Misinformation Abounds in Influencers’ Promotion of Prescription Drugs

Don’t expect accuracy and transparency in the promotion of prescription drugs by social media influencers, researchers cautioned.

Though evidence was limited in this systematic scoping review, recurrent themes in posts about prescription drugs by influencers included misinformation and blurred lines between personal testimony and paid promotion, with weak regulatory oversight, reported Raffael Heiss, PhD, of the Center for Social and Health Innovation at the MCI Management Center Innsbruck in Austria, and colleagues.

“Collectively, these issues increase the risk that audiences act on misleading or harmful recommendations,” they noted in JAMA Network Open.

Drug promotion by social media influencers is rapidly expanding, “yet until now there has been no systematic attempt to map what research actually shows about its risks and regulatory challenges,” Heiss told MedPage Today in an email.

“Influencer-pharma partnerships increasingly involve not only celebrities but also smaller patient influencers with highly engaged audiences, for example, around new GLP-1 weight-loss medications,” Heiss said. “This matters for public health because influencer promotion can shape medication demand, blur the line between personal experience and advertising, and potentially contribute to inappropriate use.”

“At the same time, many regulatory frameworks were developed before the rise of algorithm-driven social media environments,” he added.

Alex Kresovich, PhD, of NORC at the University of Chicago, told MedPage Today that “the primary value of this review is that it consolidates a small and fragmented field of emerging research into a single, cohesive framework. It identifies the core pillars that define this unregulated frontier: misinformation, weak oversight, and persuasive narratives.”

“This synthesis is critical because it validates that parasocial narratives (the feeling of a one-sided ‘friendship’ with an influencer) are being operationalized at scale,” said Kresovich, who was not involved in the research. “This review fills a major gap by documenting how these ‘psychological hooks’ are currently being used to promote prescription drugs, effectively explaining why these posts are so successful at bypassing a consumer’s natural skepticism and potentially influencing individuals’ health decisions.”

Late last year, Kresovich and colleagues reported that undisclosed influencer promotion was present in the vast majority of high-engagement social media posts related to prescription drug promotion.

Moreover, a survey of more than 300 practitioners showed that most physicians have engaged with content created by healthcare influencers or key opinion leaders at least weekly, and that many also have cited online creators as influential in their perception of medications and prescribing choices.

Heiss explained that his team “felt it was important to synthesize the existing evidence — however limited — because policymakers are making decisions now and need to understand both what is known and what remains uncertain.”

Of the review’s findings, concerns about accuracy and misinformation were raised in seven studies, Heiss and colleagues reported, which “collectively emphasized that health influencers often present content beyond their clinical expertise, exaggerate benefits, and frequently omit alternative treatment options.”

For example, one study showed that influencers discussing sexual health often shared inaccurate information about contraception and prevention of sexually transmitted infections.

In addition, several studies detailed the “critical role of parasocial dynamics in shaping trust and engagement with influencer content (persuasiveness),” the authors wrote. “Influencers often occupy overlapping roles as physicians, patients, peers, and promoters, which increases the likelihood that audiences will engage with and trust their medical advice, particularly when framed as emotionally resonant personal stories.”

One study suggested that illness disclosure narratives reduced recognition of persuasive intent and increased favorable attitudes toward a promoted drug. “This is important because current disclosure approaches — for example, adding a hashtag or brief sponsorship note — may not be sufficient when marketing is embedded in emotionally resonant personal narratives that foster trust and identification,” Heiss said.

The authors also noted that FDA and Federal Trade Commission guidance on transparency was “described as vague, outdated, and difficult to enforce across global platforms.”

Several studies identified gaps in regulation of health-related influencer content, and one study indicated that FDA frameworks fail to address unbranded prescription drug promotion on social media, “where influencers may omit key safety information and present marketing as personal testimony.”

“Together, these findings highlight the need for updated and enforceable regulatory guidance, standardized disclosure requirements, and stronger platform accountability,” the authors concluded. “Future research should examine clinical behavioral and health outcomes and evaluate regulatory and disclosure interventions to inform evidence-based policy responses.”

For this review, Heiss and colleagues searched for articles in peer-reviewed journals from 2004 to 2024 across a number of databases.

Only 12 studies — 8 empirical and 4 theoretical — met inclusion criteria. Studies were excluded from the review if they were not published in English, did not have peer review, were not a journal article, and did not have a focus on the main topics of influencers, social media, or prescription drugs. “Given the level of public and policy attention this issue is receiving, that gap between discourse and research is striking,” Heiss said.

The included studies were heterogeneous in design, methods, and outcomes, the authors noted, and most of the studies relied on qualitative, observational, or controlled experimental designs.

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