Thousands of social media creators are posting endorsements for pharmaceuticals on social media that often lack information about drug risks and could be considered undisclosed marketing, a review has found.

University of Chicago researchers reviewed 740 high-engagement posts spruiking GLP1-RAs, ADHD drugs and autoimmune biologics, finding potential “undisclosed influencer promotion” present in around 80%.

Close to one-quarter of the posts used promotional language, with creators often employing phrases like “life changing” and “revolutionary”. Just over 15% of the content reviewed had an explicit call-to-action about the treatment, like a request for the viewer to contact their doctor or visit a website to get started with a product, but fewer than 3% of posts were tagged as sponsored.

Efficacy claims were made in close to 70% of the posts reviewed, but any mention of risks or adverse events were only seen in 32.3% of cases.

“The current analysis illustrates that drug promotion content is frequently posted by individual creators, lacks essential risk information, and bears the hallmarks of undisclosed marketing,” the authors said in a letter published in JAMA [link here].

“These findings suggest that posts circumvented established advertising principles and potentially eroded the fair balance crucial for informed patient decision making, consistent with prior literature on traditional [direct-to-consumer-advertising] impact on prescribing.”

There have been recent proposals in the US to reform direct-to-consumer advertising rules for drugs to curb the ills of influencer marketing. The US Food and Drug Administration (FDA) wrote to pharmaceutical companies earlier this year, warning them to remove misleading and deceptive ads and issuing 100 cease-and-desist letters [link here].

Close to 80% of posts reviewed had the potential to be undisclosed marketing, the study found.

At the time, the US regulator said social media was making it hard for consumers to distinguish between facts from marketing when it comes to medicine.

“An increasing reliance on digital and social media channels, including undisclosed paid influencer promotion, has blurred the lines among editorial content, user-generated media and pharmaceutical advertising, making it increasingly difficult for patients to distinguish between evidence-based information and promotional material,” the FDA said.

At the start of November, Australia’s TGA updated its guidance on advertising therapeutic goods via social media, outlining common compliance issues for manufacturers and how to avoid them [link here].

Australian companies were reminded that prescription medications cannot be advertised to the public, including via social media testimonials. Advertisers should be careful to avoid unintentionally promoting a product through the use of hashtags or links online.

“Hashtags that refer to prescription medicines or substances, trade names, abbreviations, acronyms or colloquialisms are likely to be taken by a consumer as an advertisement for a specific medicine or substance,” the guidance said.

The US study authors said noted that while there was new appetite to expand oversight of drug advertising so it covered influencer posts, ensuring compliance would be a huge issue given the number of individual creators who share testimonials.

“Effective oversight will be challenging because promotion is driven by thousands of individual creators rather than a few dozen companies,” they said.