This post is from Johanna Ryan. A post on DH – Artificial I – semi links in.
Social media platforms like TikTok and Instagram, we are often told, are a portal into the Zeitgeist of today’s young adults. If you want to understand Generation Z (ages 15-30), or their Millennial elder siblings, just dip into these platforms and listen to the youth express their real feelings in chatty, spontaneous videos. You’ll soon learn that they regard psychiatric diagnoses as essential aspects of their identity. And far from recoiling against antidepressants and other psych meds, they embrace the drugs eagerly and refuse to be “shamed” out of reliance on them.
Right? Well … maybe yes, maybe no. Maybe the content we’re being served is not as authentic or unscripted as it looks.
A recent article in the Wall Street Journal found that many of those personal stories were in fact paid posts. Even more troubling, the Journal noted:
“the rosy picture painted by cheerleading TikTok and Instagram influencers glossed over potential adverse effects. Some suffered side effects that diminished rather than enriched their lives, but kept quiet about it on social media.”
In other words, their real-life experiences did not match the success stories they had fed their followers. Full WSJ article Here.
A word from our sponsor
In this case the customer was not the drug company, but a commercial telehealth platform which stood to profit by writing a prescription for the drug being praised. Hims and Hers Health specializes in “lifestyle drugs” sought after by younger patients: erectile aids for men, birth control for women, and antidepressants for both sexes.
Hims & Hers has plowed more than $521 million into digital marketing since 2021, with Hers – the business unit aimed at women – spending a significant chunk on Instagram, TikTok and Facebook …
The company ran an influencer campaign in 2022 and 2023 that targeted young women with a simple message: Don’t be ashamed to take medications for depression and anxiety. Hims & Hers paid between $3K and $10K to influencers for making Instagram and TikTok posts, a person familiar with the deals said.
Here are some of the influencers profiled by the Wall Street Journal:
Corinne Byerly
Byerly, a stay at home mom, recalled days when she felt lonely, overwhelmed and at times paralyzed with anxiety and self-doubt. Byerly, who had neither health insurance nor money for psychotherapy, was intrigued at hearing a former MTV star talk up Lexapro on a podcast in 2023.
She searched for the drug on TikTok and was connected to Hers.com, where she filled out a questionnaire. An online nurse practitioner prescribed Lexapro, telling her that “any side effects are generally mild and usually subside quickly.” Byerly posted videos to her 11,000 Tik Tok followers showing her running to the mailbox to get her pills, using hashtags like #lexaprobaddies and #gethelpmama.
But while the drug helped at first, the side effects “blew the whole thing up.” She struggled with emotional numbness, brain fog, weight gain and sexual dysfunction. She finally went off the drug completely and suffered withdrawal symptoms. But for months she held off telling her followers about her problems.
Nadya Okamoto
Okamoto was one of the influencers paid by the company, including for an Instagram video she posted in December 2022. At the time, Okamoto had, in fact, been trying to reduce her Zoloft dosage …
The medication had numbed her sex drive and caused her to sweat profusely in her sleep, Okamoto said. On a podcast a few months after her paid posts for Hers, she skewered the medical profession for pushing antidepressants.
Like Corinne Byerly, Okamoto initially found her antidepressants to be “life-changing,” but later found herself feeling numb and emotionless. She now hopes to taper off Zoloft entirely; she plans to start a family soon and doesn’t want to be on the drug while pregnant.
Elaine Davies, an influencer who also has a popular podcast on Apple, also praised Lexapro in a 2023 TikTok video paid for by Hers. She has since tapered off.
Ariella Sharf
In 2019, Ariella Sharf revealed to her Instagram followers that she had been taking ADs to cope with anxiety and depression. Without Zoloft, “I struggle silently,” posted Sharf, who has been taking ADs since college.
