On television and radio, the ads are fairly innocuous: “Hey guy,” a female narrator says playfully in one TV spot for Hims, a men’s wellness brand that sells prescription drugs to treat erectile dysfunction, oral herpes, social anxiety, hair loss, and other conditions. “Hi there. Welcome to Hims.”
The ad invites viewers to “get ED treatment started for only $5,” next to a close-up of a young man pressing a white pill seductively to his lips. What appear to be customer reviews are superimposed over the image: “Should have done it years ago and I feel like the young stud that I always imagined I was," says one. "Outstanding product, works above and beyond our expectations," reads another.
Much like other ads for Hims—and its sister brand, Hers, which sells prescription drugs and wellness products for women—that are broadcast on television, radio, podcasts, or appear in print or on billboards, this ad is rather generic. It describes a medical problem, alludes to the company’s business model—which skips a trip to the doctor in favor of an “online visit” with a physician—and invites the viewer to check out its website for more details.
Online, however, the brands take a different tack. Hims and Hers ads on Facebook and Instagram are more specific, offering a quick and easy way for users to buy prescription medications directly. “men [sic] can get Sildenafil (active ingredient in Viagra) delivered directly to the door,” reads one active Facebook ad by Hims. “try it out today for only $5. free shipping!”
Such ads violate Facebook policies that prohibit promoting the sale or use of prescription drugs or suggesting that users have a specific condition. Earlier this month, Facebook removed three Hims ads for sildenafil that had been flagged by WIRED; a Facebook spokesperson said the ads violated Facebook policies. But hundreds of other ads from Hims and Hers touting specific prescription drugs were active on Facebook as of Friday.
Many online ads from Hims and Hers also may run afoul of US Food and Drug Administration guidelines that require marketers to disclose the side effects associated with a drug. A Hers ad for prescription anti-acne medication tretinoin, for example, calls the drug "your skin's BFF” and offers "Serious results without the hassle." The ad suggests, “Skip the drive over to the doctor's office and start today for just $5."
The ad does not mention any of the side effects required by the FDA, which in tretinoin’s case can include burning, itching, stinging, scaling, peeling, or redness of the skin, or sensitivity to sunlight, soaps, cosmetics, and other skincare products. Nor does the Hims ad for sildenafil mention side effects including low blood pressure, loss of vision or hearing, headaches, or insomnia. TV ads from Hims and Hers don’t carry these disclosures because they don’t mention specific drugs, referring instead to “treatment.
The FDA disclosure requirements apply to online, as well as traditional, media, says Hyosun Kim, a professor at the University of Wisconsin Stevens Point whose research focuses on online direct-to-consumer advertising of prescription drugs. “The FDA has these guidelines to protect consumers from misleading information, because [when it comes to] prescription drugs, it's really important for the patient to understand the risk factors and any other [interactions the drug might have],” she says. Kim says that, in her opinion, ads like those run by Hims and Hers—which do not include any risk information and in some cases claim to provide “serious results without the hassle”—violate FDA guidelines.
The FDA declined to comment on Hims and Hers ads specifically, citing department policy. However, an agency spokesperson emphasized that its prescription drug advertising guidelines generally apply to social media, and sent WIRED examples of recent actions taken against companies that had run Facebook ads for prescription drugswithout properly disclosing the risks.
“Regardless of the platform, the FDA’s requirements should be applied to ensure any manufacturer or distributor communication about a prescription drug is truthful, balanced and non-misleading, and ensures there is appropriate risk information,” said Nathan Arnold, an agency spokesperson. “In general, if promotion of an approved product results in violation of FDA statute or regulations, the FDA may take a compliance action, such as sending a warning letter to the company or imposing an injunction.”
Asked about the FDA requirements and the ads’ silence on side effects, a spokesperson for Hims and Hers said the company’s mission is to “empower all people with important information and options for their health and happiness and our advertising is intended to begin that conversation with the hundreds of thousands of men and women who have faced barriers to care or treatment options …”
“This is why we make sure that no matter what advertising a customer may see or engage with,” the spokesperson continued, “anyone who seeks treatment through the Hims & Hers platform is presented with information about potential risks at multiple points during this process and are only prescribed a medication if an independent, licensed physician determines it is the best treatment option for that individual.”
Hims and Hers offer a range of drugs, from erectile dysfunction and acne meds, to oral herpes drug valacyclovir and low libido medication addyi. In some cases, the brands promote drugs to treat conditions other than those a drug was approved to treat, a practice known as off-label use. For example, Hims and Hers market the blood-pressure drug propranolol as a treatment for anxiety.
According to the FDA, “The law does not allow drug companies to advertise benefits unless they are related to the FDA-approved use.”
Asked about the propranolol ads, the spokesperson from Hims and Hers said “the product page for Propranolol (through which a customer must proceed in order to purchase) specifically states that Propranolol is not FDA approved for the treatment of performance or other anxiety. Customers are again advised of this and required to specifically acknowledge their understanding during the consultation process.”
Beyond the FDA, many Hims and Hers ads appear to violate Facebook’s drug-advertising policies. A Facebook spokesperson said that three Hims ads identified by WIRED violated Facebook’s policies by specifically referencing prescription drugs. The spokesperson noted that other Hims ads violated a different Facebook policy, which prohibits ads that presume to know personal details about the viewer, or imply that the viewer has a particular attribute. The Facebook spokesperson said that the ad shown below implied that the viewer may be experiencing erectile dysfunction because of the words, “ED? yeah [sic], it’s normal.”
On June 12, Facebook told WIRED that the three offending ads had been removed. But a review of Facebook’s Ad Library on Friday found more than 600 Hims and Hers ads, most of which specifically promote the sale or use of prescription medication without disclosing the risks of such drugs. In fact, around the time Facebook told WIRED it removed the offending ads, Facebook approved dozens of ads by Hims and Hers that promoted the sale and use of the same prescription drugs. The Facebook spokesperson did not respond to five requests for comment about why the other ads remain active and how Facebook enforces its policies. After publication, the spokesperson said Facebook is “looking into these and looking to clarify our policies with advertisers where necessary.”
With respect to Facebook, the Hims and Hers spokesperson said, “their policies are updated on a frequent and ongoing basis and we work extremely closely with their advertising team to ensure all of our ads are in compliance with their requirements.”
Some experts say these online ads could endanger patients. “It's dangerous [and] irresponsible,” says Arthur Caplan, director of NYU Langone Medical Center’s Division of Medical Ethics. “A lot of people are looking for a quick fix [when it comes to their health]. These [online] direct-to-consumer ads are undercutting the idea that you should be seeing a doctor—which is the wrong attitude.” Caplan says “popping pills to solve your medical symptoms is not good medicine. You want to figure out what is the underlying disease. It's putting you at risk if you don't get that paid attention to.”
This article first appeared on wired.com.
