The iPhone and Nest inventor believes that “we should be incentivizing those who are going after our existential problems."

Tony Fadell is putting climate change and other “existential problems” front and center as the principal at Future Shape.

Capitalism has arguably driven the climate crisis. Tony Fadell, the inventor of consumer tech products that have swept the globe, is on board with that line of thinking. But the inventor and entrepreneur also staunchly believes that rather than tearing it down, the system can work for the planet with a few tweaks.

Fadell is responsible for technology that has transformed society. He led the team at Apple that invented both the iPod and iPhone, and went on to develop Nest, the smart thermostat ultimately acquired by Google.

Now, Fadell is putting climate change and other “existential problems” front and center as the principal at Future Shape, an investment and advisory firm that coaches technology startups, many of which are climate- or environment-focused. This approach speaks to Fadell’s fundamental belief that capitalism will be central to ameliorating the climate crisis, and that the government's role is to stop the “hacks” that have let the system run amok.

In an interview with Protocol, Fadell delved deeper into the relationship between consumer technology, investment and the climate crisis, and why he believes the world’s first trillionaire will be “produced out of the climate crisis.” Fadell’s book “Build: An Unorthodox Guide to Making Things Worth Making” is out later this month.

This interview has been edited for brevity and clarity.

The landscape of technology and climate change has changed substantially since you first started at Apple. Has what we now know about climate change and the environment shifted how you think about your role as an inventor?

I think that without the technologies that were built pre-climate crisis, we would not have the tools to solve it at our disposal today. Certain technologies come up at certain times of need, and I'm glad that in the early part of my career, I was able to build the things that really helped to make things happen faster through mobile communications and mobile information.

Today, I want to go where there are really interesting problems and really interesting solutions, and that’s the climate crisis. And those solutions are not just going to come out of Silicon Valley; they’re going to come out of every nook and cranny of this planet, because everyone has different climate-related problems they need to solve in their own local way. Everyone has to get involved in this.

In the years since the development of the iPod and iPhone, I have heard concerns about the environmental impacts caused by our attachment to technology. How do you reconcile the development of hugely impactful consumer technologies with your very vocal concerns about the environment? Do you think the way we develop technology may need to shift?

I think the way we consume technology might need to shift. We don't need to see new cell phones every year; my cell phone right now is not the latest iPhone.

When we were creating the Nest thermostat, we wanted to make sure that it sat on your wall for 12 to 15 years, which was the typical lifespan of those types of products. We made sure we had the software update and various hardware in it so it can live that long. As designers, as engineers, as businesspeople, we need to think about making sure we're extending the lifetimes of products. And even then, we need to think about circularity and what's going to happen at the end of a product’s life.

The reason why I think that a trillionaire will be produced out of the climate crisis is because we are talking about an existential problem not just for one country or for one city ... That's trillions of dollars of capital.

What I love seeing is that in Europe right now, whenever you want to put up a new battery factory, you have to put up a battery recycling factory; you can't get one without the other. We need more of those kinds of approaches. Technology is how we're going to get out of this problem if we don’t want to go back into caves, so we have to figure out how to have a circular relationship with that technology.

You have said that the world’s first trillionaire will be someone who fixes climate change. Can you elaborate on why you say that? Is this something that you think capitalism can fix?

I think if capitalism isn't a part of it, we're not going to fix it. The reason why we got into this state was because of capitalism: We didn't make the right decisions to stop emitting carbon dioxide, because it was the cheapest and easiest way of just scaling up the things that we already had. I'm not saying capitalism is bad, but the incentives were wrong. The only way we're going to solve this is with proper regulation and government intervention to make sure we're aligning incentives and make sure that capitalism is working with the solutions, as opposed to against them.

The reason why I think that a trillionaire will be produced out of the climate crisis is because we are talking about an existential problem not just for one country or for one city: We're talking about the entire planet of billions of people. Most of these people are using the same exact resources or technologies to power their homes and businesses. Those things need to be revolutionized, not over a span of 100 or 150 years — which is how long it took to create these systems — but in the next 20 years. That's trillions of dollars of capital. And it's not just one industry. It's every industry that needs to be addressed. That's the scope and scale of problems that we have on this planet; there will be some people that will fix them, and they will reap the benefits.