The 32-year-old now has a different message for her 6,500 followers. The pills she credits with saving her life also “nearly broke me,” Sharf said. Zoloft made her emotionally numb, took away her appetite and left her sweaty and sleepy …
Sharf decided last year to taper off Zoloft … she described on Instagram her body shakes, dizziness, “nausea creeping up my throat” and “eyes and lips drier than the Sahara desert.” “Emotionally, mentally and physically excruciating in ways that make no sense,” she wrote at the end of July.
Authenticity, Inc.: an alpha influencer
At least one apparently satisfied influencer was Alix Earle. However, the Journal was unable to speak to Ms. Earle; her agent told them she was unavailable to comment.
Earle, who has 7.7 million followers on TikTok, disclosed in a December 2022 video that she has been on Lexapro for anxiety since high school. In the video, which got 6.6 million views, she shook a prescription bottle of pills and urged watchers to talk to a therapist if they have similar symptoms. She has since posted more videos about Lexapro and anxiety
At 27, Earle is a giant of the influencer world whose net worth reached $6 million by 2023. For a time her podcast, Hot Mess with Alix Earle, outranked even Joe Rogan’s.
She’s regarded by millions of young women as their “hot best friend” or big sister as marketers explain. The perceived honesty and relatability of her personal day-in-the-life videos builds “a sort of trusting, friendly familiarity with her audience” so that her endorsements seem more like advice from a friend than advertisements.
One follower was excited to hear that the fabulous Ms. Earle was a fellow “Lexapro girly”; it proved that even “the baddest bitches have crippling anxiety.” Another woman told the Journal she had tried antidepressants twice and experienced no relief – only emotional numbness and sexual dysfunction. After watching Earle sing their praises, however, she decided to try a third time (with the same grim results).
A girl just like you—or a paid spokesperson?
Celebrity drug endorsements are nothing new, at least in the United States. From time to time drug companies have been criticized for this type of marketing, as in 2015 when Kim Kardashian’s Instagram posts for a morning-sickness drug failed to include standard FDA-required warnings. Celebrity content, however, is pretty easy to spot as paid promotion (as in this Shingles Vaccine Ad featuring 1980’s football legend Terry Bradshaw).
But influencers are different: “Authenticity” is their most important asset. The viewer must feel that Alix Earle “struggles just like me” (and maybe my life can be as amazing as hers if I use the same products.) However, digital influencing has morphed from a bottom-up, rank-and-file activity to a multi-billion dollar business which is viewed by many young adults as a promising career path.
The influencers profiled in the Journal illustrate the spectrum: Alix Earle makes millions putting her seal of approval on everything from drugs to cosmetics and cocktails. Corinne Byerly, by contrast, appears to be a genuine amateur. Nadya Okamoto, Elaine Davies and Ariella Sharf are somewhere in the middle: all are professionals with their own podcasts on large platforms like Apple, Spotify and YouTube.
Their paid posts for Hers, the Journal noted, were “typically” identified by hashtags such as #sponsored or #herspartner. However, while the FDA is at least supposed to monitor pharma ads in TV or magazines, here no one is keeping track. When is your TikTok “best friend” speaking her (or his) mind, and when are they working for pay? You can’t know for sure.
The future of telehealth:
Centering products, not providers?
Telehealth moved from the periphery to the center of medicine five years ago, with the help of the Covid-19 shutdowns. Antidepressant use also spiked in this period, “especially among young women in their 20s and early 30s,” according to the Journal. “Social media chatter about the medications went viral about the same time.”
GLP-1 weight-loss medications are now the real growth market, due to a combination of high demand and insurance-company reluctance to pay without a diabetes diagnosis. Pharma is eager to get in on the action. Rather than simply working with outside platforms like Hims & Hers, companies like Lilly, Pfizer and Novo Nordisk have launched their own direct-sales platforms.
President Trump has proposed a new platform, “TrumpRx,” that would offer price cuts to patients willing and able to pay cash. A number of drug companies seem interested.
In the process, the telehealth business has increasingly moved towards “drug-first” thinking, according to Boston-based STAT Health News. What began as a way to help patients access doctors is now a way to help companies sell drugs. “Instead of starting with a set of symptoms and a clinician deciding which, if any medication might be appropriate treatment, an interaction might start with a patient putting a drug into a digital shopping cart before ‘checking out’ with a provider’s signoff,” notes STAT’s Katie Palmer.
