Even as the method for reaching consumers has changed, however, strategies for deceptive marketing have remained remarkably constant. Kardashian is only the most recent in a long line of celebrities who have provided paid testimonials for pharmaceutical manufacturers, a list that includes, among others, the celebrity chef Paula Deen (who appeared in commercials for Victoza, a diabetes treatment, in 2012); the actress Sally Field (Boniva, a treatment for osteoporosis, in 2006); and Lucille Ball, Milton Berle, George Burns, Judy Garland, Groucho Marx, and Mickey Rooney, all of whom participated in radio promotions of Hadacol, a highly profitable mid-20th-century remedy for “stomach disturbances, gas, heartburn, indigestion, nagging aches and pains, and certain nervous disorders.”

Hadacol was the brainchild of the four-term Louisiana State Senator Dudley J. Leblanc, who offered his own testimonials to successfully market the mixture of vitamin B and 12 percent alcohol in dry counties throughout the South. Leblanc also wasn’t the first elected official to profit from pharmaceutical testimonials: Peruna Tonic, the subject of one of Adams’s 1905 exposés, had been extensively promoted in testimonials from W. V. Sullivan, a U.S. Senator from Mississippi.

A century’s worth of regulation has worked to replace personal anecdote with rigorous scientific evaluation as proof of a drug’s effectiveness or safety, a fact that Kardashian gestures toward when she reminds her followers that “most importantly, it’s been studied and there is no risk to the baby.” But despite the FDA’s best efforts, testimonials have stuck around and continue to have market power. Kardashian’s value to Ducheshay lies not so much in the number of followers her posts may reach, but in the weight her words carry for many of those followers—she is, in the jargon of pharmaceutical marketers, an “influential” or a “key opinion leader,” even if she claims no expertise.

The Diclegis episode is yet another reminder of the double-edged sword of direct-to-consumer advertising of prescription drugs, which has been criticized as a tactic that often fails to clearly communicate a drug’s risks. Kardashian’s post for Diclegis was framed as a way of promoting disease awareness, but pharmaceutical companies generally have the incentive to “partner” with celebrities only when there is significant profit to be made on patent-protected drugs. No one is paying stars to tweet about the use of generic thiazides to treat hypertension, for example, even though high blood pressure is undertreated in many populations. In the case of Diclegis, specifically, the argument for “disease awareness” is particularly flimsy—after all, pregnant women and their families have been aware of morning sickness for millennia.

This is not the first time that the FDA has tried to exert its authority in the social-media space, but it is one of the most visible—and as a result, it serves to highlight a few of the ways in which social media can negate consumer-protection measures. The top 10 most-followed accounts on Instagram (a list that includes multiple members of the Kardashian clan, as well as Beyoncé and Taylor Swift) all have tens of millions of followers. These numbers represent a new scale of possibility for advertisers to connect directly with consumers, dwarfing the reach of printed periodicals or even most television shows. Social media also blurs the line between commercial and noncommercial communication, making paid sponsorships more difficult to spot: How is the FDA to distinguish between the times when a celebrity is acting as a paid spokesperson and the times when she is merely using social media to share her personal opinion, an act protected by the First Amendment?