• Much of the growth in Instagram ad revenue in the second half of 2020 was due to small and medium-sized businesses, according to Facebook.
• The surge in smaller businesses advertising on Instagram has led to a number of medical and wellness products being advertised under the noses of regulators.
• I asked medical experts about whether the products I’m advertised on Instagram live up to their claims.
• Visit Business Insider Australia’s homepage for more stories.

A toddler applying bolognese sauce like lotion, a meme about anxiety and then an ad for a chin lifting mask with eight active ingredients for which I can buy now and pay later. A bowl of shallot pasta then a slow zoom into the smoochable skull of a brindle staffy. A clique of lorikeets on a balcony railing, an impossibly blue coastal vista and then an ad for little pink socks to moisturise my “UGLY FEET”.

Glimpses into the lives of my friends are routinely interrupted with Instagram ads that feel a little more chaotic lately.

“Mummas,” the black typewriter font addresses me, a childless woman. “If you are looking for solutions for your kids beyond antibiotics and Panadol, please know they exist. Reach out. X.”

The ad leads me to the account of a woman with a few hundred followers selling essential oils for Doterra, a multi-level marketing scheme. When I watch a video in which she encourages people to add the oils to their food — something health departments warn against due to the risk of poisoning — I realise the proposed ‘alternatives’ to pharmaceuticals might be the oils themselves.

I used to experience Instagram like a glossy magazine. There were influencers but I was primarily targeted by established, recognisable brands with a history of profiting off my penchant for a quick fix. I couldn’t remember ever being served anything akin to an ad from an aromatherapy mum in regional NSW with few followers but many feelings about vaccines.

The rise of small-to-medium business on Instagram

Am I being paranoid? Yes and no, says Curtin University internet studies professor Tama Leaver.

Instagram, which surpassed the 1 billion user mark as 2020 drew to a close, is in the midst of an “identity crisis” between commerce and communication, he says.

“For a long time, even when Instagram was first bought by Facebook, the emphasis was really on communication and it was about the connections you make with other people more than anything else, and over the last few years they are rethinking what the app means,” he tells me.

E-commerce became the app’s focus as coronavirus outbreaks forced businesses online.

The chief financial officer of Facebook, which owns Instagram, has said the rise in ad revenue during the second quarter of 2020 was primarily driven by small and medium-sized businesses. In November, when the platform rolled out Instagram Shops in Australia, the local group industry director said 80% of Australians had bought a product on Instagram.

“In the last year, Instagram has radically pushed into pitching itself as the space of small business,” Professor Leaver says. “They spent the entire pandemic saying ‘we are the saviour of small business’ and you can basically run an entire business through Instagram and not need any other infrastructure.”

What does this mean for my ads?

“Microtargeting works much better on Instagram, so you’re probably going to get more quirky, unusual and less mainstream stuff simply because the cost to do a small targeted ad is really small,” Professor Leaver says.

I asked him whether it was more likely people could breach advertising guidelines on Instagram because they had a smaller audience in each ad.

“Advertising guidelines only really get enacted if you’re visible enough that someone complains and takes the time to screenshot something and send it to the [Australian Competition and Consumer Commission],” he says. “When I see strange things I completely ignore them.”

So I decided I’d call experts to ask if I should buy them.

I begin with the EarWipePro, which the ad tells me is “THE TOOL THAT [SIC] MAKING THE COTTON SWAB INDUSTRY SO ANGRY” with two flame emojis. It is a tiny metal ear-cleaning wand with a silica tip and camera on the end.

Ear nose and throat surgeon Dr Jennifer Ha says that unless you frequently use hearing aids or ear plugs, have congenitally narrow ear canals or ear canal dermatitis, you shouldn’t be putting anything smaller than your elbow into your ears.

But what if the small thing in question has a three megapixel sensor that wirelessly streams a full view of the inside of your ear to your phone, “giving you access to information that you’ve never had before”?

“The depth and anatomy of the ear canal is kind of hard to judge without proper training,” Dr Ha says.

“If they perforate the eardrum they may dislocate the whole hearing chain, so there is a fair bit of risk involved.”

Dr Ha explains the ear has self-cleaning properties and earwax that does not cause symptoms or block the ear canal should be left alone.

“The most common thing I see is people with good intentions try to clean their ears with a cotton bud and end up with an ear infection,” she says. “It can cause microtrauma and skin tear. Sometimes I have patients who come to see me and they want to present with clean ears and have cleaned with cotton buds. When I look in their ears there’s blood everywhere and it looks like a crime scene.”

When I call Dr Gayle Fischer, a dermatologist specialising in vulvovaginal skin disease, to ask her whether I should invest in an advertised “pussy wash”, “pussy mist” or “pussy cream” for use after “sexy time” or a “poo sesh” she replied she would like to “run out of the room screaming”.

“Look, if you have a skin disease that is one thing – but if you have normal vulval skin it is normal for there to be some discharge from the vagina because the vagina is a self-lubricating surface of your body,” Dr Fischer says.

“It is completely normal and healthy and the idea that you have to have special wipes and deodorants down there suggests something that reminds me of female body shaming.”

I tell her the products promise to protect the “delicate pH balance of the vaginal flora”.

“If you’re a premenopausal woman you have a slightly lower than neutral pH and only a few infections such as bacterial vaginosis change it,” she says.

Dr Fischer says that feminine hygiene products aren’t worth the risk of exposing yourself to potential allergy, chemical injury or contact dermatitis when your vagina was already cleaning and moisturising itself.

‘Endosisters. We’ve been lied to.’

I have endometriosis, a disease where tissue similar to that which lines the uterine walls grows beyond it. With luck (and an IUD) I have managed most of the symptoms associated with the condition: heavy and irregular bleeding, chronic pelvic, back and leg pain as well as pain during periods and sex.

