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The digital town square is no longer a level playing field.
As social media platforms grapple with a deluge of misinformation, their automated content moderation systems are inadvertently silencing legitimate scientific discourse and creating a high-stakes game of cat and mouse for pharmaceutical companies.
But here's what most people don't realize...
There is a complex interplay between social media censorship, the rise of "algospeak" for illicit compounds, and there is a strategic imperative for the pharmaceutical industry to navigate this new, unforgiving landscape.
The promise of a global, interconnected community has been a cornerstone of the social media revolution.
However, this utopian vision has been increasingly challenged by the proliferation of harmful content, forcing platforms to implement ever-more-sophisticated content moderation systems.
And that's where things get interesting...
While well-intentioned, these algorithmic gatekeepers have created a new set of challenges, particularly for the pharmaceutical industry.
The very mechanisms designed to protect users from misinformation are now being exploited by those promoting illicit compounds and peptides, while simultaneously penalizing legitimate scientific communication.
This has given rise to a phenomenon known as "algospeak" – the use of code words and euphemisms to bypass automated content filters.
But this isn't just clever wordplay...
This linguistic arms race represents a fundamental shift in how information, both legitimate and illicit, is disseminated and consumed online.
The consequences for public health, pharmaceutical marketing, and the integrity of online discourse are profound.
Want to see how deep this rabbit hole goes?
One of the most striking examples of this trend is the case of retatrutide, an experimental weight-loss drug currently in late-stage clinical trials.
Despite not yet being approved for public use, a thriving black market for the compound has emerged on social media platforms like TikTok and Instagram.
Here's the kicker...
To circumvent content moderation flags associated with the drug's actual name, users have adopted the seemingly innocuous moniker "ratatouille" or "ratatouie."
A quick search for these terms reveals a flood of content, from before-and-after transformation videos to tutorials on how to mix and administer the compound.
However, we're increasingly seeing platforms remove search results completely. A search for Retatrutide on TikTok, in certain regions, results in zero returns and a note about community guidelines.
As one Instagram post brazenly declared, using a string of hashtags to maximize reach: "#Retatrutide #RatatouillePeptide #Tirzepatide #PeptideTherapy #GLP1 #GIP #Glucagon" [1].
But wait, it gets worse...
This is not an isolated incident. The use of algospeak is rampant across the digital landscape.
Anti-vaccine groups have rebranded themselves as "Dance Parties" or "Dinner Parties," with "getting vaccinated" becoming "dancing" or "drinking beer" [2].
The pharmaceutical companies Pfizer and Moderna have been given the code names "pizza" and "Moana" respectively [2].
This systematic evasion of content moderation not only allows for the proliferation of dangerous misinformation but also creates a significant challenge for legitimate pharmaceutical companies seeking to engage with patients and healthcare professionals online.
So why are these systems failing so spectacularly?
The problem lies in the very nature of automated content moderation.
These systems are designed to identify and flag specific keywords and phrases associated with harmful content.
However, they often lack the contextual understanding to differentiate between legitimate scientific discussion and illicit promotion.
As Casey Fiesler, a content creator and researcher, explains: "Content's getting flagged because they are someone from a marginalised group who is talking about their experiences with racism. Hate speech and talking about hate speech can look very similar to an algorithm" [2].
This same principle applies to pharmaceutical content.
Clinical terminology, discussions of side effects, and even educational materials about specific medical conditions can trigger automated content filters, leading to the suppression of valuable information.
And the numbers are staggering...
A February 2025 study revealed that 68% of plastic surgeons report being shadow-banned by Meta's platforms, with educational medical content routinely flagged for "nudity" while far more revealing influencer content sails through moderation unchallenged [3].
This creates a dangerous information vacuum, where sensationalism and misinformation can thrive while scientifically accurate content is systematically suppressed.
The unintended consequence of this algorithmic arms race is the widespread "shadow-banning" of legitimate pharmaceutical and healthcare content.
Shadow-banning, also known as stealth banning or ghost banning, is the practice of blocking or partially blocking a user or their content from an online community so that it will not be readily apparent to the user that they have been banned.
For pharmaceutical companies, this can have a devastating impact on their ability to reach patients, educate the public, and build trust.
But how devastating, exactly?
The data paints a stark picture of the challenges facing the pharmaceutical industry.
A global survey of 6,270 healthcare professionals (HCPs) found that social media scored a dismal 37 out of 100 in Customer Experience Quotient (CXQ) research – the worst of any measured activity [4].
The picture is even more bleak for patients, with a CXQ score of just 28 out of 100, perilously close to the lowest possible level of "poor" [4].
This poor performance is not due to a lack of effort.