You’ve said before that investors are pouring money into technology that is, shall we say, not an urgent need. Given that billions if not trillions of dollars will be needed to halt the progress of climate change, are you optimistic that investors can be swayed away from the easy money of crypto or similar endeavors?

I think they can, but it's going to take government intervention. In the U.S. investment world, there’s something called a qualified small business. If you invest in one, you can get zero taxes on the gains years later, so people pour money into QSBs. But you could be a QSB doing climate or a QSB working on the metaverse, and you get the same tax treatment. That absolutely shouldn’t be the case. We should be incentivizing those who are going after our existential problems, and making sure that resources are being funneled there. If the country instead decided to define qualified small climate businesses, we could raise the tax rates for those QSBs that are not taking on existential problems. You have to hack investors’ brains and hack the system to make them go that way. These are the kinds of government incentives and nudges that we need to make sure that capitalism is used in the right way, not the wrong way.

We should be incentivizing those who are going after our existential problems, and making sure that resources are being funneled there.

We need a carbon economy, a methane economy, a plastic economy. They need to be taxed just like they have luxury taxes in Europe. People don't like it, but we need to incentivize.

So many of the world’s richest people tend to be some of the greatest contributors to climate change. What would you say to those who say that the way wealth operates today is fundamentally incompatible with the changes we need to see on a societal and global scale?

Well, I know billionaires who are climate-conscious, and I know billionaires who are not climate-conscious. At the end of the day, people who have the resources — whether they’re middle, higher or lower income — choose to live the life they want. And we as a society need to tax the things that contribute to climate change. People always find a way to consume more if there is a hack for it.

Here’s a perfect hack that we have going on right now: I’m a big oil company, I get subsidized and I have carbon-emitting entities on my balance sheet. Certain shareholders scream about it, customers scream about it, the general press screams about it. So what do I do? I sell it off to other firms who pick it up, and then it’s not on my balance sheet. But that facility is still running, probably even less transparently than it was before; it’s not even managed, because it’s no longer a public company! And these people are just trouncing the planet without making any changes, while making the oil companies look great. The government needs to come in and regulate those sales and make sure that those shutdowns happen. They can't just turn the facility over to a bad actor and let them continue to pump the oil. We need to make sure that those hacks are stopped.

Unfortunately, there are many countries that use too many resources for the number of people on this planet. We need to also understand that there are developing countries who want to have what we have in the more developed world. And we have to not say, “You’ve got to make more sacrifices so we can live the way that you wish you could live.”

Is there anything that you think has real potential to thread this needle of both potential profitability and potential benefits for the climate?

I see the hydrogen economy as potentially really great. Now I'm not saying hydrogen for cars; I'm saying for long-haul transit, for steel-making, for cement-making. And I’m saying green hydrogen — not gray, not blue — but truly green hydrogen from renewable energy sources. It’s going to be transformative. Why? One, we don't have the emissions problem. And two, it's more profitable. It's literally more profitable to use hydrogen to make these other materials than it is to use the common stuff today. So it's a great alignment of capitalism and the climate.

How tech is tackling climate change — and reckoning with its own impact on the planet.

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Lisa Martine Jenkins is a senior reporter at Protocol covering climate. Lisa previously wrote for Morning Consult, Chemical Watch and the Associated Press. Lisa is currently based in Brooklyn, and is originally from the Bay Area. Find her on Twitter ( @l_m_j_) or reach out via email (ljenkins@protocol.com).

A first-in-the-nation bill would support wave and tidal energy as a way to meet the Garden State's climate goals.

Technological challenges mean wave and tidal power remain generally more expensive than their other renewable counterparts. But government support could help spur more innovation that brings down cost.

Lisa Martine Jenkins is a senior reporter at Protocol covering climate. Lisa previously wrote for Morning Consult, Chemical Watch and the Associated Press. Lisa is currently based in Brooklyn, and is originally from the Bay Area. Find her on Twitter ( @l_m_j_) or reach out via email (ljenkins@protocol.com).

Move over, solar and wind. There’s a new kid on the renewable energy block: waves and tides.

Harnessing the ocean’s power is still in its early stages, but the industry is poised for a big legislative boost, with the potential for real investment down the line.

