How TikTok spreads false cures, false hopes

LEYTE, Philippines – Are you suffering from gout or simply wanting to lose weight? Going to TikTok for advice may not be to your best interest.

In a video posted in August last year by an account named “ALO DRUGSTORE,” a woman who claims to be a “pharmacist” promoted a product known as “OsteoFlex X7,” which promises to cure gout. One must take 25 tablets of the supplement per hour, she said. Come to think of it, that’s a total of 600 tablets every day. Incredible. The video has so far accumulated more than 70,000 views, 461 reactions, and 57 shares.

One user asked if the supplement was available in a local pharmacy – to which there was no clear reply. When we checked with the verification portal of the Food and Drug Administration (FDA), we did not see OsteoFlex X7 in their database. 

In another video, a user endorsed “Lishou Slimming Coffee” for weight loss. Her tactic involved using a T-shirt as a marketing display for the product, such that it would seem like she’s selling a shirt. For her other products, she uses other pictures and graphics but none show the actual photo of Lishou Slimming Coffee.

The seller would also change the spelling of the product in the label, position it backwards during live streams or cover it with paper to hide the name of the brand. This puzzled us, but it made sense when we discovered that the FDA has issued a warning to the public against Lishou Slimming Coffee under Advisory No.2022-1753, on the basis of findings that the product contained hidden illegal drugs.

Health-related videos like these have flooded TikTok after the platform started incorporating e-commerce in its network and officially launched “TikTok Shop” in 2022. The shop allows users to sell items through live streams and online transactions. 

As the fastest-rising social media platform in the Philippines today, TikTok’s e-commerce transactions raise concerns about the unregulated sale of items that put people at risk. In 2023 alone, the FDA recorded a 43% increase in illegal products sold online in platforms such as Facebook, Lazada, and Shoppee. They range from food supplements, medication drugs, perfumery and cosmetics, among others. 

Today, TikTok has become the new target marketplace for unregistered and unverified medical products. Despite its own guidelines that prohibit the sale of “unsafe products” and medicines that make “misleading claims” on the platform, these continue to proliferate.  

Various tactics

In the last two months, we watched and assessed more than 60 TikTok videos containing exaggerated and dubious health claims. We found out the following: 

• Users frequently employ popular, yet irrelevant, tags to enhance their visibility on the platform.
• Numerous accounts promote unsafe homemade treatments and remedies.
• Sellers tamper with documents, such as falsified certificates of registration purportedly issued by the FDA.
• They use manipulated and edited videos of celebrities and influencers.
• A new trend is the use of AI-generated “doctors.” 
• TikTok’s report feature offers a limited selection of violations that can be considered as subject for termination of the video or suspension of the account, making it difficult to push for takedowns of false health claims. 
• When some users engaged the sellers to further ask about the safety of their products, they would be muted or blocked; this also happened to us when we started probing.

Hashtags as bandwagons

Filipinos are the 8th biggest TikTok users in the world at 49.9 million, according to Statista in 2023. Nearly half (45.86%) of Filipino TikTok users are between 18 and 24 years old, with a significant portion (32.93%) belonging to the 25-34 age group. Globally, each user would spend 52 minutes on average on the platform, with 90% checking their feed every single day. The global reach of the media platform is seen to reach two billion by the end of 2024.

Try going on TikTok’s search engine and enter keywords such as “health tips,” “wellness tips,” and “medical advice.” The search would yield a ton of videos ranging from online consultations, people debunking health misconceptions, and detailing the benefits of specific goods that are usually soft endorsements for products.

Many of the health-related videos we studied carried hashtags that were not related at all to the topic. Attaching a specific hashtag to a video enhances its discoverability when users search for that particular topic – whether on TikTok, Twitter, Instagram, or other platforms. This allows promoters to use any tags for greater traction. They serve as a bandwagon to pull up the viewership of the video, specifically disinformation videos.

One of the accounts posting multiple health-related videos used hashtags like #moroccangirl, #fypspotted, or simply #fyp (a short term meaning “For You Page”) in their captions. It also put #doctor, #easyrecipe, #wellness, and other tags just to increase visibility within the health universe of TikTok.

Several TikTok accounts promote a wide range of promised cures for cancer, gout, weight loss, beauty and hygiene care, and liver failure. Some of the products found are:

• Neora Diet – weight loss
• Almira Perfect – beauty
• Osteoflex X7 – can cure gout
• Liver Vital – can remedy fatty liver
• Crina LadyCare – discomfort for pregnant women
• Soursop products – can cure cancer
• Batana Oil – hair growth
• Sea moss supplements – multivitamins
• Glutathione – whitening
• Apple Cider Berry – Slimming products
• Lishou Slimming Coffee – weight loss
• Slimina/Slaymina – weight loss

These products are non-existent in the database of the FDA verification portal and have not been verified for safety standards. 

