Case: In Malaysia, online marketing tactics drive a health products boom with side effects The market for health and beauty products in the country is soaring. But there have also been concerns about bogus and misleading claims, so how safe and effective are these supplements? The programme Undercover Asia investigates. KUALA LUMPUR: When Fauzi (not his real name) faced a weight problem due to irregular eating and sleeping habits, he turned to Choco Fit, a chocolate slimming drink he found online. "Because these products had been endorsed by (Malaysian) celebrities, I was attracted to them," he said. "I thought they were suitable for me because I don't exercise." Fauzi, who weighed 90 kilogrammes, lost 5 to 6 kg within three months. "I was like, 'Wow.' In the morning, I'd eat roti prata or nasi lemak. After eating, I'd drink the (slimming product). It'd last me until dinner I'd just drink water," he recounted. "The celebrity (who marketed the product) asked me to take pictures. She wanted me to take 'before and after' photos of myself after one month, for her to share on her Instagram." Full-time home baker Azie, 31, is another who turned to a dietary supplement she found online, one that promised weight loss within three days. When she initially felt nauseous, the seller advised her to reduce her intake of the drink."I still experienced discomfort, such as headaches and nausea. So I stopped taking it," said Azie, who eventually found another product that worked for her. The weight-loss photos she shared on Facebook led "a lot of people" to ask how she had achieved it, which in turn got her persuading them to try the product. She eventually became a sales agent, or drop-ship retailer. With more than 80 per cent of Malaysia's population tapping into the internet, Azie and Fauzi are among a growing number who are buying vitamin and dietary supplements online. And the marketing boom on social media has contributed to the growth of a multimillion dollar market for these products. Sales reached RM3.1 billion (S$1 billion) in 2019 up by 50 per cent in five years according to Euromonitor. But amid the e-commerce tactics are some misleading and exaggerated claims, including about being able to cure COVID-19. The continued use of online products also led to vastly different results for Azie and Fauzi. The programme Undercover Asia explores the true picture behind this marketing phenomenon and whether there is a hidden price to pay for these products. One of the well-known names in Malaysia's health and food supplements industry is entrepreneur and social media influencer Aliff Syukri Kamarzaman, the 34-year-old founder of D'Herbs Holdings. He presides over more than 30 direct employees who help him manage a network of over 20,000 sales agents. In the past three years, his Instagram following has grown to 4.3 million subscribers. He also has a lavish home and lifestyle, which he shows on his TV Terlajak Laris YouTube channel, with 1.47 million subscribers. His social media following and extensive online channels have boosted his business since its founding in 2010. His personal brand has grown to more than 100 products, and by his own account, his sales topped RM70 million in 2019. Another influencer is Hasmiza Othman, better known by the moniker of Dato Vida. Like Aliff, she is her own boss and has a line of health products as well as a penchant for self-promotion and displays of material wealth. Entertainment value explains a large part of their popularity, said Nurzihan Hassim, a senior lecturer in media and communication at Taylor's University, Malaysia. "(They) are larger than life ... They flaunt their riches (and) outfits," she noted. "So when you come back to the idea of social comparison ... you look at that influencer and you're like, 'Oh, I wish I could be like him.' "A lot people have this upwards comparison ... so they'd want to believe what the influencer says is true." Although Aliff's and Hasmiza's videos and content often "look tacky", and they may talk in ways that "intentionally provoke the audience", said influencer marketing expert Yuh Wen Foong, their fans and netizens come back for more. "They remember (the content) ... It's a very good recall for the brain." When asked, however, if his company overreaches itself in making promises, Aliff said: "If we don't praise our own products and claim that they're good, who would? "In 10 claims, we go overboard with one. We can't possibly be too honest. We're selling products." In 2017, D'Herbs Holdings was fined RM11,000 for its misleading advertisements for two products, which included the claim that its Jus Perawan (Virgin Juice) Gold could boost the immune system. Such an assertion contravenes Malaysia's Food Act. That same year, Hasmiza was fined RM4,800 under the Medicines (Advertisement and Sale) Act after she was convicted of unlawfully advertising her Pamoga health drink. SAFETY CALLED INTO QUESTION Over the years, general surgeon Ahmad Tarmizi Mohammad has had his fair share of patients who fell for the far-fetched claims of some health product sellers, especially patients with multiple or serious medical conditions. "You drink this and you're cured of diabetes, hypertension, gout, cholesterol or even heart disease. And the most ridiculous is of course cancer," he cited. I've been treating cancer patients ... Most of the time when they're diagnosed, they're looking for a cure, in whatever stage they are. But claims aside, the safety of these products has been called into question. Tarmizi said some so-called energy boosters contain steroids, which "can cause a lot of problems" if ingested in large amounts. "The worst-case scenario is it can cause (stomach) ulcers ... (and) bleeding that can cause death," he added. Fauzi, who was consuming Choco Fit, is one who suffered side effects including chronic headaches and gastric problems. The influencer who sold him the product advised him to continue taking it but stop whenever he had gastric problems. Fauzi followed the advice, but he later had to go into hospital when he felt a "sharp pain" in his chest. Eventually, he was diagnosed as having a severe case of acid reflux, a condition sometimes associated