The US pharmaceutical industry spent $6.1 billion on advertising prescription drugs directly to consumers in 2017. Since 1962 these ads have been regulated by the Food and Drug Administration (FDA) to ensure that they are not false or misleading. The United States and New Zealand are the only two countries where direct-to-consumer (DTC) advertising of prescription drugs is legal.

Proponents of DTC prescription drug ads contend that the ads inform patients about diseases and possible treatments, encourage people to seek medical advice, help remove stigma associated with medical conditions, and provide needed sales revenue to fund costly research and development (R&D) of new drugs.

Opponents contend that DTC drug ads misinform patients, promote drugs before long-term safety-profiles can be known, medicalize and stigmatize normal conditions and bodily functions like wrinkles and low testosterone, waste valuable medical appointment time, and have led to our society’s overuse of prescription drugs. Read more background…

Pro & Con Arguments

Pro 1 Direct-to-consumer (DTC) prescription drug ads encourage people to seek medical advice from health professionals. 64% of physicians surveyed in Apr. 2013 agreed that DTC ads encourage patients to contact a health professional. A 2010 Prevention Magazine survey reported that 29 million patients talked to their doctors about a medical condition after seeing DTC prescription drug ads and most discussed behavioral and lifestyle changes; over half of those patients received non-prescription or generic drugs rather than the brand-name prescription drug seen in the ad, meaning that talking to the doctor was the real benefit. Patients with lower incomes and education levels who are less likely to seek medical care in general were more likely to see a doctor after seeing DTC prescription drug ads. A 2005 Journal of Family Practice article found that 83% of prescription drug print ads focused on patient-physician communication and 76% promoted dialogue with health care professionals. According to a 2004 FDA survey, 77% of people said DTC ads increased awareness of new drugs and 58% thought the ads gave enough information to help them decide whether to speak to a doctor. 73% of doctors thought patients asked thoughtful questions because of DTC ads and about 33% of patients thought of a question to ask their doctors as a result of a DTC drug ad. Pro 2 DTC prescription drug ads inform patients about diseases/medical conditions and possible treatments. 44% of patients responding to a 2007 survey published in Clinical Orthopaedics and Related Research said DTC prescription drug ads helped educate them about drugs, medical conditions, and treatments. An Apr. 2013 FDA survey found that 48% of doctors agree that DTC ads “inform, educate, and empower” patients. The FDA requires that benefits and risks of drugs be included in ads to inform patients. Pro 3 DTC prescription drug ads encourage patient compliance with treatment instructions. 81% of doctors surveyed for a 2007 article published in Clinical Orthopaedics and Related Research thought DTC prescription drug ads had a positive impact on patient compliance (taking drugs as directed). The most compliant group of prescription drug takers were patients who requested a prescription as a result of having seen a DTC ad. 18% of people responding to a FDA survey said DTC ads reminded them to take their medications. Pro 4 Diseases and medical conditions are more likely to be treated when consumers see DTC prescription drug ads. According to a 2004 FDA survey, 88% of the physicians who had patients ask about drugs seen in DTC ads reported that the patients had the conditions the drugs treat and were thus able to get treatment. For example, Procrit is a drug used to counteract anemia and can be used to help chemotherapy patients with fatigue. Prior to an ad campaign for the drug, it was rarely prescribed because chemotherapy patients were not reporting fatigue caused by the chemotherapy to their doctors. After seeing the ad, however, patients reported fatigue and could be appropriately diagnosed. In 2007 the FDA approved a drug for fibromyalgia, a condition that previously had no drug treatment, so patients with the condition were made aware of a possible treatment through DTC prescription drug ads and could speak to their doctors in order to receive treatment. Pro 5 DTC prescription drug ads help remove the stigma associated with certain diseases and medical conditions. According to a 2013 CMI/Compass survey, 52% of physicians agree that DTC ads help remove stigma associated with health conditions. The removal of stigma makes it easier for patients to acknowledge their health issues and feel comfortable discussing their health problems with physicians and others. The advertisements for Viagra, for example, have made male sexual dysfunction and treatment commonplace. Ads for drugs treating mental illnesses like depression has contributed