Observations Medicine and the Media

Miracle pills and fireproof trainers: user endorsement in social media

BMJ 2012; 345 doi: http://dx.doi.org/10.1136/bmj.e4682 (Published 18 July 2012) Cite this as: BMJ 2012;345:e4682
  1. Adam Smith, freelance journalist, London,
  2. Greg Jones, freelance journalist, London
  1. Correspondence to: A Smith adam{at}adamesmith.co.uk

Adam Smith and Greg Jones investigate the marketing of sports products in social media in the UK and the US

“Boosted metabolism” and “increased stamina” are but two of the many benefits promised to wearers of ion emitting wristbands. These claims were made on Facebook by the wristband manufacturer Ionic Balance—until the UK Advertising Standards Authority (ASA) took a look. In October 2011 the authority ruled that the evidence provided by Ionic Balance was “not sufficiently robust to substantiate the claims.”1

Ordered to stop making claims of effectiveness unless they could be supported by science, Ionic Balance removed an entire list of assertions from its Facebook page. But the company continued to allow consumers to post their own messages about wristbands, ions, and health.

In fact, Ionic Balance relies on consumer conversation as part of its marketing. “Beware of companies with no online reviews,” the company states on its website.2 “Do they have a Facebook page for user feedback? Are any of the reviews praising customer service as well as product performance? Are the reviews recent? Do the reviews even have a date on them?!”

Although Ionic Balance may appear to be concerned about the information that consumers receive, the company’s behaviour remains a cause for concern at the ASA. The regulator told us: “Ionic Balance is currently on our list of non-compliant advertisers3 for continuing to feature problematic claims on its website and Facebook page, in contravention of the ASA ruling.”

One of the key problems faced by regulators used to adjudicating in traditional, not social, media is “user generated content” (UGC), such as that left by Ionic Balance’s customers. The ASA says that it does not adjudicate on private individuals’ opinions. However, a company that removes negative feedback from its social media presence could be seen as manipulating user generated content for marketing purposes. We left a comment on Ionic Balance’s Facebook page, highlighting the ASA’s decision regarding the veracity of the company’s claims. Within 24 hours the comment had been deleted. We asked the chief executive of Ionic Balance to explain the rationale for this, but he said he was unavailable.

This is only a single example, but if any company were to manipulate its UGC in this way, would the ASA step in? A spokesperson said, “The ASA has never dealt with a case where the manipulation of UGC in the way you describe has been judged to be a breach, or not, of the advertising codes.4 Without any precedent to use, and considering that social media are a new and evolving arena, we can’t really indicate one way or another whether or not those types of manipulation would be problematic. However, it would only take one complaint about an action such as that for us to assess and form an opinion of the complaint.”

Given that regulators have no precedents on which to rely when monitoring health claims made in social media environments, are online platforms becoming the international waters of the web, where jurisdictional boundaries are confused and lawlessness prevails? And are regulators partly to blame for this problematic situation? Even the ASA is not yet clear about how companies should behave. It requires every advertisement to abide by the advertising codes in whatever form it takes, but it has also said, “We’re continuing to investigate precedent setting cases which mark out the rules and boundaries for the ad industry.”

Ionic Balance is but one company still testing these waters. Facebook and Twitter are certainly facilitating dialogue between companies and their customers, some of which is marketing and some not. Our analysis shows that the line between conversation, advertising, and health claims is being blurred.

As social media expand, regulators in the UK and the United States are still catching up. It was only in March last year that the ASA extended its remit to regulate advertisements on company websites and other sites over which they have control, including Facebook and Twitter.

Regulators in the US are just as stretched. “There’s been an explosion with regard to claims,” said Mary Engle, director of the advertising practices division at the Federal Trade Commission. The advent of social media, she added, has meant that “there’s a lot to keep track of.” This is especially the case in the sports and health product industry, which includes not just wristbands but also compression socks, hydration drinks, fitness trainers, and dietary supplements, such as PacificHealth Laboratories’ Endurox Excel training pills.

In the US dietary supplements are regulated by the Food and Drug Administration (FDA) as “food” and as such do not require preapproval from the FDA for safety or efficacy as pharmaceutical products do. “With respect to dietary supplements, anything can go on the market,” said Engle, whose team enforces the statutes that require advertising claims to be truthful, substantiated, and not misleading.

On Facebook PacificHealth posted this message about Endurox Excel: “No substitute for hard work, but if there was a ‘miracle pill,’ this is it.”5 The post linked to the company’s web page for the product, claiming that the pill “contains the remarkable ‘adaptogenic herb’ ciwujia proven to improve your immune system, increase your fat metabolism by 24% and boost your endurance by 23%.”6

As in the UK, regulations in the US require such claims to be substantiated. (PacificHealth’s page cites three studies on ciwujia, also known as Siberian ginseng, but no studies on Endurox Excel itself.) But customers remain free, of course, to say anything: one apparent Endurox Excel user claims on the product page, “It really does work!”6

User generated content extends beyond words and into images too. Our trawl of social media also turned up the page of a runner with a photograph of himself jumping over fire in his Merrell Barefoot trainers. He posted the image on Merrell’s Facebook page.7

Although the runner made no specific product claims, US regulators told us that there could at least be a health and safety issue. For example, other customers could harm themselves performing the same stunt after seeing the photo on the official Merrell Facebook page. “The company has the ability to take down what’s posted on their page,” Engle noted.