The online nurse practitioner who administered a questionnaire to Corinne Byerly and “signed off” on her script for Lexapro may soon be a fairly typical provider, with a shrinking role and diminished authority. Who will fill the resulting power vacuum – patients, or profit-driven drug and healthcare companies?
There are 2 Stat articles on this topic here
A Reuters article
And an older article by Freya India, who has a RxISK fan club
And there are semi-linked articles on DH – Artificial I – with another coming next week and one the week after.
Dr. David Healy says
There’s a 2006 film called Idiocracy. It’s a comedy about a man who is cryogenically frozen as part of a science experiment and wakes up several hundred years in the future.
He discovers that humanity has devolved into a state of extreme stupidity. Society has collapsed because nobody can do even basic tasks or understand simple concepts.
It’s not a very good film, but it’s amazing how accurate it has become.
There’s even a plot about big corporations who have replaced all water with their soft drink, which is inadvertently preventing people from growing crops. When the guy discovers this and takes steps to rectify the water grid, the corporations start firing people and so everyone gets angry at the guy for causing trouble.
Such a parallel with people getting angry when told their drugs can be harmful.
Peter Selley says
Thank you Johanna
Sanofi has put together a squad of paid celebrity ambassadors for Beyfortus, including actor-singer Mandy Moore, author Elaine Welteroth, chef Gaby Dalkin, citizen astronaut Katya Echazarreta and gold-medal Olympic gymnast Shawn Johnson East.
https://youtu.be/zw48YjBFzog
They would know.
“Join the more than 6 million moms who’ve had their babies Beyrified—verified they got Beyfortus”
annie says
These smart young folk are amassing more money than most young folk can dream of as influencers. Influencers are everywhere and their audiences are huge in the Gen Z market.
It seems to have been a hidden industry until the WSJ exposed it. Who needs Pharma ads when the influencers are influencing.
Of course, the more elderly and experienced will look stricken by the level of naivety.
Influencers peddle everything and anything that gets them thousands of clicks. Here you have a leader and follower syndrome. Somewhat like the Pharma ads, they talk, the sheep follow. Robert Kennedy is planning to make Pharma promote adverse effects clearly.
This is a new generation finding their feet, making money, being primed by soulless enterprises. It won’t be on their radar, the fifty odd years of science debunking, that they are ’emotionally labile’, that they might turn in to an alcoholic, end up with no sexuality, go on one of the worst trips of their life.
Perhaps these antidepressant influencers should be left to learn by experience, how else do you learn if not by experiences. They are too young to have learnt that they could be being exploited, what harm in a pill. Hey girls, let’s take it, ClickClickClick
After all, this is what we did. Hey, Hims and Hers..
Dr. David Healy says
Annie
It hasn’t been hidden. Its been out there for a while.
One of the big issues is that I often mention for instance with Woody Witczak would be alive today if he took the very strong SSRI – chlorpheniramine – because it is OTC and no doctor would have stood in the way of him stopping it when it didn’t suit him
When I first raised the OTC option nearly 30 years ago it was to invite people to recognize that one of the hazards of prescription only is that it meant a doctor had to give you an illness, make you ill, in order to give you a drug. I said at the time and since that while there might be benefits this arrangement would generate its own perversities, its own hazards.
The other thing what was very clear with drugs that are both lifestyle and routinely give reliable results – like Viagra or Propecia – there would be a push to making these available OTC
We are seeing marketing imperatives impacting on this scene now. Some people will get killed as a result. Some European countries are aiming at getting Propecia banned completely – which also seems a mistake – it very reliably gets hair regrowing.
We need to find a sensible way to live with drugs. The problem is that most of us are like Oscar Wilde – we can resist everything except temptation – even an old dude like me can feel the temptation to try Propecia.
Will we? Can we? Or are they too like forbidden fruit on a tree.
D