First of 2 parts

One quiet afternoon in October 2024, my 72-year-old mother approached me, her smartphone in hand. “Is this true?” she asked, her voice tinged with concern. She turned the screen toward me, revealing a YouTube ad video featuring a familiar face: Dr. Terawan Agus Putranto, a well-known former Indonesian health minister who served from 2019 to 2020.

In the video, Dr. Terawan appeared to endorse a miraculous cure for joint pain. However, something about it felt off. With a closer look and the help of a digital tool, I discovered that the video was a deepfake — a computer-generated manipulation of Dr. Terawan’s image and voice designed to peddle a fraudulent health remedy. 

The video my mother stumbled upon is part of a much larger, more alarming trend. Deepfakes have become favorite tools for scammers. These fakes are being circulated across platforms, not just YouTube. 

While working on this story, this author also found many more deepfakes by wading through data obtained from Meta’s Ads Library platform, which has an inventory of ads posted on Facebook and Instagram. 

In 2023, Tempo’s Cek Fakta team debunked only four deepfakes. In 2024, this number jumped to 43. Most are health-related. This sharp growth highlights a concerning trend in the use of deepfake technology for promoting health-related claims within just one year. These fakes capitalize on the credibility of trusted figures like Terawan, manipulating their likenesses to sell fraudulent or falsely advertised health products.

As a pensioner, my mother consistently engages with videos and links shared in a WhatsApp group of alumni and work colleagues. This is where she stumbles from time to time on various deceptive content. She isn’t alone in her vulnerability. Countless Indonesians with online behavior similar to hers are unknowingly exposed to scams every day.

My mother does not suffer from arthritis or joint pain. However, she does have hypertension. What is most worrisome is data that shows that many of these health-related fakes appear to be targeting individuals like her who have serious diseases like hypertension and diabetes. 

Indonesian health regulations strictly prohibit deceptive advertising, according to the agency regulating food and drug products in the country. However, the law lags behind rapidly evolving technologies like AI-generated fakes, making it difficult for authorities and those who were impersonated to go after perpetrators.

A rising deepfake epidemic

Apart from Dr. Terawan, several prominent Indonesian medical professionals and public figures and TV presenters, have become victims of deepfake technology used to promote unverified health products. Two other former health ministers have also been frequently impersonated. They are Dr. Nila Djuwita Faried Anfasa Moeloek, who served as health minister from 2014 to 2019, and Dr. Siti Fadilah Supari who was health minister from 2004 to 2009.

Of these personalities, however, it is Terawan — a retired lieutenant general from the Indonesian Army — who has become one of the most frequently impersonated individuals in a wave of deepfake videos circulating across Indonesian social media platforms. These videos often feature his image promoting everything — from arthritis cures to treatments for hypertension and diabetes — conditions that disproportionately affect older adults like my mother.

From 2023 to 2024, Cek Fakta Tempo has already debunked 29 health-related deepfake videos, with 35.7% targeting hypertension treatments alone. Other conditions, like diabetes and joint pain, are also frequent targets.

Many of these were being promoted through boosted posts and ads. In fact, this author found that Meta’s Ads Library is teeming with ads that use deepfakes promoting dubious health products. 

To get a sense of the extent of boosted promotional content that use deepfakes, this author reviewed data collated from Meta’s Ads Library from October 30 to November 18, 2024, and manually identified each content type. 

Among 2,454 ads featuring the keyword “hypertension cure,” 999 (40.7%) were identified as deepfakes. These ads stemmed from just 10 unique contents, boosted multiple times as evidenced by multiple ad IDs through various Meta platforms. 

On the other hand, at least 16,318 out of 56,837 ads (28.7%) with “Diabetes cure” keywords are deepfakes. The fakes typically consist of stolen video clips manipulated using artificial intelligence (AI) and paired with fabricated narratives to mislead audiences.

This author tried to get a comment from Meta’s representatives concerning findings from this research but has yet to get a response. This story will be updated as soon as we receive a response.

