actually increasing people’s belief in the misinformation.

The answer? Try to step outside silos, and don’t waste your time presenting quality data in an echo chamber. Your efforts are better spent elsewhere.

Reports in the Media and Press

When the media picks up viral claims, it only increases the exposure to the misinformation and can also heighten placebo effects or nocebo, a reverse placebo response, except with negative side effects. Did you know that when the media dials up their intensity on covering supposed statin-related side effects, reports of side effects increase? Media coverage creates both perceived benefits and negative expectations.

Internet communities

These can also play a central role in shaping and reinforcing ideas like the notion that antihistamines treat brain fog. People form online groups, they develop shared language and beliefs, and reinforce each other’s convictions. The community validates that interpretation.

In addition, not all internet communities are as organic as they seem. There are several where moderators delete any responses that legitimately question the accuracy of the content.

All of This is Hard

Social media algorithms are designed to trigger engagement, and the more emotional, the better. What’s more, it’s against our nature to verify. We aren’t sharing bad information because we are bad people. We’re doing it because the social media world is its own ecosystem that has been intentionally designed to train us to share misinformation.

There are things that do work. For example, prompts that ask people whether they have verified the information or even read the entire piece, create enough friction to reduce the sharing of misinformation. If you remember back in the early days of COVID-19, Instagram used accuracy prompts in the forms of “get the facts” style pop-ups and suggesting the CDC as a source for information. It was part of a broader system of labels, friction, and down ranking. That is long gone.

Meta’s position is that COVID-era accuracy prompts were part of emergency misinformation controls, and they were scaled back as the platform moved away from pandemic-specific enforcement toward a broader, less intrusive moderation model and community-generated context. They also faced political pressure to scale back. It absolutely activates my confirmation bias that they did this as they saw engagement drop.

Since you can’t count on social media to provide that prompt, you will have to do it for yourself ( I know, it’s a bit like saying, “Eat your vegetables.”). Here are a few prompts for you to consider before you share content:

• Does this post feature emotional language designed to make me outraged?

• Does this claim offer a simple solution to a complex problem?

• To the best of my knowledge, is this content accurate enough to share?

• Am I in an echo chamber?

• Did I read the entire post before sharing?

• Does the influencer use the phrase, “Women can’t wait for the science.”

I understand that it is hard, especially with a lot of unmet medical needs, but the attention economy doesn’t want to help women, it seeks to exploit them.

The next time you see a doctor or influencer claiming “women can’t wait for the science,” know that is a predatory claim that exploits both a real historical grievance as well as health anxiety, and the solution being offered (bypass science) is the opposite of what could actually help.

References

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