Imagine that you’re young and pregnant and more than a little anxious about the changes you are experiencing. And then “morning sickness” rears its ugly head. Looking for advice, you have a few choices: consult your Doctor, seek out an online Doctor for help, or see what Kim Kardashian says on Instagram and Twitter. As ridiculous as it sounds, Kim Kardashian was the “expert” of choice for many 18- to 24-year-olds. When she endorsed the Duchesnay Inc., drug Diclegis (used for morning sickness) online nearly a half of million people “liked” it. Kardashian is one of high profile “influencers” Big Pharma and other companies are recruiting to push their products.

Product endorsements via social media by YouTube and celebrity influencers, the term used for social media product advocates, have always been powerful in the direct-to-consumer advertising for prescription and over-the-counter drugs. But social media has changed the rules of the road. While TV and print advertising is heavily regulated and must include risk factors and side effects, the same restrictions, which companies find onerous, are not yet in place for social media influencers. But the times, they are changing.

Following the Kardashian endorsement, federal regulators sounded the alarm. After the FDA sent a letter to Duchesnay asserting that not including safety information as part of Kardashian’s original posts endangered consumers’ safety, Kardashian took corrective action and updated her post to include the pill’s side effects. However, the FDA is still sorting through how to police this vast and unregulated brave new world. They are coming late to the party, however.

It’s not like the whole idea of “influencers” in the medical industry is new. As the internet first evolved some Patients became natural influencers to talk about their own health issues. There is no shortage of people willing to share their medical stories and interact with others commenting with their own health issues or seek advice from someone in their shoes. It’s like crowdsourcing in some informal way. And it would have continued on a small benign scale if drug companies didn’t seize upon this concept as a great way to push their products. While Patient influencers continued to share their personal experiences, drug companies stepped in and incentivized these influencers to recommend their products. These companies knew that Patient influencers have relatability and have the trust of those afflicted with the same medical condition. For Patients already dealing with high medical bills, some meager compensation has been well appreciated.

What it evolved into has become a system that uses A list to D list celebrities to extoll the virtues of a particular medical device, Medicine or treatment as a brand builder or influencer without having the obligation of describing the dangers or side effects of these products. And drug companies aren’t going anywhere. They have read the data. According to a Pew Research study, 90% of people age 18 to 24 put their trust in medical information found on social media. Instagram has become the go-to vehicle for advertisers. Half of its billion users in 2019 were in the 18 to 24 age category. An influencer is paid by the eyeballs they attract, which can run on average of $1,000 per 100,000 followers. It’s a trending advertising movement. According to the World Federation of Advertisers 65% of global brands are increasing their spending on influencer marketing.

But influencer campaigns can go terribly wrong. Just like the Kardashian example, Erin Ziering, wife of Beverly Hills 90210 star Ian Ziering, promoted Allergan breast implants. The company recalled them after receiving a notice from the Food and Drug Administration that women given these implants were at risk of developing breast-implant anaplastic large cell lymphoma. The FDA couldn’t compel Allergan to recall the implants, but the company complied voluntarily.

While the FDA plays catch-up trying to issue guidelines for companies to self-police their social media advertising presence, companies like Wego Health in Boston have launched a web-based platform that is a landing place for pharmaceutical, medical device and insurance companies, as well as hospitals to find Patient influencers to participate in surveys and/or promote their products. Think of it as a community bulletin board for companies to connect with what Wego says are their carefully vetted influencers.

Vetted or not, the most reliable source for medical advice is a Doctor you trust. Buyer beware should be the watchwords as the Federal Trade Commission and the Food and Drug Association work with politicians to impose rules of the road to protect consumers. Now more than ever it is the time to be our own health advocates and by all means gather as much information as we can from a variety of sources.  The bottom line, however, is don’t be “under the influence” when making crucial health decisions.