A systematic scoping review published March 23 in JAMA Network Open found that influencer promotion of prescription drugs was associated with misinformation, limited regulatory oversight, and the use of personal narratives that can obscure promotional intent—raising public health concerns in a largely unmonitored marketing environment, according to researchers led by Sascha Gell, MA, of the University of North Carolina at Chapel Hill, and colleagues.
Researchers identified 12 articles that met inclusion criteria from an initial 3,502 records across 8 databases—MEDLINE, Communication & Mass Media Complete, CINAHL Complete, PsycInfo, Web of Science, Business Source Complete, Scopus, and the Cochrane Library—covering research published between 2004 and March 13, 2024. Of the 12 included articles, 8 were empirical studies (including content analyses, interviews, and experiments) and 4 were theoretical papers (editorials, commentaries, and viewpoints). Topics included birth control advertising, performance- and image-enhancing drugs, and broader pharmaceutical promotion.
Misinformation and Limited Expertise
Across studies, influencers were described as sometimes presenting health information beyond their clinical expertise, overstating benefits, or omitting alternative treatment options.
One content analysis found that influencers discussing sexual health frequently shared inaccurate information about contraception and sexually transmitted infection prevention, despite expressing high confidence in their knowledge. A qualitative interview study found that patient influencers—often motivated by peer support—could blur the boundary between personal experience and promotional messaging. "Patient influencers often share their experiences in genuine good faith, and these voices can play an important and legitimate role in peer support, awareness, and navigating illness," said corresponding author Raffael Heiss, PhD, of the Center for Social and Health Innovation, MCI Management Center Innsbruck. "But the same authenticity that makes personal stories helpful and relatable can also make them highly persuasive."
Not all findings were unfavorable. One study of Japanese physician influencers' posts about COVID-19 treatments found that most content was accurate, suggesting that clinically trained professionals can contribute reliable information in social media settings. Heiss noted that the finding points toward a potential credentialing model. "Medical societies already certify professional expertise, and platforms could make that credibility more visible to users to help them navigate complex health information," he said, while cautioning that elevating physician voices should complement—not displace—patient advocacy. However, the review noted that physicians who act as influencers may also face tensions between professional and commercial roles, particularly when industry relationships are involved.
Regulatory Gaps and Disclosure Challenges
Seven articles identified gaps in the regulation of health-related influencer content. Researchers described existing FDA and Federal Trade Commission guidance as vague, outdated, and difficult to enforce across global digital platforms.
Heiss said there is "no clean regulatory line" between authentic patient advocacy and undisclosed pharmaceutical promotion—and that this is precisely the challenge. Disclosure rules already exist in principle, with influencers expected to use hashtags such as #ad or #sponsored, but he described these measures as "inconsistent, easy to overlook, and poorly adapted to the way persuasive storytelling works on social media." He pointed to enforcement limitations as a particular concern: even high-profile cases have often resulted mainly in warning letters issued after misleading posts had already reached millions of users—a dynamic illustrated by an FDA untitled letter issued to a celebrity influencer who promoted a migraine drug without adequate risk disclosure.
"Any material financial relationship between an influencer and a pharmaceutical company—payments, free products, or affiliate arrangements—should trigger clear, standardized, and unavoidable disclosure," Heiss said. He added that responsibility must be shared: pharmaceutical companies should maintain public registers of influencer partnerships, platforms should be accountable for the promotional content they algorithmically amplify, and regulators need updated guidance that reflects how social media persuasion actually works. Researchers also pointed to the European Union's Digital Services Act as a potential international model for improving platform accountability.
Parasocial Dynamics and Persuasive Narratives
Six articles examined how parasocial relationships—one-sided perceived connections between audiences and influencers—may shape trust and engagement. Influencers often occupy overlapping roles as patients, peers, clinicians, and promoters, which can increase perceived credibility.
The review found that illness-related personal narratives embedded in sponsored posts reduced recognition of persuasive intent and were associated with more favorable attitudes toward promoted drugs. "Our review shows that illness narratives can reduce audiences' recognition that they are being persuaded, which can weaken critical evaluation of drug-related claims regardless of the influencer's intent," Heiss said. Similar effects were observed in unbranded disease awareness content that lacked clear sponsorship disclosure. One observational analysis found that posts by a high-profile public figure about psychiatric medications were followed by increased online search activity and interest in treatment.
Limitations
Researchers noted that the evidence base is limited and heterogeneous. Included studies varied in design, methods, and outcomes, making comparisons difficult. Much of the literature relied on qualitative, observational, or experimental approaches, limiting conclusions about real-world clinical outcomes such as prescribing patterns or health effects. The review was also restricted to English-language academic literature, which may have excluded relevant gray literature, regulatory reports, and studies from non–English-speaking regions.
Implications
Researchers called for clearer and more enforceable regulatory guidance, standardized disclosure practices, greater platform accountability, and improved digital health literacy among consumers. Heiss said the risks identified stem from "multiple structural factors—including weak disclosure practices, platform amplification of persuasive storytelling, and low digital health literacy," and that addressing them requires a combination of stronger regulation, standardized transparency requirements, and public education.
"Applying the precautionary principle," the researchers wrote, policymakers may consider strengthening oversight and investing in digital literacy, noting that limited evidence should not preclude action.
Disclosures can be found in the study.
Source: JAMA Network Open