TikTok’s reporting feature

TikTok’s report feature does not function the same way as other platforms where a user can explain why a specific video is considered fake or harmful and must be taken down. The platform has a limited selection of violations that can be considered as basis for termination of the video or suspension of the account. The supposed violations cover misinformation, disinformation, intellectual property issues, and cyberbullying, among others. 

However, the platform doesn’t have clear guidelines for reporting videos selling unregistered products. The basis for reporting is even very specific; it asks users to alert TikTok to videos that show or promote unhealthy living such as “disordered eating, extreme dieting, fasting, binging, and intentional vomiting, as well as other dangerous weight loss behaviors, including compulsive exercise and use of potentially harmful medications and supplements.”

For this story, we reported to TikTok nine sample videos from March 6 to 18, which we thought peddled incredible claims. In a span of two days, TikTok dismissed our reports, including the video that recommended taking 25 tablets of a supplement per hour to cure gout. TikTok told us that it failed to find suitable violations to take down the videos.

This contradicts their Prohibited Products Guidelines, specifically Article 3 sections 14 and 15. The guidelines prohibit the sale of “unlicensed medicines” or those that “make misleading claims about curing diseases” as well as any food product that has “medicinal claims.” 

We exhausted all means to reach out to TikTok Philippines through their communication channels. But they have not responded to our questions. Based on TikTok’s guidelines, the platform adheres to their “misinformation policies,” which apply to content “regardless of the poster’s intent, as the content’s harm is the same either way.” This covers both “disinformation (intentionally shared to mislead) and harmful misinformation that may not have been shared with the goal of deceiving people.”

The platform also commits to “address disinformation by removing accounts that repeatedly post misinformation that violates their policies, and have expert teams who continuously monitor for disinformation campaigns, inauthentic behavior, and influence operations.”

Eat this to stay young

A significant number of TikTok videos analyzed were found to present exaggerated claims to bait users to click on them. “Eat these foods so you don’t get old,” proclaimed one video, or “Use this ointment and whiten skin in three days.” Another video said, “This is what you should eat if you don’t want to get cancer.” 

Videos suggesting quick fixes for issues like oily skin, weight problems, and even serious health illnesses like liver failure, often provided surface-level information without scientific backing.

A study by Adobe in 2023  showed that “tutorial” types of video are the most popular, raking in 62% of the total TikTok users’ preference. This is evident in the number of videos in the app promoting homemade treatments to remedy health complications and using resources they can find at home. These include mixing toothpaste with lotion and other ointments to whiten skin; drinking olive oil before drinking alcohol to avoid intoxication; adding cornstarch to shampoo or conditioner to strengthen hair; and using avocado pits mixed with carbonated drinks as ointment for pain cramps. 

While some are benign and known to be beneficial, other “remedies” present a real health risk, according to doctors. What’s particularly concerning is that these risks propagate through “viral challenges” with thousands of users blindly replicating them without assessing potential hazards beforehand.

Dr. Albert Francis Domingo, Assistant Secretary at the Department of Health (DOH), said these homemade trends are dangerous especially if they’re “new and promoted via influencers or online without scientific backing.”

Another new practice is the use of the platform’s built-in feature for AI-generated contents. This ranges from using manipulated photos of scientists supposedly giving the advice, to the use of machine-generated images. Others directly manipulate videos of professional doctors and selectively delete some parts to make it look like they are promoting the product.

These products are found to be non-existent in the database of the FDA verification portal and therefore considered unverified and deemed to be sold illegally.

Platform for professionals but…

It’s not all muck, however.

Medical professionals – doctors, nurses, and pharmacists – see TikTok as their channel to educate the public about various health issues and processes. They even share information that people don’t usually get to see on a daily basis – such as behind-the-scenes procedures through a doctor’s camera.

But because of these professionals’ popularity on TikTok, they have been a target of fake promotions on the platform. 

In some videos, even FDA registered products would resort to fake and misleading promotions such as using videos of doctors supposedly “promoting” food supplements and other drugs. Some of the victim doctors are the popular ones on TikTok such as Dr. Willie Ong and Dr. Alvin Francisco.

Doctors have tried to correct the disinformation by denying any connections with such products, but these denials backfired as the clips were instead used by unscrupulous sellers to promote products by manipulating these videos. For example, several videos have used Dr. Alvin Francisco’s name and image to promote a collagen gummies supplement purported to aid in weight loss, skin whitening, and the treatment of various ailments. Francisco has debunked his connection with this product along with other fake promotions in a YouTube video. 

