If you've googled "weight loss," there's a good chance that one of the first search results that came up was a website for Ozempic.
But Ozempic hasn't been approved by the Food and Drug Administration for weight loss — it's only approved to treat Type 2 diabetes. So why is it showing up there?
The answer is something called a sponsored search result. Companies pay search engines so that their websites are among the first results you see, if you enter certain keywords or phrases.
"Search engines are often the first place people go when they have health questions," says Daniel Eisenkraft Klein, a research fellow at the Program on Regulation, Therapeutics and Law at Harvard Medical School and Brigham and Women's Hospital.
"Pharmaceutical companies have figured out how to game that system with pay-per-click ads, which are essentially their way of buying their way to the top of search results," he added.
Normally, drug companies have to follow strict rules when it comes to advertising their products in magazines or television commercials.
They have to do things like disclose risks or side effects of the drug, and they can't advertise a drug to treat a condition it hasn't been FDA-approved to treat, even if doctors may sometimes prescribe that drug "off label," to treat other conditions.
If they do, the companies can get in trouble with the FDA. The idea is to prevent ads containing false or misleading material that can potentially hurt someone.
But online sponsored search results, which usually appear on top of other results, aren't regulated the way TV ads are. The law hasn't caught up to the changing technology.
Eisenkraft Klein and his colleagues looked at two years of paid search results for Ozempic sponsored by the drug's maker, Novo Nordisk.
They published their study results in the medical journal JAMA Network Open.
They found that 11 percent of the search keywords or phrases the company paid for contained the word 'weight' even though Ozempic isn't approved for weight loss.
They also found that Novo Nordisk paid for search results even when the keywords referred to the drug's main competitors, such as Trulicity and Mounjaro, manufactured by Eli Lilly.
"Novo Nordisk sponsored the search term 'Kelly Clarkson weight loss', presumably because those searching for celebrities and weight loss might be interested in their product," Eisenkraft Klein says.
The researchers focused only on Ozempic for their study, and more research is needed to look into sponsored results for other drugs and therapeutics, he says.
Still, Eisenkraft Klein says the study can be a lesson for consumers: "Don't assume that Google is showing you the most relevant information. Just because it's first doesn't mean it's the most objective, or the most relevant."
He recommended scrolling past the sponsored search results and looking for independent sources, such as academic medical centers, when doing medication research online.
Contacted by NPR for comment, Novo Nordisk spokeswoman Liz Skrbkova said in an email the study misrepresents the company's "paid search approach," which she says uses "industry-standard" capabilities to reach consumers.
Novo Nordisk is in compliance with U.S. laws and regulations, she added, as well as its own ethical standards, "so that patients can find information about our medicines to make shared decisions with their healthcare professionals about their care."
The United States is one of the only countries that allows direct-to-consumer advertising for prescription drugs.
The Trump administration signed a memo calling on the FDA to crack down on prescription drug advertising in September, saying companies had been lax about disclosing risks.
The FDA also sent out a slew of enforcement letters to companies about their drug ads.
The FDA is committed to making sure that promotional communications for prescription drugs are "truthful, balanced and accurately communicated," according to an email from Emily Hilliard, a spokeswoman for the Department of Health and Human Services, the parent agency for the FDA. She also encouraged people to report concerns to the agency's Bad Ad Program.
A Google spokesman, Nate Funkhouser, said in a statement to NPR that it has clear policies for advertising prescription drugs: "Advertisers are fully responsible for ensuring their advertising strategy, including all keywords and content, adheres to regulatory requirements."
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