The impact of these deepfakes on public health cannot be underestimated. After all, according to the World Health Organization, diabetes and hypertension are among the 10 leading causes of death in Indonesia. Indonesian Health Survey in 2023 records show that the prevalence of diabetes in the country has increased in the past half decade. It is now at 11.7% of the population aged 15 and older in 2023, up from 10.9% in 2018.

Exaggerated claims, serious consequences

The consequences of these deepfake advertisements could be serious. Not only do they alienate people from conventional medical treatment, they also shake the confidence of patients who have been routinely treated. 

Most of the fakes found by this author are promoting products that fall under the category of Jamu or traditional herbal medicines. While these are legitimate products, they are not approved as treatments for these chronic conditions.

Health experts stress that while these herbal supplements can play a complementary role in managing chronic conditions, they should not replace treatment plans prescribed by qualified medical professionals.

Diabetes mellitus is a disease that requires pharmacological therapy, meaning medications are needed to control and lower blood sugar levels, Dr. Arie Trisandy Adesaputra, a doctor at Surabaya’s Ketabang Health Community Center, said.

“Avoiding standard treatment for diabetes, such as Metformin, can be very harmful to patients,” Adesaputra said. He added that if a patient stops taking Metformin or other medications prescribed to control blood sugar, their diabetes will not be controlled. 

“This lack of control can lead to various negative effects, including complications that affect all organs in the body,” he said. Irregular blood sugar levels can have severe consequences. It is crucial to take prescribed diabetes medications regularly and as directed to maintain proper blood sugar control and avoid detrimental side effects.

Patients whose blood sugar levels exceed 288 mg/dL, will need to be carefully managed, Djoko Agus Purwanto, a professor of pharmaceutical chemistry at Airlangga University pointed out. This is to avoid further harm to the pancreas caused by such high sugar levels. 

Purwanto pointed out that while anti-diabetic drugs are able to swiftly reduce blood sugar levels, herbal medicine can take a long time to take effect. “Resolving the disease’s symptoms in time can prevent various damages,” he said. 

He added, “Patients may use herbs as antioxidants after the symptoms have subsided because they can restore physiological conditions.”

Troubling concern

Unfortunately, the health supplement deepfakes ignore these nuances and often exaggerate claims, to the point of disparaging health experts. 

One concerning impersonation deepfake features Dr. Terawan calling all those who manage their hypertension with surgery and drugs that only lower blood pressure, as “stupid.” The fake portrayed Terawan as appearing to sharply criticize modern methods of treating hypertension promoted by “fake cardiologists and pharmacists.”

“Corrupt pharmacists and cardiologists will despise me for this revelation,” the fake Dr. Terawan said in the video. The video went on to discuss a “cure” that will supposedly “permanently normalize” patients’ blood pressure “within 17 days — no dietary restrictions or exercise needed.”

Adesaputra shared a troubling experience related to this with a couple of elderly female diabetes patients who abruptly stopped their prescribed treatments after encountering a deepfake video. 

Both patients raised concerns with Adesaputra over rumors of the dangers of using Metformin during their routine check ups. One of the patients said that she was afraid to be given Metformin because she saw a video of “Dr. Terawan” saying that Metformin has been banned from being used to reduce diabetes. 

“She did not mention if it was a video on YouTube or WhatsApp. I didn’t ask for the evidence because it was difficult for her to remember how she got it,” Adesaputra explained.

Adesaputra explained to his patient that Metformin is still listed in the diabetes treatment guidelines for healthcare workers worldwide. Health centers, he said, still prescribe Metformin for this reason. 

He also explained to the patients that while Metformin does have potential side effects, these are rare. They can include headaches, lack of energy, digestive problems, such as diarrhea, vomiting, and flatulence, abdominal discomfort. 

“But Ma’am, would you rather have uncontrolled blood sugar or to have Metformin side effects that are theoretically only a few percent likely to occur?” he asked. Fortunately, both patients accepted his explanation and accepted prescribed treatment.