A New Jersey bill introduced this week would make the state the first in the U.S. to throw government support behind ocean energy. It would direct the state’s utility board to both initiate a study of generating power from waves and tides (they’re different, but more on that in a second), and simultaneously support ocean energy pilot projects. The bill isn’t just focused on studies and pilots, though; it calls for the board to produce a plan for deploying these technologies and potentially offering financial incentives as well.

The bill doesn’t provide funds for the fledgling technology at this point, but the state’s 2023 budget — signed into law Thursday — includes $500,000 dedicated to a feasibility study and pilot program for ocean-based energy, opening the door for New Jersey to continue to ride the wave energy … wave.

With the legislation, “New Jersey serves as a model to all states seeking to bring new forms of renewable energy into the future,” said Democrat Assemblyman Robert Karabinchak, who introduced the bill. The state has set a 2050 net zero goal, and Karabinchak said that wave and tidal energy could help make progress toward that North Star.

There’s a subtle difference between tidal and wave energy. In broad strokes, the former uses the push and pull of the tides themselves to push a paddle or spin a turbine and convert its flow into electricity, while wave energy relies upon the thrust of often-unpredictable surface waves to do so.

According to the Energy Information Administration, waves off the coast of the country are churning out 2.64 trillion kilowatt hours of untapped energy. That’s equivalent to 66% of U.S. electricity generation in 2020.

Wave energy has been around as a concept since 1799, when Pierre-Simon Girard filed a patent in his native France for using the waves “like motors” for simple machines like pumps. Modern wave energy converter technology, however, didn’t see its debut until the 1940s, when Japanese navy commander Yoshio Masuda created a wave-fueled navigation buoy that was ultimately sold commercially in the 1960s. Yet despite early work and the promise of abundant energy, the ocean presents challenges and surprises that have made it hard to tap.

“The problem is that these converters have to operate in very harsh environments,” said Muhammad Hajj, chair of the civil, environmental and ocean engineering department at the Stevens Institute. “You could design something to harness the energy of a 3-meter wave … but if the wave height becomes 8 meters, how will it respond?”

These technological challenges mean wave and tidal power remain generally more expensive than their other renewable counterparts. But government support could help spur more innovation that brings down costs.

The New Jersey legislation would provide a path to include the nascent ocean-based energy technologies in the state’s energy master plan, released once per decade. The 2019 installment pushed for the state to develop renewable technologies such as offshore wind, solar and storage, but made no mention of ocean power.

While the bill’s fate is anything but certain, the mere fact of its existence is encouraging to Inna Braverman, founder and CEO of Eco Wave Power. Her company has developed technology that converts wave power to electricity directly at breakwaters.

“I really believe that not only [will it] enable us to implement projects in New Jersey, which has amazing wave conditions, but also other states will follow,” she told Protocol.

Both Braverman and Hajj testified at a New Jersey Assembly committee hearing on the topic back in March, where Braverman characterized the response from both sides of the aisle as enthusiastic.

Various companies have tried to harvest energy from waves in recent years, but most have yet to succeed. That includes the high-profile failure of Ocean Power in 2014, which dealt with cost overruns and other challenges.That’s meant that waves have lagged behind both wind and the sun for generating electricity. Braverman attributes some of these to the fact that early efforts were far offshore.

“Not only is it expensive to install offshore, but … you get waves with a height of 20 meters. And no man-made stationary equipment can really withstand the load of a 20-meter wave height,” Braverman said. It became difficult to fund and insure these earlier projects, not to mention build the transmission lines to connect them to the grid.

In contrast, Eco Wave Power connects its technology to existing man-made structures — piers, breakwaters, jetties and other marine structures — in order to keep overall construction costs low and avoid the practical pitfalls of the open ocean. The company has two operational projects, one at the Port of Gibraltar and one in Israel, and several more in the pipeline.

Today, Eco Wave Power is focused primarily on the U.S. and European markets, Braverman said, which differ in large part because Europe already has regulations and legislation in place that enable the easy entrance of new wave projects while the U.S. does not — yet.

“We really need to introduce new renewable energy sources in order to really be able to get to net zero carbon emissions by 2050,” she said. “And I truly believe that wave energy can be the solution for that. New Jersey is just the start.”

