Meta and TikTok pulled advertisements from a major mental health care startup this week after receiving inquiries from NBC News. The social media platforms found the ads promoted negative body images and contained misleading health claims.
One of the ads run by Cerebral, which was recently valued at $4.8 billion and has hired Olympic gold medalist Simone Biles as its chief impact officer, featured a woman surrounded by junk food such as cake, doughnuts and chips. The accompanying text read, “Those who live by impulse, eat by impulse.” The ad said obesity is “five times more prevalent” among adults with ADHD, and stated that getting treatment for the mental health disorder could help patients “stop overeating.”
Meta removed ads featuring the imagery last week after receiving inquiries from Forbes. But NBC News found a version of the same ad running on TikTok two days later. TikTok said it removed two Cerebral ads Tuesday after receiving an inquiry from NBC News.
“TikTok has strict policies to protect users from fake, fraudulent, misleading or harmful ads, and in this case, we removed two of Cerebral’s ads for violating our body image policies,” Ashley Nash-Hahn, a spokeswoman for TikTok, said in a statement.
Since Friday, the San Francisco-based Cerebral has continued to run ads for other treatments on Facebook, which is also owned by Meta. Several promoted a class of Type 2 diabetes medications as a “wonder drug” for weight loss. The Mayo Clinic says that while these drugs, called GLP-1 agonists, may lead to modest weight loss, they often need to be injected and can cause side effects such as vomiting and diarrhea. After being contacted by NBC News, Stephanie Chan, a spokesperson for Instagram’s parent company, Meta, said the ads violated its policies and had been taken down.
“We don’t allow content that promotes misleading health claims or that attempt to generate negative self-perception in order to promote health-related products. We remove ads that break these rules,” she said in a statement.
Dr. David Mou, Cerebral’s chief medical officer, said in an interview that an outside agency came up with the company’s advertisements. In the past, he said, he and his team of clinicians reviewed many of the ads. But they didn’t approve the ones that connected ADHD to obesity and featured images of junk food.
“I would not have been OK with that as a clinician. I would say that’s my mistake,” he said. “We immediately pulled it and have already come up with a process where I and my clinical team will be reviewing everything that comes through, so that nothing like this happens again.”
When asked about the ads promoting diabetes medications, Mou said “I think the wording there can definitely be improved.” He noted that GLP-1 agonists are only for patients with obesity who have a body mass index over 30.
But he added that Cerebral, which launched in January 2020, did not have to include those disclaimers in its advertisements.
“If you put the drug name in the advertisement, you have to put all the disclaimers,” Mou said. “If you talk about weight management or medications for that, you don’t have to do that.”
Startups like Cerebral often act as platforms that connect patients to medical providers, and are not subject to the same advertising regulations as drug manufacturers. The Food and Drug Administration does not regulate medical ads that don’t recommend or suggest the use of a certain drug.
Biles, who partnered with the company in October, spoke publicly about the benefits of Cerebral in an interview with the "TODAY" show. “The app, for one thing, has been a great thing and it’s worked for me,” she said. Representatives for Biles did not immediately respond to a request for comment.
Kevin Antshel, a psychology professor at Syracuse University who has extensively studied ADHD, said that Cerebral’s ads painted an incomplete picture of the condition. While research has associated obesity with attention deficit hyperactivity disorder, ADHD has been linked to many illnesses, he said.
“ADHD is associated with just about anything else that you can imagine,” he said, including autism, schizophrenia and depression. He added that Cerebral’s ads appeared to be playing on concerns among Americans about “being thin and concerns with diet and weight loss.”
It’s not just Cerebral that is posting ads for mental health care online. NBC News also found a series of ads on TikTok from one of Cerebral’s competitors called Done that some experts say similarly misrepresented aspects of ADHD. One ad from the company, which specializes in ADHD treatment, said that “taking ADHD medication medication for the first time,” could lead patients to focus and “have a quiet mind.”
“If it’s truly ADHD, you don’t get that kind of incredible response to medication,” Antshel said. Patients often need time to develop strategies and coping mechanisms for managing their symptoms.
Many ADHD medications are stimulants that can be addictive and cause side effects such as nausea, dizziness, nervousness and trouble sleeping. In its terms of service and on its website, Done notes that the “medicine can be dangerous and habit forming” and may “have severe bad side effects.” But it’s not required to include that information in its TikTok ads.
Another ad from Done that appeared on TikTok suggested that vague symptoms such as “feeling empty” and “feeling motivation deficiency” were related to ADHD. But Antshel said the emotions are common and could have many different causes.
“They’re taking symptoms that probably, frankly, every adult in the United States is feeling from time to time now in the middle of the pandemic, and they’re associating it with ADHD,” he said.
TikTok said the Done ads NBC News identified don’t violate its policies. Done, which is based in San Francisco, did not respond to requests for comment.
A Covid boom
Cerebral and Done are two of the many mental health care startups that have grown in popularity during the pandemic as more people began seeking out telemedicine services. The companies often promise online access to clinicians who can prescribe prescription medication for disorders such as anxiety, depression and ADHD in exchange for a monthly fee ranging from $79 to $325.
Last month, Cerebral announced it raised an additional $300 million from investors led by Japan’s SoftBank, bringing the company’s total funding to more than $460 million. It said it now has more than 2,000 clinicians practicing in all 50 states and recently launched a nutrition service.
“We are a comprehensive health care system, we care about mental health and we care about everything that can touch mental health, and that includes obesity,” Mou said.
Antshel said that telemedicine startups can potentially help provide greater access to mental health care, which isn’t currently available to everyone who needs it. It became even harder to access these services during the pandemic as more people sought help and many in-person practices closed.
“There was a shortage of mental health providers before the pandemic, and now, it’s almost impossible to get appointments,” he said.
But these companies readily admit that there are limits to what they can provide. Cerebral notes on its website that it is not a good fit for people experiencing thoughts of suicide, schizophrenia or certain substance use disorders.
Mou said that Cerebral does, in fact, treat patients with thoughts of suicide, but is not a replacement for emergency services.
“We have a very, very careful system of screening patients and then making sure that they get triaged to the right level of care,” he said. “We have a dedicated crisis response team, meaning any clinician who’s on the call with a patient who is, let’s say, suicidal, they can within minutes get another crisis specialist on the line in order to help.”
Health experts have raised concerns about the advertising tactics mental health care startups have been using to attract patients they do believe are appropriate candidates for their services.
“When you see ads like this, you kind of worry about their marketing, who they want to reach, and how they’re reaching people,” said Dr. John Torous, director of digital psychiatry at Beth Israel Deaconess Medical Center and the chair of the American Psychiatric Association’s Mental Health IT committee.
Because mental health care startups are often backed by venture capital, they may have a mandate to grow as quickly as possible in order to provide a return to investors, he said.
“I wonder if we’re seeing more aggressive advertising reflect the broader trend that it’s hard to acquire new customers,” Torous said. “Because as you and I know, health care is hard.”
Mou stressed that Cerebral was aligning its own incentives with patient outcomes. “We have industry leading outcomes in terms of depression, anxiety, bipolar disorder and a number of other things,” he said. “The future of behavioral health, and health care in general, is not fee for service, it’s fee for value.”