Violating food and drug control laws

Misrepresentation of facts about food and drug products — particularly those featuring former health ministers, healthcare professionals, or public figures — violate various regulations governing food and drug promotions, according to the Badan Pengawas Obat dan Makanan (BPOM, or the Indonesian National Agency of Drug and Food Control).

“Such promotional tactics are deceptive and can confuse the public, erode trust in registered products, and harm the reputation of the individuals whose names are misused,” said Taruna Ikrar, head of BPOM, in a written statement to this author via WhatsApp on January 8, 2025.

Ikrar cited two BPOM regulations that could be used to go after the deepfake perpetrators. 

One of the regulations is Regulation BPOM No. 34 of 2022 concerning the Supervision of Advertising of Herbal Medicines, Quasi Drugs, and Health Supplements, which governs the advertising of traditional medicines — also known as herbal medicines. 

The other regulation, Regulation BPOM No. 6 of 2021, concerns the Supervision of Advertising of Processed Food, and regulates the advertising of processed food.

According to these regulations, advertisements must be objective and not misleading, they cannot feature visualizations or information related to nutrition claims, health claims, or other claims not approved during product registration, and they cannot contain statements about health, beauty, or skincare unless they are consistent with the approved product label.

The BPOM also emphasizes that advertisements must not deviate from the product’s inherent properties, benefits, and safety. “Furthermore, advertisements should not mislead by exaggerating, exploiting public anxieties about specific health conditions, or creating false perceptions.”

Ikrar said the institution is committed to tackling the issue of misleading and deceptive AI-generated ads by implementing several strategies to address violations, particularly those promoting traditional medicines and processed foods. 

“We are actively working to strengthen regulations, enhance monitoring efforts, collaborate with stakeholders, educate the public, and take down illegal content to protect consumers from harm,” he said. Related to this, he said the BPOM has identified over 1.3 million illegal product promotional links since 2021. 

“We already recommended blocking these links to the relevant parties, including Kemenkominfo,” he said.

Legal blindspot

At a broader level, however, Indonesia still lacks clearer legislation around AI-generated content. Victims who have been impersonated, like the health ministers impersonated in fraudulent ads, often find themselves with limited recourse against the perpetrators.

Former health minister Siti Fadilah Supari, a frequent target of deepfake advertisements, described her frustration in seeking justice. “I wanted to sue them, and I even consulted a lawyer, but there is no specific law on AI-generated impersonations,” she said. 

Her sentiment is echoed by other public figures whose reputations have been tarnished by these digital manipulations. For example, former health minister Nila Faried Anfasa Moeloek. Moeloek, who is an ophthalmologist, was misrepresented as an expert on sexual health promoting a prostate cancer cure in a TV show titled, “Kick Andy.” Moeloek was embarrassed because this is clearly out of her field of expertise. 

Even when authorities act, their efforts often feel like a game of whack-a-mole. 

Websites hosting fraudulent content disappear, only to resurface under new domains. Moeloek has reported the deepfake, which impersonated her to the Ministry of Communication and Information (now called Ministry of Communication and Digital) and the Badan Pengawas Obat dan Makanan (Indonesian National Agency of Drug and Food Control). 

“It’s difficult. Sometimes they disappear, but then they reappear. I’m really annoyed by them.” (To be concluded) – with Gemma B Mendoza/Rappler.com

Artika Farmita is a journalist and fact-checker Tempo Indonesia’s Cek Fakta fact-checking arm. She is based in Surabaya, Indonesia and is one of Rappler’s #FactsMatter Fellows for 2024.. She has a strong interest in health and science issues, contributing to Tempo’s 2015 investigative reportage on the collusion between pharmaceutical companies, doctors, and hospitals, and has covered science topics from tropical to stem cell research developments. Now, she focuses on raising awareness about online scams, health-related disinformation, and the ethical implications of AI.