By Manoshij Banerjee, independent consultant on digital culture and workplace, and Mohammed Shahid Abdulla, Faculty member, IIM Kozhikode
When the US Food and Drug Administration required Merck to add warnings about suicidal thoughts to Finasteride’s packaging in 2022, it marked the latest chapter in a decades-long saga surrounding the male pattern baldness drug. Yet the real story wasn’t unfolding in regulatory offices or medical journals—it was playing out across Reddit forums, YouTube testimonials, and X (formerly Twitter) threads, where users were building their own parallel universe of risk assessment, completely divorced from official guidance.
This disconnect reveals something profound about how we make decisions about our bodies in the digital age. Lifestyle pharmaceuticals—drugs designed to enhance non-essential aspects of human life such as appearance, mood, or performance – have become a $150 billion global market. Scholars however note that there’s considerable disagreement over this definition, particularly for conditions that blur the line between medical necessity and social desirability. Even so, they’ve become cultural flashpoints where technology, behavior, and governance collide in ways that challenge our traditional understanding of pharmaceutical regulation.
The echo chamber economy
Social media hasn’t just changed how we communicate about drugs; it’s fundamentally restructured how we form beliefs about them. The algorithmic architecture of platforms like Reddit and YouTube doesn’t simply connect people with similar interests—it actively amplifies and reinforces existing viewpoints through “availability cascades” (i.e., a curated rabbit hole of information). When someone searches for information about weight-loss medications or hair-growth treatments, they’re not encountering a balanced marketplace of ideas. They’re entering carefully curated echo chambers that shape perception through selective exposure, even if unwittingly.
Consider the trajectory of GLP-1 receptor agonists like Ozempic and Wegovy. These drugs were originally approved for treating type 2 diabetes, but physicians began prescribing them “off-label”—meaning for a purpose not explicitly approved by regulators—for weight loss after patients reported significant weight reduction as a side effect. Social media accelerated this trend dramatically, with TikTok influencers and Instagram users sharing their weight-loss experiences and creating a groundswell of demand that pharmaceutical marketing teams couldn’t have manufactured on their own.
The FDA’s 2025 decision to reclassify obesity from “a chronic health risk” to “a chronic disease”—a move critics say favors pharmaceutical companies by enabling insurance coverage for weight-loss drugs and expanding the eligible patient population—came after social media had reinforced the medicalization of weight management.
This isn’t accidental. The business model of social media platforms depends on engagement, and few topics drive engagement like body image, appearance anxiety, and the promise of transformation. Algorithms learn to serve us content that keeps us scrolling, often heightening our insecurities while simultaneously offering high-margin pharmaceutical solutions, which are in turn linked to high-priced ads and thereby higher revenue for the influencer whose content we’re watching or reading.
When consumers become their own regulators
What also emerges from this dynamic is a peculiar form of distributed governance for pharma companies. Traditional pharmaceutical regulation assumes a relatively passive public that receives expert guidance from doctors and regulatory authorities. But social media has created what some may call “epistemic insurgency”—communities that actively distrust official sources and construct their own frameworks for evaluating drug safety and efficacy.
Visit any major forum dedicated to finasteride or minoxidil, and you’ll find elaborate spreadsheets tracking side effects, crowd-sourced protocols for usage, and heated debates about study methodology. These aren’t simply support groups; they’re alternative regulatory bodies operating in parallel to—and often in opposition to—official institutions. When the FDA issues warnings, forum users don’t automatically defer to expertise. They interrogate the evidence, share anecdotal counter-narratives, and collectively decide whether to accept or reject regulatory guidance. In the US, an existing anti-regulatory climate aid such a posture.
This represents a fundamental shift in how authority operates in pharmaceutical governance. The signature of power, as scholars have argued, lies not just in the capacity to regulate but in the ability to shape the terms of debate itself. Social media has fragmented this power, creating multiple competing authorities—each with its own epistemology (its own theory of what counts as valid knowledge), its own standards of evidence, and its own conception of acceptable risk.
The corporate advantage
Pharmaceutical companies haven’t been passive observers of these dynamics; they’ve become sophisticated players in the echo chamber economy. While traditional direct-to-consumer advertising remains heavily regulated, social media offers companies plausible deniability. They don’t need to make claims themselves when influencers, patient advocates, and wellness gurus will do it for them.
It is called strategic ignorance—the deliberate cultivation of ambiguity that allows corporations to benefit from favorable narratives while maintaining distance from problematic ones. They can benefit from organic user-generated content and influencer partnerships that operate in regulatory gray zones. When side effects emerge or safety concerns arise, companies can point to regulatory compliance and scientific studies. But when demand needs to be generated or criticism deflected, the distributed nature of social media communication provides cover.
The result is an asymmetric information environment. Companies can monitor sentiment, identify influential voices, and strategically engage with communities—all while consumers struggle to distinguish between authentic peer experiences, influencer marketing, and corporate messaging. The line between patient advocacy and pharmaceutical promotion has become so blurred as to be nearly invisible. This could repeat among pockets of developing country markets, where social media trends could even be shaped differently from the prevailing narrative in a given drug’s top market.
The trap of recursive validation
Perhaps most concerning is how these dynamics feed back into each other. Consumer discourse on social media influences corporate strategy, which in turn shapes regulatory priorities, which affects public perception, which drives more social media conversation. Each domain reinforces the others in what we might call recursive validation—a self-perpetuating cycle where initial biases become entrenched through repeated confirmation.
This matters because lifestyle drugs occupy an inherently ambiguous space. Unlike medications for clear pathologies, lifestyle drugs treat conditions that are simultaneously medical and social. Hair loss, obesity and certain mental health conditions are medical phenomena, of course, but they’re also deeply shaped by cultural norms of activity, attractiveness and worth – some of these conditions may even be the target of companies’ ‘health’ drives for employees, or the sheer economic pull of appearance in a sales job. Social media amplifies this ambiguity by providing endless opportunities for comparison and competition, while also offering pharmaceutical solutions to the anxieties it creates.
Toward digital health literacy
Breaking out of these feedback loops requires more than traditional health literacy campaigns. We need digital health literacy i.e. the capacity to navigate algorithmic curation, recognize echo chambers, and critically evaluate the distributed authority structures that shape pharmaceutical discourse online.
To begin with, this means to understand that the first page of search results about a drug isn’t necessarily the most reliable information—it’s just the most engagement-optimizing information. It means recognizing that compelling personal testimonials, while genuine, may not be representative. And it means appreciating that pharmaceutical decisions made in the echo chamber of like-minded peers may not adequately account for risk.
Regulators, too, must evolve. The FDA’s traditional model of episodic interventions—a warning label here, a guidance document there—struggles to keep pace with the velocity and virality of social media discourse. Effective governance in the digital age requires continuous engagement, not periodic pronouncements. This might not be easy to come by as the funding axe falls on FDA-like agencies, perceived as overly careful and operating on ‘woke’ science.
The $150 billion lifestyle drug market isn’t going away. But as these medications become increasingly entangled with social media dynamics, we need to think more carefully about how technology shapes our relationship with pharmaceutical enhancement. The algorithm may not be qualified to see you now—but it’s already shaping what you see, what you want, and what risks you’re willing to accept in pursuit of transformation.