Lisa Martine Jenkins is a senior reporter at Protocol covering climate. Lisa previously wrote for Morning Consult, Chemical Watch and the Associated Press. Lisa is currently based in Brooklyn, and is originally from the Bay Area. Find her on Twitter ( @l_m_j_) or reach out via email (ljenkins@protocol.com).

Every day, millions of us press the “order” button on our favorite coffee store's mobile application: Our chosen brew will be on the counter when we arrive. It’s a personalized, seamless experience that we have all come to expect. What we don’t know is what’s happening behind the scenes. The mobile application is sourcing data from a database that stores information about each customer and what their favorite coffee drinks are. It is also leveraging event-streaming data in real time to ensure the ingredients for your personal coffee are in supply at your local store.

Applications like this power our daily lives, and if they can’t access massive amounts of data stored in a database as well as stream data “in motion” instantaneously, you — and millions of customers — won’t have these in-the-moment experiences.

“Customers demand these real-time experiences, and companies that fail to meet those expectations risk falling behind,” said Chet Kapoor, chairman and CEO at DataStax, a technology company that helps businesses deliver real-time data at scale. “We live in a time where real-time applications are the engines of innovation and economic growth.”

In my conversation with Kapoor, he shared his perspective on why every business must embrace real-time data today.

Companies that don’t harness real-time data risk becoming irrelevant

While the concept of utilizing real-time data is not new, the urgency to do so is. Digital leaders — those at the forefront of building a data-driven business — are effectively capturing and processing data in real time, and then using it to deliver instantaneous experiences. Customers not only expect these digital experiences; they are increasingly demanding them from every business.

McKinsey & Company supports this view. According to a recent McKinsey report, “The Data-Driven Enterprise of 2025,” real-time data is key to success. It listed the following characteristics of top data-driven enterprises:

However, McKinsey & Company also reported that only a fraction of the amount of data from connected devices is processed in real time. The report found common roadblocks include legacy software, the challenges of adopting modern architecture and high computational demands.

“The great news is that technology has advanced to the point where real-time applications are now possible — not only for the largest organizations, but every organization,” said Kapoor. “And those who can’t deliver these experiences risk becoming irrelevant.”

Real-time technology is finally here — and it just works

Constant innovation is what solves today’s business problems. Leading enterprises prioritize giving their developers the tools and data that inspire them to innovate and do what they do best: Build the applications that improve our lives.

“Software developers are on the front lines, and their mission is to bring modern applications to life,” said Kapoor. “The good news is, the technology to build real-time applications is here; it’s easy and affordable. We’re enabling developers to do what they do best: build.”

Kapoor said that spurring developer creativity is one of the many reasons he’s excited about DataStax’s open data stack for real-time applications. Available on any cloud, DataStax delivers both a massively scalable database — Astra DB — and advanced streaming technology, Astra Streaming. Together, Astra DB and Astra Streaming provide developers with a stack that mobilizes all enterprise data to build powerful real-time applications.

“Astra DB brings the power and scale of Apache Cassandra to every developer. It uses simple developer APIs and works with developers’ favorite tools and languages, so developers can focus on what they do best — building real-time, high-growth applications that drive change,” said Kapoor.

Kapoor is also enthusiastic about the company’s event streaming and messaging technology Astra Streaming, built on the advanced Apache Pulsar open-source software. As the only streaming service that can easily turn existing messaging data into real-time data, Astra Streaming can give many types of data real-time value.

“An open stack with Astra Streaming and Astra DB enables enterprises to activate all real-time data — it just works,” he said.

Real-time data drives real change

Many of the challenges facing our world today are increasingly complex and critical, such as climate change, talent shortages and supply chain disruptions. Solving these problems requires analyzing large data sets, quickly. Additionally, organizations must use data to predict future issues and then determine the most effective solution. According to Kapoor, activating data in real time can be a powerful way to help organizations create the innovations needed to overcome both big and small challenges. In fact, new business models are being forged on the back of real-time data all the time.

As an example, a DataStax customer and AI-based irrigation company that made the Time Best Inventions list uses real-time data to conserve water while improving farmers’ outcomes. By using IoT devices sitting on or near the crops, the system sends data to the cloud, which then triggers alerts based on the data analytics. If fruit on the vine is at risk for spoiling, the system notifies the farmer to harvest the crops to reduce loss. The technology also helps farmers manage water resources, prevent plant stress, improve production and maximize crop potential — all in real time.