User generated content like this is not regulated unless a company incorporates it into its marketing claims. But there seems to be uncertainty as to whether a user’s claim made on the company’s page becomes a part of the company’s marketing. And the lack of clarity means that some companies push the envelope, especially in the new world of social media. “Plenty of companies adopt a policy that they’ll be very aggressive until the regulator dials it back,” noted Brian Waldman, an attorney who co-manages the regulatory department at Arent Fox, a law firm in Washington, DC. “That’s a business model for some companies.”

But the limited resources of the regulators, combined with the explosion of social media, means that regulators focus on big offenders, such as Skechers, recently fined $40m (£26m; €33m) for unfounded claims that its Shape-ups trainers could help wearers lose weight.8

Waldman said that regulators are more inclined to pursue a small number of high value cases to set an example. With regard to the Skechers case, which focused on ads in traditional media, he said, “The general view of the legislators is that this is enough of a shot across the bow.” But the obvious question then is whether smaller companies such as Ionic Balance, especially those that focus their marketing in low cost social media, are more likely to get away with bogus claims.

Even if that were the case, the proliferation of online information is often seen as enabling consumers to make more informed choices and scrutinise marketing claims. But when it comes to the sports products we looked at in this research, this does not seem to be happening. We searched through thousands of tweets and Facebook postings and found barely a handful of instances in which customers asked for the science to back up claims about sports products.

On the Facebook page for the Maxitone weight loss product, one customer asked whether she could take fluoxetine at the same time as its product. The company replied that while “there are no expected side effects,” the customer might want to consult a doctor.9 There was no link to the studies conducted on Maxitone.

Our observation that little science is being discussed by customers is backed up by Scott Baptie, who receives free Maximuscle supplements in exchange for providing advice about the product on Facebook. “I’ve never seen anybody ask about the science behind Maximuscle on the Facebook page,” he said.

But science is important to consumers, apparently. “Some people will just want to look at the lay science; others will want to drill down into the studies,” said Baptie. “A lot of people will base their decisions on what influential people and companies say. They’re almost placing trust in companies that they will be telling the truth.”

Of course, Baptie is one individual in whom consumers place their trust. With a big online following, Baptie knows that his reputation is crucial. “Any time I give any advice I’ll always try and get the research behind it,” he said. “I’ll go to PubMed and look at the studies. If you promote a product that has no scientific research, you lose your credibility.”

While Baptie is open about his arrangement with a company, others are not. Indeed, one of the insidious aspects of social media marketing is the way some people are paid by brands to act as stealthy advocates without disclosing their affiliations. This is “a big issue,” said Engle. She explained: “Companies have hired people to write glowing reviews of their product and haven’t identified that these were made up or being paid by the company.”

Engle admitted to not having any empirical evidence on the extent of the problem. “We have just more anecdotal [evidence] or just even some news reports. It seems to be somewhat widespread,” she said.

But Engle and her colleagues at the Federal Trade Commission had an idea to combat the problem as far as Twitter was concerned. They recommended that customer advocates use the hashtag #ad when promoting a product for some form of payment. The ASA also backs the use of a hashtag to label endorsements. In June the watchdog banned a Nike campaign for using the Twitter accounts of Wayne Rooney and Jack Wilshere without disclosing that it sponsors the footballers.10

But our research indicates that very few tweets about sports products carry a disclosure tag. Baptie, who has tweeted about Maximuscle products, thinks that the limitations of Twitter mean that disclosure in a tweet would be cumbersome. “You have 140 characters, and you have to get across the clearest message possible.” In any case, he explained, endorsements are commonplace in the fitness world. Consumers expect to see them from the people they trust to provide recommendations.

In social media, then, personal brand is just as powerful as corporate brand. The rugby union player Andy Saull is another tweeter who does not use #ad but tweets endorsements all the same.11

The league Saull plays in is sponsored by the “hydration partner” Gatorade, the brand associated with the popular Twitter meme the #watersucks hashtag. The hashtag arises from Gatorade’s product placement in the 1998 film The Waterboy (“Water sucks; Gatorade is better”).12 But the hashtag is now owned by any Twitter user who cares to tweet it—a bonus for Gatorade but a threat too, as the tag could be hijacked by unhappy consumers.

User generated content is part of a widening ecosystem of content that includes obvious advertisements and opaque, paid-for endorsements. While the regulatory divisions between these types of message remain unclear, social media continue to grow and to provide new opportunities. An enterprising brand could even conduct huge scientific product tests by engaging consumers (“test subjects”) through the likes of Twitter and Facebook.

With more than 10 million Twitter users in the UK alone, and the total number of people on Facebook set to hit a billion this year, power is shifting to the consumers, but they remain as vulnerable to manipulation as ever.


Cite this as: BMJ 2012;345:e4682