Honey Carandang, a psychologist, was browsing through her Facebook feed when she spotted the video that featured Rappler CEO Maria Ressa “talking” about diabetes.
The video was a deepfake that used a previously recorded interview of Ressa and altered it using lipsync and voice spoofing technologies — two of the most commonly known generative AI technologies used to produce deepfakes.
Ressa has never promoted any diabetes cure. Rappler has since published a post on social media warning the public against this specific deepfake. It has also reported the issue to Meta, the owner of Facebook.
The social media platform immediately took down the original page that circulated the fake. But concerned users alerted Rappler to other pages that were also circulating the same fake content.
Ressa herself tried reporting the ads through Facebook’s reporting feature. On Saturday, August 24, she received a response from Facebook’s automated moderation system that said the platform did not remove the video.
The Ressa deepfake is also not the only one that has been peddling dubious diabetes-related cures on social media. To date, Rappler’s fact-check team has already fact-checked over a dozen claims related to dubious diabetes remedies.
Many of these fakes, which were promoted through programmatic advertising, have never been certified by health authorities. Generative AI technologies, however, are making the promotion of these dubious remedies more potent and convincing.
As Carandang put it, “It was made to appear that she (Ressa) was really the one speaking.” She added, “If I did not know Maria, I would believe it.”
Vulnerable market
Ressa is not the only personality whose clout and reputation the fakers are taking advantage of.
A quick check revealed that the page that circulated the ad was also running several other ads that featured other personalities promoting the similar, if not the exact same, message. These included celebrities Vilma Santos, Lucy Torres, and Regine Velasquez.
Responding to Rappler’s queries, Santos and Velasquez both sent messages through their respective representatives denying they endorse any diabetes treatment.
“That video is FAKE and completely fabricated. There is no truth to that,” Santos said in a statement.
“I call upon those people involved in this misinformation to immediately take down the said video and put an end to this kind of activity otherwise appropriate legal action will be made to protect my interest.”
Velasquez also denied endorsing any kind of drug for the treatment of diabetes. “Any kind of print, audio, or video depicting me at this time of doing anything of the sort, let alone advising anyone what to do with their insulin, is a fake and is an infuriating, disgusting lie.”
Potential harm
What was alarming about this series of deepfakes was the advice it was giving to diabetes patients: that they should discard existing remedies like insulin and metformin in favor of a home remedy and an unspecified capsule.
Insulin and metformin are treatments for managing blood sugar which are often prescribed by endocrinologists to patients with diabetes, a common ailment in the Philippines.
Approximately 4.3 million Filipinos were diagnosed with diabetes as of 2021. Experts estimate that millions more are likely to be undiagnosed. Diabetes was also one of the leading causes of death in the Philippines in 2023, according to the Philippine Statistics Authority.
In the fake Ressa video, the Nobel laureate falsely advises diabetes patients to “throw away” any insulin or metformin they have. She also supposedly claims that sales of these drugs have dropped by 76% allegedly because a “renowned endocrinologist” has “caused a stir online after revealing a natural way to get rid of type 2 diabetes without the use of these medications.”
The video does not name the “renowned endocrinologist.”
The post that circulated it only linked to what appears to be a website promoting health and fitness goals.
The website talks about personalized meal plans and urges users to “get a consultation” by giving their name and email address. It does not provide any specific scientific information about diabetes.
“They are mixing scientific evidence with lies,” endocrinologist Nemecio Nicodemus told Rappler.
There is some truth to what the videos were saying, Nicodemus said. “There are really studies that indicate that cinnamon may lower blood sugar. However, he warns that it (cinnamon) is a very weak blood sugar-lowering substance. “Therefore, by just taking this alone, your diabetes will not be controlled adequately.”
Leading cause of death
Promotional efforts such as these are targeting a huge potential and profitable market.
The Ressa deepfake did not mention a specific product. Glufarelin, a milk product marketed to diabetics and whose ads have been fact-checked by Rappler multiple times, sells for roughly P600 to P700 per can. Golden Insu, another product that figured in numerous Rappler fact-checks, sells for roughly P500. Both products are not FDA-registered.
It is therefore not surprising that social media platforms are deluged with content and advertising promoting supposed remedies to this disease.
Patients living with diabetes could be particularly vulnerable to manipulative advertising like these because, presently, there is no scientific evidence that shows that diabetes can be cured, Nicodemus explained.