The Gartner report "Innovation Insight for Streaming Data in Motion: The Collision of Messaging, Analytics and DBMS”, explored opportunities for organizations to use event streaming for diverse business purposes. For example, “traffic, weather and vehicle telemetry streams enable trucking companies, railroads, airlines, shipping companies, car ride services and other transportation operators to monitor and manage fleet movements.” According to Gartner, "Large organizations already have copious amounts of streaming data in motion, but many fail to use it effectively. Data and analytics leaders must adopt recent advances in stream analytics, event broker messaging and data management technology to implement real-time systems with more business value.”

Kapoor observed that when we use data in real time, customers and companies get smarter together.

“Everyone succeeds by delivering more value, faster. We are all on a journey toward doing this. The only question is whether companies will be ahead of the curve — or playing catch-up,” he said. “Today, you’re either real time or you’re out of time.”

Learn more about DataStax’s open data stack for real-time applications here.

Don’t know what to do this weekend? We’ve got you covered.

Here are our picks for your long weekend.

Nick Statt is Protocol's video game reporter. Prior to joining Protocol, he was news editor at The Verge covering the gaming industry, mobile apps and antitrust out of San Francisco, in addition to managing coverage of Silicon Valley tech giants and startups. He now resides in Rochester, New York, home of the garbage plate and, completely coincidentally, the World Video Game Hall of Fame. He can be reached at nstatt@protocol.com.

Kick off your long weekend with an extra-long two-part “Stranger Things” finale; a deep dive into the deckbuilding games like Magic: The Gathering; and Neon White, which mashes up several genres, including a dating sim.

The finale of Stranger Things’ fourth season debuts today, bringing an end to the show’s most horror-filled and grave storyline to date. Though this volume is billed as a second part to the show’s fourth installment, it is in fact two extra-long additions tacked onto a season already filled with hour-plus episodes. The first will be 85 minutes, and the second is roughly 2.5 hours long. That’s a lot of “Stranger Things” to tide you over this holiday weekend. I’m hoping for a happy ending, though given the tone so far, it sure seems like “Stranger Things Vol. 2” might have its fair share of tragedy, too.

Neon White is best described by its inexplicable mashup of genres. It is one part speedrun-friendly parkour game, one part first-person shooter disguised as a deckbuilder and one part … dating sim. The resulting combination somehow works wonderfully, creating a high-octane action platformer that dares you to try to beat your high scores by striving for near-perfect runs. Between the action, you chat with NPCs and can even romance other characters, sending this bizarre gaming concoction to a totally unnecessary but hilarious new height.

The surprising combination of two of the most influential video game genres into the so-called roguelike deckbuilder has, against all odds, inspired a massive and enduring movement in the indie game community. In a great new report for The Verge, writer Lewis Gordon spoke to early pioneers like Magic: The Gathering creator Richard Garfield, Slay the Spire designer Anthony Giovannetti and Signs of the Sojourner maker Dyala Kattan-Wright about the evolution of card games and procedural design, and why so many breakout Steam hits these days are incorporating elements of the genre.

A Coen Brothers take on Macbeth ends up being a lot more interesting than it sounds, thanks in part to the noted absence of Ethan Coen. Directed by Joel Coen, in his solo directorial debut, this monochrome and rather faithful adaptation of the classic Shakespeare tale is a big departure from the duo’s typical dark humor-infused Americana, featuring a legendary performance by Denzel Washington as the title character. The A24 film was released last year in a limited theatrical run; it picked up three Oscar nominations, and landed on Apple TV+ back in January.

A version of this story also appeared in today’s Entertainment newsletter; subscribe here.

Nick Statt is Protocol's video game reporter. Prior to joining Protocol, he was news editor at The Verge covering the gaming industry, mobile apps and antitrust out of San Francisco, in addition to managing coverage of Silicon Valley tech giants and startups. He now resides in Rochester, New York, home of the garbage plate and, completely coincidentally, the World Video Game Hall of Fame. He can be reached at nstatt@protocol.com.