In fact, many pharmaceutical companies were early adopters of social media, with Roche and Novartis joining Twitter before Coca-Cola and Pepsi [4].
So what's really going on here?
The problem lies in the algorithmic suppression of their content.
The same study that found widespread shadow-banning of plastic surgeons also revealed that 85% of surveyed surgeons noticed their professional pages systematically disappearing from followers' feeds [3].
This has a direct impact on the bottom line.
When a fake Eli Lilly account tweeted "insulin is free now," it caused a significant drop in the company's share price, as well as those of its competitors, Novo Nordisk and Sanofi [4].
The incident highlights the real-world consequences of the current social media landscape, where misinformation can spread like wildfire while legitimate voices are struggling to be heard.
To make matters worse, pharmaceutical companies are operating in a highly regulated environment.
The U.S. Food and Drug Administration (FDA) has issued specific guidance on the use of social media, covering everything from character space limitations to the correction of third-party misinformation [5].
This creates a compliance catch-22...
Companies are forced to choose between adhering to strict regulatory guidelines and tailoring their content for algorithmic approval.
As one BuzzRadar report notes: "Pharmaceutical communicators are increasingly forced to choose between adhering to pharmaceutical regulations (and triggering algorithmic penalties) or tailoring content for algorithmic approval (potentially risking regulatory compliance issues)" [3].
This creates an uneven playing field, where less regulated, less scientifically rigorous content can achieve viral distribution while carefully validated pharmaceutical messaging is systematically blocked or limited.
The result?
A dangerous information vacuum, where patients are more likely to encounter misinformation and illicit promotions than they are to find accurate, reliable information from trusted sources.
The challenges are significant, but they are not insurmountable.
By adopting a strategic, data-driven approach to social media, pharmaceutical companies can navigate the complexities of the current landscape and effectively engage with patients and healthcare professionals.
This requires a multi-pronged approach that encompasses content strategy, community management, and regulatory compliance.
But where do you start?
Given the volatility of individual platforms, a multi-platform strategy is essential.
Companies should not be overly reliant on any single platform and should be prepared to pivot their strategy as the landscape evolves.
This requires a deep understanding of the nuances of each platform and the development of platform-specific content that is tailored to the audience and the algorithmic environment.
Advanced social listening tools are critical for this.
These tools can help companies identify emerging trends, track competitor activity, and monitor for signs of shadow-banning.
By analyzing engagement patterns and sentiment data, companies can gain valuable insights into what is resonating with their audience and adjust their content strategy accordingly.
As the BuzzRadar report notes: "Modern analytics platforms can identify unnatural patterns and drops in engagement, helping communications teams spot silent suppression quickly and implement remediation strategies" [3].
In an environment rife with misinformation, building authentic community is more important than ever.
Pharmaceutical companies should focus on creating a space for open, honest dialogue, where patients can connect with each other and with trusted experts.
This requires a commitment to transparency and a willingness to engage in difficult conversations.
One of the most effective ways to counter misinformation is to proactively provide accurate, reliable information.
This can be done through a variety of channels, including educational blog posts, interactive webinars, and engaging social media content.
By becoming a trusted source of information, companies can build credibility and earn the trust of their audience.
Finally, the pharmaceutical industry has a critical role to play in advocating for a more transparent and equitable digital ecosystem.
This includes working with social media platforms to develop more nuanced and context-aware content moderation policies.
It also means collaborating with regulatory bodies like the FDA to ensure that the regulatory framework keeps pace with the ever-evolving digital landscape.
By working together, we can create a digital environment where accurate, reliable information can thrive, and where patients can make informed decisions about their health.
The stakes are too high to do otherwise.
The theoretical understanding of the challenges is only the first step.
Pharmaceutical companies need a practical, actionable framework to navigate the complex social media landscape effectively.
This framework must address the unique regulatory constraints of the industry while maximizing engagement and minimizing the risk of algorithmic suppression.
So what does this framework look like in practice?
The first line of defense against algorithmic suppression is early detection.
Companies must implement sophisticated monitoring systems that can identify unnatural drops in engagement, reach, and visibility.
These systems should track key performance indicators across multiple platforms simultaneously, looking for patterns that suggest content is being throttled or suppressed.
A comprehensive shadow-ban detection system should monitor several key metrics:
• Engagement rate per follower
• Reach percentage
• Hashtag performance
• Comment-to-view ratios
When these metrics deviate significantly from established baselines, it may indicate algorithmic suppression.
For instance, if a pharmaceutical company's educational content about diabetes management suddenly sees a 70% drop in reach without any corresponding change in content quality or posting frequency, this could signal shadow-banning.
