A classic Saturday Night Live sketch from more than a decade ago starring Tina Fey features birth-control pills that can turn your baby into a firemonster if you happen to get pregnant, among other deranged risks. The sketch is meant to parody the often bonkers land of TV ads for prescription drugs, where happy people skip through pastel-colored landscapes while a voiceover reports side effects that sometimes sound worse than the condition they aim to treat. Of course, these warnings are required by the FDA, intended to protect credulous and vulnerable consumers against companies that might otherwise present their drugs as cure-alls.
But in recent years, social media has created a massive loophole in the regulation of drug advertising, and celebrities seem to be filling it. Last year, tennis legend Serena Williams starred in a social media campaign launched by telehealth company Ro for GLP-1 drugs she bought on the platform. In the video, Williams says her body “needed” the drugs when she was recovering from giving birth, but she doesn’t mention any of the potential risks, which include pancreatitis and thyroid tumors.
Williams isn’t the only one hawking prescription pills online. Celebrities and influencers are increasingly taking to social media to promote drugs, without disclosing risks or financial relationships they may have with the companies that make those drugs, according to physician and data scientist Nils Krüger and his colleagues, who recently authored a paper about it in the New England Journal of Medicine.
When Krüger and his team analyzed Google trend data, they noticed a 60-percent spike in searches for GLP-1s right after the Serena Williams’ Ro campaign went live. And that interest extends to the doctor’s office. Recent research, they note, found that nearly 70 percent of prescribers have been asked by patients about medications the patients saw on social media. And about half of these physicians went ahead and prescribed the drug they’d been approached about.
I spoke with Krüger about who is most vulnerable to drug misinformation online, and what remedies he’s most hopeful about.
You note in your paper that the United States is one of just two high-income countries that allow direct-to-consumer advertising for drugs, the other being New Zealand. Why has it lagged so far behind other nations?
This gap has really grown historically. I think it’s based on different interpretations of the law in the U.S., including First Amendment protections for corporations. Other nations have moved quite differently. In Europe, they’ve banned direct-to-consumer advertising, and there’s always been a big discussion about what we should do about it in the U.S., but in the digital age, we’ve seen the barriers between nations dissolve. So even though other nations have restrictions on direct-to-consumer advertising, it can spread from the U.S. into the newsfeeds, timelines, and Instagram accounts outside of the U.S. This proliferation of digital advertising combined with social media platforms represents a new age in direct-to-consumer advertising.
Read more: “These Pills Talk to Your Doctor”
Are there any efforts from other countries to regulate promotion of drugs on social media from the U.S., since these messages can so easily cross borders?
Yes, and we highlight that in our paper. We showcase one example from Germany. A court in Germany ruled that paid influencers can be treated as agents of the drug company and that their promotional content must comply with traditional regulatory disclosure requirements under German law, which basically bans direct-to-consumer promotion.
Does that translate to U.S. companies as well?
It translates to U.S. companies, but it’s only applicable to influencers who are based in Germany, and not to influencers who reside in the U.S.
Do you think that there’s an appetite for similar regulations in the U.S.?
It’s very difficult in the U.S. The historic evolution of the regulatory system in the U.S. wouldn’t favor this. There have been some bipartisan efforts to scrutinize direct-to-consumer advertising further and one bipartisan bill, the Protecting Patients from Deceptive Drug Ads Act. But finding the majority votes to pass that law has been difficult. There have been other proposals over time, but so far they haven’t been passed.
When did celebrity promotion of prescription drugs on social media become a significant problem in the U.S.?
I cannot pinpoint a specific year, but with the emergence of social media, this has slowly crept into content feeds. One prominent example from a few years ago was Kim Kardashian and the Kardashian family at large, who have promoted multiple drugs over their careers on social media, which actually resulted in FDA warning letters. Over time, this has only grown, and there have been more and more examples, the latest being now with the GLP-1s. This is a really good example because GLP-1s aren’t only medicine for people with recognized illnesses, but can also be perceived as lifestyle drugs.
You mention in your paper Oprah Winfrey promoting the GLP-1s on her show, and then the telehealth campaign featuring Serena Williams. But the regulatory response was very different in those two cases. Why did Oprah Winfrey get a warning while Serena Williams did not?
The way our legislation is currently written dictates what parts of the media are targeted. So traditionally, advertising was limited to TV and newspapers, and that’s when most legislation regulating drug advertising was written. That legislation hasn’t been updated to account for the emergence of social media platforms. But also, regulation only targets manufacturing companies. In Serena Williams’ case, the advertisement was for a telehealth company called Ro, which isn’t the manufacturer, but rather the distributor of the drug. That doesn’t trigger any regulatory scrutiny.
We’ve also published online on our GitHub an analysis of Google trends, where you can measure interest in certain search terms, after these two campaigns went live. In both cases, we see a 60-percent surge in search for GLP-1 medicines. The stunning finding, basically, is that the response in both campaigns was almost the same. Both of them showed that 60-percent increase in interest. But only one of them received the warning letter. So the public doesn’t care about how the information is distributed.
What other drugs, aside from GLP-1s, are most frequently promoted by celebrities on social media today?
It really depends on how you define the term celebrity. It ranges from an influencer who might only have a few thousand followers up to Serena Williams, who is this big star and icon. If you look into those smaller influencers, this can really go into the gray zone. Some of them promote hormones, including drugs that are used for enhancing muscle growth for people who go to the gym. In some cases, they also promote supplements that include GLP-1s and vitamins in one package, which allows them to circumvent certain laws.
As you know, in recent years, we’ve seen a shortage of GLP-1s because of high demand. As a result, the laws were changed so that other manufacturers could also produce the drugs as long as they “individualized” them to the patient’s need, the meaning of which can be very widely stretched.
What about psychiatric medications?
We know ADHD medications are heavily advertised by younger influencers and target young individuals. They present these medicines as lifestyle medicines, for example, and don’t provide good information about their risks.
Read more: “Getting Googled By Your Doctor Is the New Normal”
You mention young people as an at-risk population. Are there other patient populations you’re most worried about?
We like to draw attention to the younger population because they’re the ones most active on social media and who haven’t seen the direct-to-consumer advertising of the previous age. They’re the ones familiarized with these new types of advertising, and they consume it the way previous generations would consume a Pepsi commercial on TV. It really blurs the line between different advertisers and the lack of regulation of what the influencers can claim is the problem.
You don’t seem that hopeful that the current government can pass the bills that have been proposed. What kind of strategy do you think might have some potential for success?
The U.S. needs to have a conversation about banning direct-to-consumer advertising at large, and about whether it should follow the lead of other nations around the globe, because it’s very difficult to regulate this kind of advertising. There will always be loopholes, especially with these many channels available and the difficulty of tracking individual influencers who might not have followed the law.
Hopefully, there will be more advanced systems in the future that can screen social media for those who break the regulations. But the tech companies hosting the social media platforms would have to support those screening technologies, and we know in the past that these tech companies, like Meta, haven’t really been willing to regulate content that’s dangerous for younger individuals.
Do you think there’s real potential for a full-on ban to happen?
We aren’t there yet. We need a lot of discussion, potentially a roundtable of many parties involved. We can’t give up before we even have that conversation.
It seems like in this era where everything is moving so fast, and technology is changing so rapidly, it often takes a tragedy to get any real change to happen.
That’s true. Oftentimes, we think that only a bad moment can shake everyone up. But we’ve already had enough of those moments, especially around social media and how this affects young individuals who are still developing. This is why we point these things out now. We have enough data at hand to show that this kind of advertising on social media can be harmful. We need to discuss what needs to change.
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Lead image: venimo / Adobe Stock