“The medications that we are giving our patients are mainly for control of diabetes. There is really no treatment that says once you take this, your diabetes will be gone.”
Diabetes, according to endocrinologists, is a progressive disease. This means it tends to get worse with time.
The only way to prevent complications, according to Nicodemus, is by making sure that the patient controls his or her blood sugar. This means the patients need to make sure they take medication to lower blood sugar, including insulin, among others, as a form of treatment.
Aurora Macaballug, president of the Philippine College of Endocrinology Diabetes and Metabolism (PCEDM), told Rappler in an email that if a person living with diabetes (PLWD) discontinues his/her medications and resorts to the wrong advice, he or she could potentially “develop complications both acute and chronic.”
For instance, Macaballug said a PLWD can go into a hyperglycemic hyperosmolar crisis. This is a serious complication that happens when blood sugar levels are very high for a long period of time. A hyperglycemic hyperosmolar state is a life-threatening condition in a person with diabetes that can lead to severe dehydration and confusion, lethargy, or even coma.
A patient can also become acidic/ketotic, meaning the blood becomes too acidic due to lack of insulin. Diabetes-related ketoacidosis could be fatal if untreated.
Unmanaged diabetes, according to Macaballug and Nicodemus, could also result in kidney, heart, and/or brain complications, and could be fatal.
Capitalizing on well-known, reputable personalities
The deepfakes that featured Ressa, Santos, Torres, and Velasquez represent just the tip of the iceberg of a massive disinformation problem around diabetes-related health products.
Carandang, who describes herself as “borderline diabetic,” has been finding herself bombarded with various diabetes-related advertisements. She said this started when she did research on diabetes on YouTube about five months ago.
In fact, days after spotting the deepfake featuring Ressa, Carandang spotted another video featuring Father Carmelo “Tito” Caluag, incumbent Caritas Philippines executive director. Carandang said the Caluag video was also saying the same things that Ressa supposedly said.
Another page that concerned users reported to Rappler had ads running, which promoted both the Ressa deepfake and another deepfake of actor Aga Muhlach. The Muhlach deepfake echoed the same spiel used in the Vilma Santos deepfake. (See screenshot below)
Indeed, a quick search on the Facebook ads library showed that, as of August 21, 2024, at least 4,300 active ads used the keyword ”diabetes”. If the search is expanded to include inactive ads since May 2018, the result goes well over 50,000 active and inactive ads.
Many of these ads promoted dubious products.
At one time, Carandang admitted to have bought a product because the person who was supposedly endorsing it was well-known endocrinologist Augusto Litonjua. Litonjua, the founding president of the Philippine Society of Endocrinology and Metabolism, never endorsed the supplement.
“I bought the product because the ad was good and Dr. Litonjua was a strict person.” She also noted that the ad was so believable and that the ads she saw were never taken down.
Action needed
Besieged by untruthful promotions that became more frequent when the pandemic hit, Macaballug said the PCEDM tried to address the problem by filing a complaint as an organization with the cybercrime division. We tried reaching out to the cybercrime unit of the National Bureau of Investigation, but have not gotten any response. We will update this story when we do.
“We were told that only those whose faces or names were illegally used can file the complaints,” Macaballug said.
One endocrinologist, she said, actually did, but the case did not prosper for some reason.
Immediately after spotting the Ressa deepfake, a shocked Carandang reached out to Ressa to check if she indeed made those statements. At the time she reached out, Ressa and Rappler had already been alerted about the circulation of the deepfake that Carandang saw.
Rapper reported this to Meta, which promptly took down the original page that circulated the video. But as in previous instances of disinformation, it’s a whack-a-mole game.
Soon after Meta took down the page that originally circulated the diabetes deepfakes, other pages circulating the same ad cropped up. The post that Carandang spotted was posted by a different page. It was still active as of Tuesday, August 27.
Carandang is concerned that people might believe the ad because of Ressa’s credibility.
“There has to be a punishment,” said Carandang, who works with Cyberguardians PH, a non-profit that advocates for the protection of children and youth in cyberspace. She lamented how lying has been normalized on social media.
“It is not just a crime anymore, it is a way of life. Normalized na. ‘Yan ang nakakatakot,” Carandang said. (It’s already normalized. This is what’s frightening.”)
Nicodemus urged the public to be vigilant. “Before you even believe, make sure you validate it and verify it. In the healthcare field, the best source would be your doctor.” – Rappler.com