Leverage helped mining operations expand as they borrowed against their hardware or the crypto it generated.

Dropping crypto prices have upended the economics of mining.

Tomio Geron ( @tomiogeron) is a San Francisco-based reporter covering fintech. He was previously a reporter and editor at The Wall Street Journal, covering venture capital and startups. Before that, he worked as a staff writer at Forbes, covering social media and venture capital, and also edited the Midas List of top tech investors. He has also worked at newspapers covering crime, courts, health and other topics. He can be reached at tgeron@protocol.com or tgeron@protonmail.com.

As bitcoin boomed, crypto mining seemed almost like printing money. But in reality, miners have always had to juggle the cost of hardware, electricity and operations against the tokens their work yielded. Often miners held onto their crypto, betting it would appreciate, or borrowed against it to buy more mining rigs. Now all those bills are coming due: The industry has accumulated as much as $4 billion in debt, according to some estimates.

The crypto boom encouraged excess. “The approach was get rich quick, build it big, build it fast, use leverage. Do it now,” said Andrew Webber, founder and CEO at crypto mining service provider Digital Power Optimization.

Bitcoin miners are HODLers by nature. Many preferred to hold most of the bitcoin they generated, selling just what they needed to pay employees or other suppliers, because they believed it would go up in value.

Everything in this crypto market comes back to leverage. While miners are typically borrowing to operate, not speculate, debt is still a key part of the business.

Are defaults coming? As the price of bitcoin and other cryptocurrencies has fallen, so has the value of mining hardware. This could be forcing some to decide whether it’s worth making payments, Webber said. “I expect there's gonna be some meaningful distress and likely some liquidation or consolidation across the space.” It wouldn’t be the first time a rush for money turned to bust.

Tomio Geron ( @tomiogeron) is a San Francisco-based reporter covering fintech. He was previously a reporter and editor at The Wall Street Journal, covering venture capital and startups. Before that, he worked as a staff writer at Forbes, covering social media and venture capital, and also edited the Midas List of top tech investors. He has also worked at newspapers covering crime, courts, health and other topics. He can be reached at tgeron@protocol.com or tgeron@protonmail.com.

Prescription drug ads are all over TikTok, Facebook and Instagram. As the potential harms become clear, why haven’t the companies updated their advertising policies?

Even as providers like Cerebral draw federal attention, Meta’s and TikTok’s advertising policies still allow telehealth providers to turbocharge their marketing efforts.

Hirsh Chitkara ( @HirshChitkara) is a reporter at Protocol focused on the intersection of politics, technology and society. Before joining Protocol, he helped write a daily newsletter at Insider that covered all things Big Tech. He's based in New York and can be reached at hchitkara@protocol.com.

In the United States, prescription drug advertisements are as commonplace as drive-thru lanes and Pete Davidson relationship updates. We’re told every day — often multiple times a day — to ask our doctor if some new medication is right for us. Saturday Night Live has for decades parodied the breathless parade of side effect warnings tacked onto drug commercials. Here in New York, even our subway swipes are subsidized by advertisements that deliver the good news: We can last longer in bed and keep our hair, if only we turn to the latest VC-backed telehealth service.

The U.S. is almost alone in embracing direct-to-consumer prescription drug advertisements. Nations as disparate as Saudi Arabia, France and China all find common ground in banning such ads. In fact, of all developed nations, only New Zealand joins the U.S. in giving pharmaceutical companies a direct line to consumers.

As it so happens, Americans are also highly medicated. A Mayo Clinic study from 2013 found that nearly 70% of Americans regularly took at least one prescription drug. Nearly half the population took at least two, and more than 20% of Americans took five or more. The researchers identified prescription drug abuse as the “fastest-growing drug problem” in the U.S. They also found prescription rates had increased significantly over that preceding decade.

Given the continuity of these trends, it would be easy to overlook a new factor in the equation: social media. Telehealth services have spent millions of dollars promoting prescription drugs on TikTok, Instagram and Facebook. They play on users' insecurities, describing symptoms as vague as “stress” and “losing track of time.” Mood-altering medications such as SSRIs are sold as having straightforward benefits, with companies promising those suffering from depression and loneliness that 80% of customers feel better with treatment.