The BuzzRadar study found that competitive visibility tracking is particularly revealing.
If competitor content consistently outperforms yours by significant margins – say, 300% higher engagement – the differential rarely stems from quality alone but is frequently indicative of algorithmic favoritism [3].
This type of analysis can help companies understand not just when they're being suppressed, but also identify which competitors may be benefiting from more favorable algorithmic treatment.
Each social media platform has its own algorithmic preferences, user demographics, and content formats.
A one-size-fits-all approach is not only ineffective but can actually trigger suppression mechanisms.
Pharmaceutical companies must develop nuanced, platform-specific strategies that account for these differences.
On LinkedIn, for example, professional medical content tends to perform better, making it an ideal platform for engaging with healthcare professionals.
The platform's algorithm favors longer-form content and professional discussions, making it suitable for detailed case studies, research findings, and industry insights.
However, even on LinkedIn, pharmaceutical companies must be careful about promotional content, as the platform has specific restrictions on pharmaceutical advertising.
Instagram and TikTok present different challenges and opportunities.
These visually-driven platforms favor engaging, educational content that can be consumed quickly.
However, they also have more aggressive content moderation systems that may flag medical terminology or discussions of side effects.
Companies operating on these platforms must develop creative ways to communicate complex medical information while avoiding algorithmic triggers.
The key is to understand that what works on one platform may not work on another.
A successful diabetes awareness campaign on Facebook might need to be completely reimagined for TikTok, using different language, visual elements, and engagement strategies to avoid suppression while still delivering valuable information to patients.
Modern social media management requires sophisticated analytics capabilities that go beyond basic engagement metrics.
Pharmaceutical companies need tools that can analyze sentiment, track conversation themes, and identify emerging trends in real-time.
This data-driven approach enables companies to adapt their content strategy quickly and effectively.
Sentiment analysis is particularly valuable for pharmaceutical companies, as it can help identify when conversations about specific drugs or conditions are trending negative, allowing for proactive response.
For example, if sentiment analysis reveals growing concerns about a particular medication's side effects, the company can quickly develop educational content to address these concerns before misinformation spreads.
Advanced analytics can also help identify the most effective content formats and messaging strategies for different audiences.
By analyzing which types of posts generate the most meaningful engagement – not just likes and shares, but comments, saves, and click-throughs – companies can refine their content strategy to maximize impact while minimizing the risk of algorithmic suppression.
The regulatory environment for pharmaceutical marketing is complex and constantly evolving.
Companies must balance the need to create engaging, shareable content with strict compliance requirements.
This requires a deep understanding of both regulatory guidelines and platform-specific best practices.
The FDA's guidance on social media marketing provides a framework for compliant content creation, but it was developed before the current era of algorithmic suppression.
Companies must now consider not just regulatory compliance, but also algorithmic compatibility.
This means developing content that satisfies regulatory requirements while using language and formats that are less likely to trigger content moderation systems.
One effective approach is to focus on educational content that provides value to patients and healthcare professionals without making specific product claims.
For example, instead of promoting a specific diabetes medication, a company might create content about diabetes management techniques, dietary recommendations, or the importance of regular monitoring.
This type of content is less likely to trigger algorithmic suppression while still building brand awareness and trust.
In an environment where content can be suppressed or removed without warning, building a resilient community becomes crucial.
This means creating multiple touchpoints with your audience and developing relationships that extend beyond any single platform.
Email marketing, while not as glamorous as social media, provides a direct line of communication that cannot be algorithmically suppressed.
Companies should use social media to drive email subscriptions, creating an owned media channel that complements their social media presence.
This approach ensures that even if social media content is suppressed, the company can still reach its audience with important information.
Community building also involves fostering authentic relationships with key opinion leaders, patient advocates, and healthcare professionals.
These relationships can provide valuable amplification for important messages and help counter misinformation when it arises.
However, companies must be careful to ensure that these relationships comply with regulatory guidelines and disclosure requirements.
The social media landscape is inherently unstable, as demonstrated by the recent turmoil at Twitter/X and the ongoing regulatory challenges facing TikTok.
Pharmaceutical companies must be prepared for sudden changes in platform policies, ownership, or availability.
This preparation involves several key strategies:
First, companies should maintain a presence on multiple platforms to reduce dependence on any single channel.
Second, they should regularly backup their content and follower data to ensure continuity in case of platform changes.
Third, they should develop contingency plans for rapid migration to alternative platforms if necessary.
The recent example of Twitter's policy changes regarding COVID-19 misinformation illustrates the importance of this preparation.
