Kim Kardashian's FDA run-in shows the challenge of policing drug ads in the Instagram age

Reality TV star Kim Kardashian just offered an unlikely lesson about the challenges of medical regulation in the social media era.

It was easy to police misleading pharmaceutical ads on TV or in newspapers — relative to the billions of self-made, ever-changing pages of Twitter, Instagram, and Facebook.

Kardashian caught the eye of federal regulators in July, when she posted this picture on Instagram for her 45 million followers (along with a tweet for her Twitter fans) touting the controversial morning sickness drug Diclegis:

Kardashian had suffered from morning sickness during her pregnancies and claimed that the drug helped her. But her post, unsurprisingly, was not exactly the gold standard for drug advertising.

She failed to mention any of the drug's side effects or contraindications — for example, that the drug has never been studied in women who suffer from a pregnancy complication called hyperemesis gravidarum, and that some women should not take Diclegis because of allergies to certain ingredients or dangerous interactions with other drugs.

About a week later, the Food and Drug Administration sent a warning letter to the drug company, demanding that the post be taken down. "The social media post is false or misleading in that it presents efficacy claims for Diclegis," the letter reads, "but fails to communicate any risk information associated with its use and it omits material facts."

Kardashian complied. The original post was deleted, and this new Instagram post appeared on Monday:

The corrective is a lot more nuanced than the original, with warnings about hyperemesis gravidarum, as well as new side effect and safety information. Hopefully, Kardashian learned the lesson that peddling a drug on social media isn't like talking up the best lip gloss. The stakes are life and death.

But other similarly misleading claims on social media may go unnoticed or untouched. This is not only because the FDA is overwhelmed with the volume of health claims on the internet, as Thomas Abrams, the FDA's director of the Office of Prescription Drug Promotion, explained in a Q&A, but also because the agency only has authority to respond to claims that are made by companies or people who are acting on behalf of a company.

In this case, Kardashian had become a paid spokesperson for the drug's maker, Duchesnay, which is the only reason the FDA could go after her — another way not everyone is a Kardashian.

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