One major telehealth provider, Cerebral, is now under investigation by the Department of Justice over possible violations of the Controlled Substances Act. Nurse practitioners working for Cerebral said they felt pressure to see dozens of patients a day and push prescriptions, according to reports from Insider, The Wall Street Journal and Bloomberg. (A Cerebral spokesperson told The Wall Street Journal they encourage clinicians not to rush diagnoses and provide time beyond 30 minutes if needed.)

Even as providers like Cerebral draw federal attention, Meta’s and TikTok’s advertising policies still allow telehealth providers to turbocharge their marketing efforts, enticing many patients to start treatments they may regret. As one Cerebral patient told Protocol, “On principle, I want to shout from the mountaintops so no one else falls into their nonsense.”

Both Meta and TikTok allow telehealth providers to promote prescription drugs to users ages 18 and up in the U.S. and New Zealand. Both companies make a distinction between promoting prescription medication, which is allowed, and direct drug sales, which are not. Meta and TikTok work with third-party compliance companies such as LegitScript to approve telehealth providers. Advertisements must also comply with any other relevant platform rules — for example, both platforms prohibit ads for weight loss treatments.

When asked for comment, spokespeople from Meta and TikTok referred Protocol to their respective advertising and community guidelines. (Meta’s policies are available here and here, and TikTok’s are here, here and here.) After being contacted by Protocol, Meta also removed three advertisements from its sites for violating its policies.

Meta and TikTok also say ads cannot contain misleading or inaccurate claims. However, medical experts said advertisements on their platforms do exactly that. On several prior occasions, the companies pulled certain pharmaceutical ads only after the media brought policy violations to their attention. And despite the high stakes involved in promoting medication, both companies rely in large part on automated ad verification systems, which can be prone to error.

Telehealth provider Done, for example, promoted a TikTok ad that describes how being “spacey, forgetful, or chatty” can be a symptom of ADHD. Another Done ad warned symptoms of ADHD in women “are often viewed as character traits rather than symptoms.” In an active ad campaign on Meta, Done promises gaining access to “worry-free refills” is “as easy as” taking a one-minute assessment, followed by a 30-minute appointment available as soon as the next day. (Many of the ad campaigns referenced in this article come from Meta rather than from TikTok because, to Meta’s credit, it has a transparency tool for archiving ad campaigns.)

Ads that generalize ADHD symptoms could violate Meta’s and TikTok’s own policies on misleading consumers, as nonprofit research organization Media Matters points out.

“I think this is really playing on people’s insecurities,” Dr. Kevin Martin Antshel, a psychology professor at Syracuse University who specializes in ADHD, told Protocol. Dr. Antshel noted that ADHD in adults often co-occurs with other psychological disorders such as anxiety and depression. He expressed concern that ads from telehealth providers were leading people to believe ADHD could be treated with stimulants alone, which he said is almost never the case.

Telehealth providers also seem to play on users’ insecurities when promoting erectile dysfunction medication. On Instagram, a recently removed ad campaign from Hims depicted a man asking himself, “What if it happens again today? What if I can’t get it up?” Another of its ads, which was active as of June 26 but has since been removed, shows a couple in bed with text overlaid: “POV: There’s a gorgeous woman in your bed. But you have ED & can’t get it up.” Some of the videos instruct users to “take the quiz” — a rather casual euphemism for kicking off a process that could lead to a medical diagnosis — next to a picture of someone holding a pill.

Meta has touted Roman, one of the telehealth providers that sells ED medication, as a “success story” that could serve as a case study for marketers. Meta’s case study details how Roman was able to double its sales and click-through rate on an ad campaign that promoted testosterone supplements between mid-September and mid-November 2019. Roman was among the top 10 mobile advertising spenders on Facebook that year, as were Pfizer, Allergan and Merck.

Active ad campaigns from Hims entice customers with simple solutions for treating anxiety and depression. One advertisement — which directs users to a page offering generic versions of SSRIs Prozac and Zoloft — tells viewers that “80% of customers feel better with treatment.”

Such straightforward promises don’t always align with patient experiences. One Cerebral patient described suffering severe withdrawal symptoms after being unable to schedule a refill appointment through the company. “I would fret for days over collecting my meds. I would become sick and incapable when they’d miss the refill,” the person told Protocol.