to de-stigmatizing those conditions, which have helped patients get treatment. Pro 6 DTC prescription drug ads create revenue for drug companies, which can be used for research & development (R&D) to create new life-changing drugs. Drug development is expensive so pharmaceutical companies need to recoup that expense through advertising. For every $1 spent on DTC ads, sales of prescription drugs rose by $4.20. In 2012, the pharmaceutical industry spent $3.1 billion on direct-to-consumer advertising. On average, drug development for a single drug costs at least $4 billion and as much as $11 billion. Drug companies that develop new drugs have a period of market exclusivity before generic drugs can be made by any company. Revenue is needed to recoup R&D costs before generic drugs enter the marketplace and lower the prescription drugs’ retail prices. Pro 7 DTC prescription drug ads should be allowed as protected free speech. Doctors, hospitals, medical device makers, insurance companies and all types of health care-related companies can advertise their products. Prescriptions drug companies should be allowed to advertise their legal, FDA-approved, life-improving products too. Uwe Reinhardt, PhD, Professor of Political Economy, Economics and Public Affairs at Princeton University, in an Oct. 9, 2002 interview with Frontline, stated: “There is the First Amendment. You make new products. Why can’t you tell people about it? Why should that industry be forbidden to do it, when the auto industry can advertise SUVs? Right? You can ask yourself.” In 1975 in Virginia State Board of Pharmacy v. Virginia Citizens Consumer Council, Inc., the US Supreme Court (7-1) found that “a State may not suppress the dissemination of concededly truthful information about entirely lawful activity, fearful of the information’s effect upon it disseminators and its recipients” when considering whether Virginia could prevent prices from being included in DTC prescription drug ads. Con 1 Direct-to-consumer (DTC) drug ads misinform patients. 63% of physicians surveyed in Apr. 2013 believed DTC prescription drug ads misinformed patients and 74% of physicians believed DTC prescription drug ads overemphasized the benefits of the drugs, resulting in misinformed patients. According to a study published in the Sep. 2013 issue of Journal of General Internal Medicine, 60% of claims made in DTC prescription drug ads aired from 2008 to 2010 “left out important information, exaggerated information, provided opinions, or made meaningless associations with lifestyles.” The study found 43% of the claims in DTC drug ads were “objectively true” while 55% were “potentially misleading” and 2% were “false.” DTC prescription drug ads are often above the recommended 8th grade reading level for mass-distributed information, meaning a lot of consumers cannot understand the information presented. Most DTC prescription drug ads spend more time on benefits than negative side effects. 84% of regulatory letters sent by the FDA from 1997 to 2006 cited ads for minimizing risks and/or exaggerating effectiveness of drugs. A Feb. 26, 2018 study published in the Journal of General Internal Medicine found that “few broadcast DTC ads were fully compliant with FDA guidelines,” and that the “overall quality of information provided in ads was low.” Con 2 DTC prescription drug ads promote drugs before long-term safety information is known. According to an Apr. 2013 survey, 68% of doctors agree that prescription drugs are marketed before safety profiles can be known. Although the FDA does not approve ads before they air on TV or radio, 50% of consumers surveyed thought DTC prescription drug ads were approved by the government. 43% of consumers surveyed thought the drug had to be 100% safe before being advertised but not all drugs have completed long-term safety trials before advertising begins. Vioxx was advertised, requested by patients, and prescribed from 1999 to 2004 for arthritis and pain relief before being withdrawn from the market for causing strokes and heart attacks. Vioxx was listed as the primary suspected cause of death in 4,540 mortalities from Jan. 1, 1999 to June 30, 2005. Other drugs like Bextra (for arthritis), Quaalude (a sleeping aid), Cylert (for ADHD), Darvon (for pain relief), and Zelnorm (for irritable bowel syndrome) have been taken off the market for safety concerns after being advertised to the public. Between the 1970s and 2014, at least 35 drugs were pulled from the market, most for safety concerns. A Sep. 2006 Institute of Medicine (IOM) report recommended that DTC advertising be banned for new drugs for two years. Con 3 Normal conditions and bodily functions are medicalized and stigmatized by DTC prescription drug ads. DTC prescription drug ads tell consumers that normal attributes, such as thinner eyelashes, or normal aging processes, such as lower testosterone levels and wrinkles, are medical conditions that need to be remedied with drugs. DTC ads create the idea that normal conditions are “bad,” resulting in the stigmatization of non-problematic conditions. Botox is promoted to treat wrinkles and Latisse is advertised for thin eyelashes while AndroGel is marketed for “LowT” or low testosterone resulting in erectile dysfunction and other conditions. Ads for “Low T” drugs include statements like, “Some men may think loss of energy is just a part of aging. However, low energy may not just be a sign of getting older—it may also be a symptom of Low T.” Con 4 DTC prescription drug ads encourage over-medication. 