Dr. Willie Ong has repeatedly assured the public that the only product that he and his wife are promoting is a milk drink for seniors. But the videos in which they expose and refute these fraudulent advertisements, along with their other content where they react to viral medical-related clips online, have been repurposed by sellers in similar videos on both Facebook and TikTok to amplify their product promotion instead of taking them down.

DOH’s Domingo said Filipinos are prone to such clickbaits largely because of how media has shaped the way people view doctors and health professionals, and this has been exploited by TikTok users to deceive others. Scammers take advantage of the doctors’ public image in white coats by using the same image online.

“Our way of communicating with patients, minsan ginagamit ‘yun ng mga influencers who are not really physicians or healthcare workers, and that’s where I say it’s becoming manipulative. Just because they see someone in a white coat, they would immediately assume that it’s a doctor,” Domingo said. 

Domingo added that specific products or substances are meant for “particular uses and must not be directly used for other purposes” if they don’t abide by safety standards. He said that “Google search” is not tantamount to scientific research and not everything we see online is comparable to consultations given by professional doctors. 

He clarified, however, that not all homemade treatments are unsafe. “Some homemade remedies are actually safe and are scientifically proven like Lagundi as treatment for coughing. But one of the biggest mistakes among our citizens is when they are bombarded with statements like a supplement claiming that it can cure cancer, they tend to forget and abandon proven and already established scientific treatments for cancer.”

He noted that due to the side effects of some medical procedures like chemotherapy, people opt for those alternative treatments even if they’re not backed by science or professional advice. This pushes them to abandon their maintenance medicines because they prefer those they see online. Domingo reminded people to “not let go of scientifically proven treatments which the doctors are prescribing and are asking you to do, because those are studied.”

Where’s regulation?

Republic Act No. 9711, also identified as the “Food and Drug Administration Act of 2009,” explicitly forbids the manufacture, importation, exportation, sale, offering for sale, distribution, transfer, non-consumer use, promotion, advertising, or sponsorship of health products, including medical devices and supplies, without appropriate authorization.

Some accounts have gone to the extent of manipulating the FDA-issued “Certificate of Registration” and attaching it to their products. One user changed the name of a surgical product stated in a registration certificate to the name of a beauty cream.

What are regulatory bodies doing about this? 

The FDA said in a statement that it currently “does not have specific policies addressing cases of social media accounts selling unregistered and unverified health products” since online selling platforms are not within their jurisdiction but of other agencies, such as the Department of Trade and Industry (DTI).

As e-commerce boomed during the pandemic, the DTI in 2022 issued an administrative order specifying, under Section 5.5, that “online business shall not compromise product, health, and food safety, not offer products which have been recalled, banned or prohibited.”

The DOH has been employing what they call “pharmacovigilance,” where they monitor drugs in the market, including those sold in online shops, for possible side effects, and to prevent risks and other problems when it comes to medications and misuse.

The department explained that some products, particularly the unregistered ones, are less likely to be reported if they don’t cause any side effects among those who are using it. This is why they are encouraging people who have experienced possible side effects of taking counterfeit products and other supplements to report these to the agency.

On average, the DOH receives three to four reports every week. These reports are handled with the help of the FDA, the National Bureau of Investigation, and the cybercrime division of the Philippine National Police. Customers are also encouraged to report any suspicious products being sold online by sending a formal complaint to DTI Fair-Trade Enforcement Bureau at fteb@dti.gov.ph.

The FDA has also warned online businesses that selling unregistered and unverified products online “can lead to misinformation, disintegrate trust in regulated healthcare systems, delay proper treatment, and potentially worsen public health outcomes by promoting ineffective or harmful remedies.”

The agency said the proliferation of online products can “create disparities in access to safe and effective healthcare, as those with the means to seek out regulated products may fare better than those who rely on unregulated options.”

The FDA is also currently drafting guidelines concerning the proliferation of unregistered products on social media which is set to be completed by the middle of 2025. Meantime, the FDA said the public can verify the legitimacy of health products through its verification portal at https://verification.fda.gov.ph.

With its evolving algorithm and poor regulation, TikTok has indeed become a breeding ground for harmful content. While the platform entertains, it can also endanger.  

“Social media influence has the power to shape the health-seeking behavior of the population, and we must use that power responsibly,” said Domingo.

While social media has mobilized people “towards the right health-seeking behavior,” Domingo noted, “if we prioritize sales, clout, and the fame that comes with the number of likes and follows, without checking what we’re saying – or, worse, knowing that it’s wrong but we still do it anyway – then we might actually be killing people.” – Rappler.com

Jerry Yubal Jr. is a campus journalist from the Visayas State University (VSU) in Baybay City Main Campus. The executive editor of Amaranth, he is also an Aries Rufo Journalism fellow of Rappler for 2023-2024.