“I find myself constantly pushing [Cerebral] on people because if they use my reference code I can get a $200-off credit,” another Cerebral patient told Protocol.

A campaign from Cerebral that was active as recently as June 26 told viewers they can “overcome opioid use 100% online.” That ad, which featured a large icon of a prescription container, linked to a landing page that said “reduce cravings with medications like Suboxone.”

“It's not ideal,” Jeffrey Scherrer, an associate professor at Saint Louis University who researches opioid use, told Protocol. “But it's certainly a second option for people who otherwise wouldn't even consider seeking care — because I think it offers a little bit more privacy and reduces, for those in rural areas, the need to drive long distances to reach a provider.”

It’s hard to imagine we’d ever think of the “good old days” for drug advertising as when gray-haired men were suggestively throwing footballs through tire swings between news segments on the Iraq War — yet here we are.

In the television era, regulators faced a simpler task. To start, there were only so many ad slots to fill, which limited the pool of companies that could reasonably afford to buy air time. (Devoted NFL fans can list the blue-chip advertisers by heart.) Broadcast and cable channels could review what went in their slots, and the FCC could feasibly monitor ads on the hundred-or-so cable channels beamed into American living rooms.

Social media advertisements operate at a scale that would have been unfathomable in the television era. Meta hosted over 10 million advertisers on its platform last year. In the fourth quarter of 2021 alone, TikTok removed 3.2 million ads from its platform due to policy infringements.

Social media platforms also allow for more precise targeting. A 2021 investigation from The Markup found that Meta allowed drug manufacturers to target potential patients granularly based on proxy categories. For example, an advertisement promoting a drug used for inflammatory lung disease was aimed at users interested in cigarettes. Similarly, advertisements promoting antipsychotic medication targeted users interested in therapy. Those categories allowed for targeting even though Meta says ad rankings can’t be informed by medical conditions or psychological states.

Age verification poses another significant problem. Meta and TikTok both only allow prescription drug advertisements to be shown to users above the age of 18. But their age verification systems have loopholes that could still let ads slip through to children.

Some prescription drug campaigns seem tailored for younger audiences. A Done ad that ran on Instagram as recently as June 26, but has since been taken down, depicts a young woman telling her mom and dad, “I think I may have ADHD.” The mom in the skit responds, “You’re probably fine — you’ll always be my baby.” The dad advises, “Why don’t you go to the gym and sweat it out.” But the skit concludes with the young woman deciding to ignore her parents and instead take a one-minute assessment from Done.

The other open and troubling question is whether social media worsens users’ mental health, which could make these advertisements more appealing. In leaked internal documents from Facebook, researchers wrote that “teens blame Instagram for increases in the rate of anxiety and depression.” Mark Zuckerberg told Congress those research findings were inconclusive.

“If [social media users] are displaying symptoms of pain, despair, depression, hardship [and] loneliness, then what sort of adverts would you expect to be targeted in those situations?” Professor Victoria Nash, director of the Oxford Internet Institute, asked Protocol. “I wouldn’t be surprised that in a more unregulated context — which I think the U.S. probably is — that this is where you would see prescription drugs being targeted.”

High-frequency digital activities — like scrolling through social media — are so out of sync with the pace of ordinary life that people come to feel more distractible when they aren’t online, according to Antshel. He said social media is “in a sense conditioning people to want this kind of rapid operational speed, constant mental stimulation.” When that stimulation isn’t available in a domain such as the classroom, people are more likely to notice their distractibility, he explained.

Still, Antshel wasn’t ready to call for a ban on prescription drug advertising. He pointed to benefits from drug ads, including reaching people who lack information and access to treatments. “So knowing what to talk about with the primary care physician, I think, could potentially be a good thing. But I can also tell you that I routinely see patients coming in [and] telling me what type of medication they want [and] what type of dose they want.” The issue, he said, is that “we're taking the direct-to-consumer advertising to an extent where it really is creating the potential for harm.”

Hirsh Chitkara ( @HirshChitkara) is a reporter at Protocol focused on the intersection of politics, technology and society. Before joining Protocol, he helped write a daily newsletter at Insider that covered all things Big Tech. He's based in New York and can be reached at hchitkara@protocol.com.

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