When Elon Musk's Twitter stopped enforcing its ban on misleading COVID-19 information, many health organizations, including Finland's Institute for Health and Welfare, permanently discontinued their accounts [4].
Companies that had diversified their social media presence were better positioned to maintain their communication channels despite these changes.
As the social media landscape continues to evolve, pharmaceutical companies must stay ahead of emerging trends and technologies that could impact their marketing strategies.
Several key developments are likely to shape the future of pharmaceutical social media marketing.
But what should companies be watching for?
The next generation of content moderation systems will likely incorporate more sophisticated artificial intelligence capabilities, including natural language processing and contextual understanding.
While this could potentially reduce the false positive rate for legitimate pharmaceutical content, it may also make it easier to detect and suppress the algospeak tactics currently used by illicit promoters.
Pharmaceutical companies should prepare for this evolution by focusing on creating genuinely valuable, educational content that would pass even the most sophisticated content moderation systems.
This means moving away from promotional messaging toward truly educational and community-building content.
Regulatory frameworks are also evolving to address the challenges of social media marketing.
The FDA's guidance documents are regularly updated, and new regulations may emerge to address the specific challenges of algorithmic suppression and misinformation.
Companies must stay current with these developments and be prepared to adapt their strategies accordingly.
The European Union's Digital Services Act and similar regulations in other jurisdictions may also impact how social media platforms moderate content, potentially creating new opportunities or challenges for pharmaceutical marketing.
New social media platforms and technologies are constantly emerging, each with its own opportunities and challenges.
Virtual and augmented reality platforms may offer new ways to educate patients about medical conditions and treatments.
Voice-activated platforms like Clubhouse or Twitter Spaces provide opportunities for real-time engagement with healthcare professionals and patients.
Pharmaceutical companies must be prepared to evaluate and potentially adopt these new technologies while ensuring compliance with regulatory requirements.
This requires a balance between innovation and caution, as early adoption can provide competitive advantages but also carries risks.
The rise of algospeak and the shadow-banning of legitimate pharmaceutical content represent more than just marketing challenges – they are fundamental threats to public health communication.
When accurate, scientifically-backed information is systematically suppressed while misinformation and illicit promotions flourish, the consequences extend far beyond corporate marketing metrics.
The pharmaceutical industry stands at a crossroads.
Companies can either accept the current state of affairs, continuing to struggle with poor engagement and algorithmic suppression, or they can take proactive steps to reclaim their voice in the digital conversation.
The choice is clear, but the path forward requires commitment, resources, and a willingness to adapt to an ever-changing landscape.
Success in this new environment requires more than just better content or more sophisticated analytics.
It requires a fundamental shift in how pharmaceutical companies approach social media – from a promotional channel to a platform for genuine education and community building.
It requires collaboration with platforms, regulators, and other stakeholders to create a more transparent and equitable digital ecosystem.
Most importantly, it requires recognition that this is not just a marketing challenge but a public health imperative.
When patients cannot access accurate information about their medications, when healthcare professionals cannot share educational content, and when misinformation fills the void left by suppressed legitimate content, everyone loses.
The pharmaceutical industry has the expertise, resources, and moral imperative to lead this change.
By implementing the strategies outlined in this analysis – from shadow-ban detection systems to multi-platform content strategies to community building initiatives – companies can begin to reclaim their voice in the digital conversation and ensure that patients have access to the accurate, reliable information they need to make informed decisions about their health.
The digital town square may not be a level playing field today, but with concerted effort and strategic thinking, it can become one.
The question is not whether the pharmaceutical industry can adapt to these challenges, but whether it will choose to do so quickly enough to make a difference.
[1] Instagram Reel. (2025, March 7). Retatrutide: The triple-threat peptide that's turning up the heat on fat... [Video]. Instagram. https://www.instagram.com/reel/DG4sba3xzh2/?hl=en
[2] The Quint. (2022, April 12). Algospeak: The Simplest Way To Bypass Censorship on Social Media. https://www.thequint.com/tech-and-auto/tech-news/algospeak-the-simplest-way-to-bypass-algorithms-on-social-media
[3] BuzzRadar. (2025, April 8). How Shadow-Banning on Social Media is Silencing Pharma Brands – And What CMOs Can Do About It. https://buzzradar.com/blog/pharma-brands-social-media-shadow-banning
[4] PMLiVE. (2023, April 27). Pharma's struggles with social media. https://pmlive.com/intelligence/pharmas_struggles_with_social_media_1490675/
[5] U.S. Food and Drug Administration. (2024, May 31). For Industry: Using Social Media.
As CEO of Kubbco, Chris leads the company's vision and uses his 20 years of advertising experience to drive results for our clients.