with guarana, one of Choco Fit's ingredients. Guarana contains caffeine, which can cause acid reflux, or heartburn, when too much is consumed. Choco Fit was blacklisted in Malaysia in mid-2019, but Fauzi had suffered its ill effects by then. Some cases end in tragedy. When Haji Wanang was diagnosed with kidney failure, his family looked to all kinds of heath products until they came across a milk supplement online, with claims that it could help those with kidney disease. His son Mohammad Rosli said: "There were kidney patients saying that it was good. There were photo captions stating that the patient had kidney failure for a very long time, but after taking this milk, the patient was fine. "We thought it was perfect." Two months later, Haji was diagnosed as having liver damage, to which he recently succumbed. This was traced to the milk supplement, following confirmation that other kidney patients who had taken the supplement suffered the same problems. "As a son, I feel regret," said Rosli. "I'm angry at the person who sold it to us. I'm angry at the company who made the product." BATTLE AGAINST UNREGISTERED PRODUCTS One of the challenges faced by Malaysia is the illegal sale of unregistered health products. In August, the Health Ministry seized unregistered health and beauty products worth RM9.7 million. They were all sold online through e-commerce platforms or drop-ship agents. Some contained steroids and other controlled substances. "When we say unregulated or unregistered products, it means they've not gone through the evaluation process. So the terms of quality and safety of the products aren't ensured," said Hasenah Ali, the director of the National Pharmaceutical Regulatory Agency (NPRA). "The unregistered product might contain harmful substances, so it's very dangerous for (the public) ... When you take it for a very long period of time, it can cause any side effect, which we'd never know." Her agency tests health products for safety and efficacy before they can be approved for sale. It is, however, a game of cat and mouse because Malaysia has hundreds of original equipment manufacturers (OEMs). They are legitimate factories, and many are part of the supply chain for reputable nutritional products. But they can also make it easy for anyone to bring out a new line of products on any e-commerce platform, with little oversight. They can do this by adjusting the ingredients and tweaking the formulas of existing products to meet their clients' needs. "Say you've used one product, and it works for you. Now you want us to make a similar product," cited an employee of one OEM visited by Undercover Asia. "So you give us a sample of it, we refer to it a bit and we can make a new formula." "For example, if that existing product has Vitamin A and C, you want a new product and you want to enhance it with Vitamin E, we can do that." Undercover Asia arranged its own tests for banned or restricted ingredients by bringing five products two OEM samples and three others that were widely available online to a laboratory. One of these, a whitening pill, was found to contain hydroquinone, a chemical the NPRA has restricted and which should not be taken orally. This battle against unregistered medicines has become more acute amid the pandemic, with pharmaceutical products declared to be a cure for COVID-19 being sold online. The government has blocked at least 182 websites that sold such products. BETTER INFORMED, BETTER SERVED The authorities also do routine inspections of premises. But with online marketing, the work has become harder, said Mokhtar Abdullah, deputy director of advertisement control at the Health Ministry's Pharmacy Enforcement Division. Many people get their information about health products from the internet, unlike in the past when pharmacists and printed material, like pamphlets and posters, were the main sources, he noted. "If we find out that any advertisement goes against our rules and regulations, we can ask (the platform) to take down the advertisement," he added. "But when we ask (for) one advertisement to be removed ... there'd be another 10 or 20 new advertisements that would come up." Even someone like actress and social media influencer Adrea Abdullah, who endorses and reviews health and beauty products, finds it "very scary" that there are "dodgy" products out there. She is concerned that "quite a few" personalities who are hired to do product promotions do not use the products themselves, especially in the long run. "They know there's something wrong with (the product), but they can't say anything because they've already signed a contract," she said. "That's the hard bit. They can't ... say, 'oh, it's actually bad', because they're going to get sued." Tarmizi believes that while regular enforcement is necessary, "education is much more important" in helping vulnerable consumers who may seek an alternative remedy to their health problems. "If there's no demand, there's no need for it. If there are a lot of products (and) people pay hundreds of thousands to produce the supplements, (but) if no one's buying ... they'd stop," said the surgeon. Fauzi is sharing his experience for that reason. "I hope the public is more aware and does more research. Do make sure that the product is certified by the Health Ministry," he said

Question 1 Identify the possible motivations and influences that resulted in the consumers purchasing these unsafe products. (25 marks) Question 2. Being aware that these products might be harmful. Some consumers still take the risk and purchase them. The authorities have also acted. Explain how the authorities can use the ELM model towards these consumers to not purchase such products. (25 marks) Question 3. When consumers make purchases, there are certain risks that are present. Based on the case given, Identify and explain, what are the relevant risks that the consumers should have paid attention to, but did not or chose to ignore. (25 marks) Question 4. The consumption and use of these unsafe products are activities the authorities want to discourage. Employing Instrumental Conditioning. Explain how the authorities can use it to discourage this behaviour. (25 marks)