The FTC updated its Endorsement Guides in 2023, the first major revision in over a decade. The update tightened several areas that specifically affect healthcare practices - social media disclosure standards, incentivized review rules, liability for endorser statements, and specific rules on consumer reviews. This is the plain-English breakdown of what changed and what it means for day-to-day healthcare marketing.
What the Endorsement Guides do
The FTC Endorsement Guides (16 CFR Part 255) interpret the general FTC Act prohibition on deceptive advertising as it applies to endorsements and testimonials. They define what counts as an endorsement, what disclosures are required, who is liable for what, and what practices the FTC considers deceptive. Every practice using testimonials, influencer partnerships, or consumer reviews in marketing is subject to them.
The key 2023 changes
Change 1: Clear and conspicuous standard tightened
The 2023 update specifies that disclosures must be “clear and conspicuous” - and provides explicit guidance on what that means in different media. Fine-print disclosures, disclosures only in video descriptions (rather than the video itself), disclosures behind “more” clicks, and disclosures in non-English when the ad is in English - all explicitly addressed.
For healthcare practices: this tightens expectations on every testimonial disclosure, material-connection disclosure, and typical-experience disclosure. Most practices’ existing disclosures do not meet the updated standard.
Change 2: Social media specifics
The update addressed social-specific disclosure issues directly - Instagram Story disclosures, TikTok video disclosures, YouTube disclosures, live-stream disclosures. The principle is consistent across platforms: the disclosure must appear where and when the endorsement is seen, not linked elsewhere.
For healthcare: every Instagram caption with a testimonial, every TikTok with patient-outcome content, every live-stream with treatment discussion has specific disclosure requirements. The 2023 update makes the requirements harder to meet with retrofitted fine-print approaches.
Change 3: Incentivized reviews and review-gating
The update specifically addresses incentivized reviews (reviews given in exchange for discounts, free treatment, or other material compensation) and review-gating (soliciting feedback privately first and only asking happy patients for public reviews). Both practices are explicitly deceptive under the updated Guides.
For healthcare: many practices gate reviews in some form - asking about experience via email, following up on positive responses with review requests, not following up similarly on negatives. This practice is now explicitly flagged.
Change 4: Consumer review sections of websites
The Guides now address how a business treats its own consumer review sections. Deleting or suppressing negative reviews, responding in ways that mislead about context, and using “verified purchase” badges inconsistently all draw scrutiny.
For healthcare practices with patient portal reviews or website testimonial sections, this means review curation practices matter. Displaying only positive reviews while suppressing comparable negative ones is a deceptive-practice pattern.
Change 5: Endorser liability
The update clarifies that endorsers themselves can be liable for deceptive claims in their endorsements, not just the brand. This matters for physicians endorsing products or services, employees endorsing their employer’s services, and influencers endorsing healthcare.
Practical effect: influencers working with healthcare practices may now exercise more caution (or ask for indemnification), and practices should expect more formal contracting around endorsement relationships.
Change 6: “Fake” endorsements and AI-generated content
The update addresses fake endorsements, including AI-generated “testimonials” and stock-image before/afters presented as real patients. These practices are explicitly deceptive. The emergence of generative AI makes this category increasingly relevant.
Change 7: Expert endorsement standards
Experts endorsing products and services face clearer requirements: expertise must be genuine and relevant to the endorsement, and the endorsement must reflect the expert’s actual evaluation using the expertise. Physicians endorsing products they don’t actually use or evaluate face specific scrutiny under this section.
Practical implications for healthcare practices
Audit every testimonial
Review every testimonial in current marketing against the updated standards: clear-and-conspicuous disclosure, material connection identified, typical experience disclosed, authenticity verified. Most will need updating.
Update influencer contracts
If you work with influencers, update contract language to reflect the 2023 standards - disclosure requirements in specific formats, liability allocation, and review processes for content. Most pre-2023 influencer contracts are inadequate.
End review gating
If your review-solicitation process treats happy and unhappy patients differently, fix it. Solicit all patients for reviews the same way. Resist the instinct to screen before soliciting.
Revise disclosure placement across platforms
The same endorsement may need different disclosure formats for website, Instagram, TikTok, and email deployments. Create platform-specific templates that meet the 2023 clear-and-conspicuous standard in each format.
Train staff on new standards
Social media managers and content producers need updated training on the 2023 standards. What was compliant in 2020 isn’t necessarily compliant now - and most staff training hasn’t been updated.
Enforcement trajectory
The FTC has not yet undertaken widespread enforcement of the 2023 standards against healthcare practices specifically, but enforcement is incremental and expected. The patterns the agency targets first are typically the most-egregious and highest-reach cases. Practices aligning with the 2023 standards now are insulating themselves against expected future enforcement waves.
Frequently asked questions
Do the 2023 Guides apply retroactively?
The Guides interpret existing FTC Act prohibitions, so in principle the underlying deceptive-practice authority was always there. Practically, the 2023 Guides put practices on notice of specific interpretation updates, which affects how enforcement will look going forward.
How should disclosures look in video content?
Visible, readable text on screen throughout the relevant portion of the video. Not in the description only. Not in a two-second end card. The disclosure should be present while the endorsement is being seen.
What about testimonials we gathered years ago?
Continuing to use older testimonials in current marketing is using them now - the 2023 standards apply to current use, not just to when the testimonial was gathered. Retire testimonials that can’t be properly framed under current standards.
Does this affect patient-satisfaction marketing generally?
Yes. Any claim about patient satisfaction is effectively an endorsement-style claim. “95% of our patients are satisfied” requires substantiation meeting FTC standards and needs appropriate disclosure of the source and methodology.
How do celebrity endorsements specifically work under the 2023 update?
Celebrity endorsements face clear-and-conspicuous material connection disclosure in the specific post or piece of content itself. Bio-link disclosures, sponsorship hashtags buried in long caption blocks, and similar approaches don’t meet the updated standard.
What if a patient writes an unsolicited positive review?
Organic unsolicited reviews are still permitted and don’t require disclosures (there’s no material connection). But if your practice incentivizes or solicits reviews, then those reviews are subject to the full disclosure framework.