But just once – after that, you’re on your own

Last month, I read an article in which the authors advocated for the FDA and FTC to work together to crack down on TikTok and Instagram influencers who are advertising and promoting drugs.

The goal here is, of course, to provide some sort of guard rail for innocent social media users around the promotion of prescription drugs that may contain misleading information and lack fair balance. The article states: ‘Influencers with no medical or pharmaceutical training regularly use these platforms to promote prescription drugs. Khloe Kardashian, for example, has posted ads on Instagram to promote a prescription migraine medication. So have Lady Gaga and gold-medalist Olympic athlete Aly Raisman, who recently endorsed a competing migraine medicine in an ad that began with her talking about Women’s Mental Health Month.’

But are these social media users really innocent? With the demographic of some of these social media platforms skewing on the younger side, I can certainly see the rationale for protecting children and young teens from the potentially harmful misinformation about drugs and medicines that might understate harm and overemphasise benefits. But nobody under 18 is getting a prescription medicine without a referral to a specialist and/ or without being accompanied by a parent or a guardian. Hence, some very important guard rails are actually already in place.

That leaves us with the rest of the population. The people older than eighteen years of age. Now, again, these people also need a referral to a specialist who will undoubtedly perform a clinical workup and obtain the patient’s relevant medical history before haphazardly prescribing a medication for a particular illness. No? Sure, a patient can ask for a drug by name and cite its use by someone famous. Doesn’t mean he/she is getting it. In fact, I would submit that while the FDA and FTC might be behind the times, physicians are not. I spend time interacting with thousands of physicians each year and, with the exception of a very small minority, they are all aware of what is out there on social media. They are all (informally) trained and alert to asking the right questions and are not about to get hoodwinked into writing inappropriate prescriptions.

I’m not naïve, but why all the handwringing?

Maybe because we’ve just come through a bruising three+ years in which science, epidemiology and public health were brought to their knees by a tsunami of misinformation and mistrust brought on by COVID-19. Maybe because we feel the need to protect the dissemination of drug information very closely. Maybe because vulnerable populations are involved.

All of these are fair points.

At some point, though, people need to remember that a guy sitting in his basement in Tuscaloosa, Alabama who works at the local 7-Eleven is not a doctor and it is highly likely that he is not a medical expert. People need to remember that these posts are opinions, not facts. And people need to take some ownership of the content they consume.

Does this sound harsh? Maybe. But this comes from a place of realising it is impossible to remove all the illegal posts and to moderate all the content out there on the internet. Facebook, TikTok and YouTube (aka Google) have tried to moderate content. They have hired veritable armies of people to moderate content.

It simply can’t be done. And we need to stop pretending that we can do something about it.

We cannot find every instance where some individual has posted a thought on the benefit or harm of a medicine and scrub it from the internet. And this has nothing to do with First Amendment concerns or the right to free speech. It has to do with the sheer size and scope of the internet.

So, in this situation, what do we do? Some regulation doesn’t hurt. But it is not the solution.

We can spend a few hundred million dollars on public service announcements reminding people of the dangers of taking medical advice over social media from individuals who are not clinicians. Maybe we can introduce social media training and education into grade schools so that in a generation we have smarter and better informed young adults. We can certainly start formal training of medical students and other allied healthcare practitioners about how to deal with this issue. And there are probably a few other great ideas out there that we can implement.

But, fundamentally, people need to take ownership of the content they consume. Full stop.

As Abraham Lincoln famously said: “You can fool some of the people all of the time, and all of the people some of the time, but you cannot fool all of the people all of the time.”