It's been years since a pharmaceutical drug caught the attention of the public like semaglutide. It's the active ingredient in the diabetes injectable drug Ozempic, the pill-based diabetes treatment Rybelsus, and the weight loss injectable Wegovy — all touted as next-gen weight loss solutions, though only the last one is technically supposed to be prescribed for weight management.
In an ideal world, the decision to start taking a semaglutide-based medication would be an informed medical consultation between patients and their doctors. That way, anyone prescribed Wegovy, which was only approved for weight management in 2021, would understand the potential risks as well as potential benefits.
But in the flawed reality of the American medical system, those important conversations are often mediated — or even subverted — by a range of other players, ranging from hype-fueled media actors and the politics of health insurance coverage to the pressures of body shaming and the multi-billion dollar pharmaceutical advertising business.
Let's zoom in for a moment on those ads, which are seen everywhere from Instagram and Facebook to subway posters in New York City. In theory, they're supposed to be tightly regulated, leading to the sometimes comically lengthy enumerations of possible side effects they often cram in. Take this TV spot for Wegovy, which warns of the risk of everything from suicidal thoughts and depression to "severe stomach pain, itching, rash, trouble breathing, or swelling in your face or throat," nevermind pancreatitis and gallbladder problems.
That's good. People considering a drug should be aware of the risks. But online, pharma ads remain surprisingly laissez-faire, and that's on full display with semaglutide. As others have reported, Instagram and Facebook have been overrun with ads for the stuff, and as people look for cheaper versions of prescriptions that costs upwards of $1,650 per month — and that insurers are often refusing to pay for — they often find themselves on some very unsavory websites selling bottom-shelf vials of what purports to be semaglutide.
Now we can add the search giant Google to the list of tech companies cashing in on the phenomenon. Perusing search queries for "buy semaglutide online" and "semaglutide without prescription," we found a striking number of sponsored ads in which dodgy online pharmacies offer to sell semaglutide without the oversight of a doctor. Some are so low rent that they request that buyers send money via PayPal; needless to say, buyers are taking these black market sellers at their word that the drug will arrive at all, will actually be what it claims, and that it'll be the proper strength and purity.
Take one offending website, which sells the drug in powder form, requiring users to mix it up themselves as if they were shooting up heroin.
"THIS ITEM DOES NOT COME PRE-MIXED," the seller warns in all capital letters. "WE DO NOT SUPPLY BACTERIOSTATIC WATER OR SYRINGES IN ANY ORDER! THERE ARE NO REFUNDS ON THIS ITEM."
Results, as you would imagine, may vary.
"There was nothing in the bottle I ordered or any instructions," wrote one peeved user in the site's reviews section.
"The real deal," a more satisfied customer wrote, adding that they "felt effects after the second dose."
Some of the sites we reviewed did offer seemingly telehealth services with doctors who can, these sites promise, prescribe seemingly generic semaglutide — itself an issue, given that there is currently no FDA-approved generic of Wegovy, Ozempic, Rybelsus, or Mounjaro (which is similar but contains the active ingredient tirzepatide rather than semaglutide.)
While the sale of compounded semaglutide — that is, semaglutide mixed with another chemical, usually a B vitamin — is legal, the FDA has issued warnings about these injectable drugs after receiving reports of adverse effects, though the agency did not specify what those effects were or what about the compounded semaglutide might have caused them.
Additionally, the agency said in its press release about the warning earlier this year that some companies were selling semaglutide sodium and semaglutide acetate, which are not, the FDA said, a component of any known medication.
Other sponsored ads we reviewed claim the drugs are sold for "research use" only and are not for human consumption — wink-wink — while others don't offer any disclaimers.
After we reached out to Google, the company said that some of the ads we found had been removed because they violated the search engine's healthcare and medicines policy, though they declined to specify which exact portions were in violation because "bad actors will often utilize this information to undermine our efforts and evade enforcement."
The Google representative said that it only allows ads that have been certified by the National Association of Boards of Pharmacy (NABP) or the compliance company LegitScript. Though it appears to have removed the ads for sites that didn't require a prescription, ads that do require a prescription remain.
"Our certification partners perform ongoing monitoring throughout the certification to ensure compliance," a Google spokesperson added. "Advertisers who have not completed our certification program are not allowed to promote the sale of prescription drugs. This includes medications such as Ozempic, Wegovy, or Semaglutide."
We also reached out to Novo Nordisk, the maker of Ozempic, about the dodgy sellers. The pharma company has also begun taking legal action against the "unlawful marketing and sales of non-FDA approved counterfeit and compounded semaglutide products," but didn't respond to our request for comment.
Some will make the argument that patients should be able to choose to put anything they want in their bodies without the meddling of medical professionals. After all, cracking down on the sale and prescribing of any drug, be it opiates or amphetamines, often restricts supply and repels more scrupulous dealers, perversely making things more dangerous for people who do choose to use.
But in the real world, prescriptions exist for a reason. It's difficult to make sound health decisions without the input of an objective outside expert; most states even prohibit physicians from prescribing drugs for themselves. And even if you think sellers and buyers of black market drugs shouldn't be targeted by law enforcement, it's not clear why major tech companies like Meta and Google's parent company Alphabet should be making money by enabling such sales.
Searching for online semaglutide now, Google users will find sponsored ads for sites that offer telehealth services to prescribe the drug. While that's better than the ads Google removed that weren't even offering that level of scrutiny, the sites are still ultimately selling seemingly off-brand semaglutide in spite of there being no FDA-approved generic, and without an in-person consultation.
While there's no doubt that the enforcement of these kinds of black or grey-market weight loss drugs is difficult given the gold rush around them, the question remains: why is big tech profiting off those sales?
More on semaglutide: Sites Spring Up to Sell Semaglutide for Cheap With No Prescription
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