‘Are people believing this information?’: research raises concerns over online drug marketing

Given the ubiquity of health influencers touting cures to millions of followers, a recent review in the Journal of Pharmaceutical Health Services Research (JPHSR) has raised concerns about the quality and covertness of such drug marketing on social media.

The scoping review, published on 24 October 2024, has been awarded with the Journal of Pharmaceutical Health Services Research 2024 ‘Paper of the Year’ award. It assessed 45 relevant studies and revealed that large pharmaceutical companies have used social media to advertise their highest-grossing medicines, primarily through help-seeking advertisements (i.e. focusing on a health condition for which the sponsoring company has a treatment). 

The most alarming finding, however, was that although much of the information in social media promotion was of low quality, “viewer ratings were unaffected by content quality, raising concerns that social media may disseminate unbalanced, misleading and potentially harmful information”.

Although the United States and New Zealand are the only high-income countries where unrestricted direct-to-consumer advertising of prescription drugs is legal, the highly interactive nature of social media has broadened the reach of this advertising strategy to global markets where they may not be subject to regulations. This review provides evidence for the need for updated regulatory and ethical guidelines to “ensure transparency, optimise information quality, and protect public health”.

Here, Jessica Mor, a PhD student within the University of Toronto Lawrence Bloomberg Faculty of Nursing, and lead author of the study, shares her experiences of writing this research paper.

What was the inspiration of this research?

A few years ago, I saw an Instagram post by Kim Kardashian promoting a morning sickness drug that had a huge effect on the sales of that medication. Although the US Food and Drug Administration issued a warning letter to the drug manufacturer, this got me thinking about the relationship between social media/patient influencers and pharmaceutical companies, whether advertisements on social media are being effectively regulated, and the impact of these promotions on public health.

How did you identify your collaborators?

To conduct a study like this, it is important to have ‘content’ experts, who will help formulate the research question, and ‘methods’ experts, who will adjust the methodology and help interpret the findings. 

Qualitative work is very interpretative and so we wanted to look at our findings through as wide a lens as possible. The other co-authors of this study are: 

• Quinn Grundy, an assistant professor at the University of Toronto, who is an expert in the relationships between pharmaceutical industries and public health systems;
• Academic psychiatrist David Menkes, an associate professor at the University of Auckland; and
• Bioethics expert Elizabeth Peter, a professor at the University of Toronto.

Tina Kaur, a fellow PhD student within the University of Toronto Lawrence Bloomberg Faculty of Nursing, and I screened the data for the study.  

What is the most important finding of this paper and its implication for public health?

The finding was that a lot of the promotional content on social media was of poor quality, but the quality did not affect viewer ratings. This is very concerning since this means that viewers are not able to recognise low-quality adverts. Are people believing this information and asking their healthcare providers for medications they don’t need? 

Even in social media posts where sponsorship is declared, we found that when the advertisement is paired with a personal narrative, the disclosure does not have a negative impact. 

The world of social media influencer sponsorships and targeted promotions is very different from traditional TV or radio ads. Although direct-to-consumer advertising is not legal in Canada, where I am based, we can still view it on social media from the United States and be influenced by it. There needs to be clear guidance on which information should be included when engaging in marketing activities. 

Social media/patient influencers have this amazing chemistry with their audience that can utilised by the pharmaceutical industry; however, a medicine that works for one person may not work for another. Hence, there needs to be more scrutiny and transparency around the relationships between pharmaceutical companies, social media influencers, patient advocates, as well as the third-party companies that very often facilitate these relationships.