So, the first time I was targeted with an Instagram advertisement from a company called Ovira for a device that would relieve endometriosis pain, I wasn’t thinking about myself but of all the women I had interviewed who had exhausted their hope and drained their bank accounts trying to manage their pain.

“Endosisters. We’ve been lied to,” the advertisement began. “Pocket sized endo pain relief had existed for decades – the medical industry just forgot to give it to endo sufferers.”

I wondered who forgot to tell that woman I interviewed who spent thousands of dollars to have a complete hysterectomy in her 30s just to avoid another immobilising menstrual cycle. Still, endometriosis is both under-researched and underfunded so asked gynaecologists what they thought.

Ovira has essentially rebranded a wearable device that has been around since the 1970s called a transcutaneous electrical nerve stimulation (TENS) machine. It sends electrical pulses via electrodes to underlying nerves to try and interrupt the transmission of their signals. It has been used to relieve pain for patients with musculoskeletal conditions and some people use it in the early stages of labour.

The website claims the device “stops your period pain instantly” and can also be used to relieve secondary menstrual pain due to conditions like endometriosis so I could “say goodbye to endo pain”.

Consultant obstetrician-gynaecologist and fertility specialist Dr Tal Jacobson sees the ‘scientific plausibility’ of how TENS machines could be used for endometriosis, but that the condition involved many types of pain including bowel, bladder and pelvic pain.

“The women who come and see me with their TENS machines are usually still in pain but I wouldn’t criticise the idea of it being helpful to get through a period or a bad flare,” Dr Jacobson says. “For doctors with an interest in this area there is a much greater focus on the pain management side of it and we are far less likely to do an annual laparoscopy (surgery) to clear out the endometriosis so I think why not if people think this works for them.”

The largest meta-analysis of research on TENS machines to date was published this year. It found they reduced pain intensity more effectively than placebo for some forms of pain, but there was a “paucity” of evidence to determine whether the machines would help during painful periods. None of the 400 clinical trials studied seemed to look at pain associated with endometriosis. One which did had been retracted.

Consultant obstetrician-gynaecologist Dr Marilla Druitt refers to a 2002 Cochrane review which found in a small number of trials TENS machines could effectively treat bad period pain and as she pointed out “a part of that population may have had endometriosis”.

“If they were going to fix the world they would have by now, but I think they really have a place,” Dr Druitt says. “Some people love them and anything a person can be in charge of themselves is always more empowering than the medicine you can give them.”

Pain was “always multifactorial” and there was no panacea, she says.

“Anything we can do for pain, even if it’s a 3% (success rate) is an important experiment and anything that is an opiate substitute is hugely valuable,” she says. “And finally, any time a doctor says that anything works 100% of the time … they end up on ‘Today Tonight’ so if it sounds too good to be true then it probably is.”

Consultant gynaecologist and clinical senior lecturer at the University of Melbourne Dr Alex Polyakov says it is difficult to pinpoint why some endometriosis patients experience pain and others will not.

“We simply don’t know whether it is the inflammation, whether it is the scarring, whether it is the irritation of the nerves so some women have no pain but we find they have stage three or four endometriosis and other women have a classical presentation and we find nothing there, it is pristine,” he says.

Dr Polyakov says that when the Therapeutic Goods Administration approves a device, as it has for TENS machines, it is often evaluating risk rather than efficacy, so this was a low risk option to try.

“We have to look at these treatments in terms of harm versus benefit, and if the harm is $150 and it did nothing then you can get a refund,while there are standard treatments like hormone manipulation and nonsteroidal anti-inflammatories and laparoscopies which can be invasive,” he says.

“Extensive endometriosis can be harder to treat surgically than cancer.”

Claiming a device definitively relieves pain is of course “complete rubbish” but because there is a psychological element of pain management, he says, there could be some value. “If you believe that it works maybe it works. We don’t know a lot about pelvic pain.”

My neck, my back

I have a sore neck and back because I have worked at a desk for a decade with the posture of a prawn. Most days I will be served ads for a series of devices offering to instantly fix me. My boyfriend – whose back can only be described as an inflamed cinder block – recently purchased from Instagram a “cervical traction device”, which is a kind of plastic ramp over which he can rest his inflexible and sensitive spine.

The Australian Physiotherapy Association National Pain Group chair Tim Austin says people don’t recognise that back pain is the “most burdensome condition in the world” and it is no surprise that many are seeking relief via any product they can find.

“Almost every person on this planet at some stage has back pain and that is a marketer’s dream, but we need to look at what is evidence-based [and] what is appropriate,” Mr Austin says.

“The fundamental issue here is “who is giving the advice?” because even by choosing a certain device you’re giving yourself advice. Physiotherapists are all for people self-managing their problems, and we don’t want to be alarmist, but we also realise that any time you see a good healthcare practitioner – whether it is your GP or your physio – the first thing they are doing is putting their eye across you to make sure you don’t have any dangerous conditions. They aren’t common but they have to be identified.

There is a use for hard balls, foam rollers and even back stretchers, he says, before warning that an intense back-opening stretch would not be appropriate for people who might have small fractures in their vertebrae or who are older and might be slightly osteoporotic.

“I think [it is good] if you can get some simple guidance from a healthcare professional who says ‘this is the road you are meant to be on’,” he added.

I recently bought a $26 scourer posing as a game-changing makeup brush while sleeplessly scrolling. When I confess this to Professor Leaver he admits even an internet studies professor isn’t immune to the lure of targeted ads — he bought something actually designed to clean surfaces from Instagram.

“It is a cleaning product that has a drill bit with a brush glued onto it,” he says.

“It’s a piece of crap, really, but it looked so good in the video.”

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