81% of doctors surveyed in 2013 say that DTC prescription drug advertising promotes drug overutilization. DTC prescription drug ads tend to emphasize that drugs (vs. diet or exercise) are needed to improve health. Attention Deficit Hyperactivity Disorder (ADHD) medication is prescribed about 25 times more frequently in the United States than in the United Kingdom, which does not allow DTC prescription drug ads. From 1996 to 2005, the pharmaceutical industry tripled spending on marketing for psychotropic drugs, including a 500% increase in DTC ads. Americans’ use of psychotropic drugs, such as Prozac (an antidepressant) and Lunesta (a sleep aid), increased 22% from 2001 to 2010, resulting in one in five adults taking at least one psychotropic drug. Steven Holton, PhD, a psychology professor at Vanderbilt University, states “I would say at least half the folks who are being treated with antidepressants aren’t benefitting from the active pharmacological effects of the drugs themselves but from a placebo effect.” Con 5 Health care professionals may feel pressured by DTC prescription drug ads to prescribe drugs that may not be in the best interest of the patient. 94% of oncology nurse practitioners surveyed for an article published in the Journal of Clinical Oncology had a patient request an advertised drug, 74% had a patient request an inappropriate drug, and 43% responded that they felt pressured to prescribe the inappropriate drug. Over half of requests for prescription drugs seen in DTC ads were honored by doctors. Kurt C. Stange, PhD, Professor of family medicine and community health at Case Western Reserve University, states, “Consumer advertising, delivered to the masses as a shotgun blast, rather than as specific information to concerned patients or caregivers [from healthcare professionals], results in more prescriptions and less appropriate prescribing.” Con 6 DTC prescription drug ads weaken relationships between patients and healthcare providers. 80% of doctors surveyed in Apr. 2013 thought DTC prescription drug ads weakened doctor-patient relationships. Patients who are convinced that an advertised drug will solve their problems often mistrust a doctor’s advice if the doctor suggests an alternate solution. After being denied the requested drug, almost 50% of patients surveyed were disappointed with their doctors, 25% responded that they would try to convince the doctor to prescribe the desired medication or obtain the drug somewhere else, and 15% said they would change doctors. If a patient is denied a requested drug, the patient may stop thinking about the doctor as a learned intermediary and ignore important information from the doctor. Many doctors complain that it takes a lot of appointment time to explain to a patient why a specific drug may not be the best or most appropriate option instead of spending that time discussing appropriate treatment options, tests and screenings, and lifestyle changes. Con 7 DTC prescription drug ads increase health care costs. 78% of doctors surveyed in 2013 agreed that DTC prescription drug ads increased the cost of healthcare. 37% of doctors surveyed said they often or sometimes prescribed brand name drugs because the patient requested the brand name drug rather than prescribe the equivalent and cheaper generic drug. Brand name drugs cost 30 to 80% more than generic drugs. Because generic drugs are not advertised and do not require R&D budgets to develop, they are cheaper than brand-name drugs. According to a Nov. 23, 2009 study published in Archives of Internal Medicine, the cost of Plavix increased (as did the amount of Medicaid funds spent for Plavix in pharmacies) due to the need to recoup the high costs of DTC drug advertising. Con 8 DTC prescription drug ads are banned in every country but the United States and New Zealand. All other countries ban all forms of DTC prescription drug ads (except Canada, which allows limited forms of reminder ads). The United States is 5% of the world’s population but accounts for 42% of global prescription drug spending. The World Health Organization (WHO) stated in 2000, “Advertisements to the general public should… not generally be permitted for prescription drugs,” and in 2007 the WHO group on DTC prescription drug ads “made a unanimous recommendation to prohibit direct-to-consumer advertising.” 57% of US adults support removing prescription drug ads from TV.