Could You Live Without Direct-to-Consumer Ads?

In the New England Journal of Medicine, Dr. Miriam Shuchman writes about the movement in Congress to allow the FDA to block direct-to-consumer ads for new drugs.

“There is popular support for a ban: in a telephone survey conducted in March 2007 by Consumer Reports, 59% of respondents ‘strongly agreed’ that the FDA should ban advertisements for drugs that had safety problems,” Shuchman writes. “But some legal scholars believe that such a ban would be overturned by the courts as unconstitutional.”

There is a big difference, of course, in ads for “drugs that had safety problems” and all the rest. Still, here is a look at the increase in DTC advertising in recent years:

I was thinking about DTC advertising a few weeks ago when I was in Madison, Wisc., and visited an exhibit on the history of toys at the Wisconsin Historical Museum. The exhibit made the argument that the advent of television, and particularly TV advertising, is what turned the toy industry into a juggernaut. Why? Because, for the first time, manufacturers could market their goods directly to the customers — that is, to children. Mattel was apparently the first company to grasp this phenomenon, and saw its sales increase from $6 million to $49 million in the space of six years. (I have no idea how accurate this information is, nor do we learn how much money Mattel spent on its TV advertising; but still … the DTC point seems valid.)

Almost every knowledgable person I know in the healthcare field, when talking about high healthcare costs, points to the advent of DTC advertising as a major factor, since it is so good at driving consumer demand. These same people universally bemoan the fact that this demand is not only costly but, from a medical standpoint, often counterproductive.

I do know of some people, however, whose lives would be gravely endangered if DTC advertising were restricted or limited: TV executives. It is no secret that the networks have come to depend very heavily on pharmaceutical ad dollars, particularly the evening news broadcasts. I remember seeing a list not long ago of the top ten advertisers on the three big networks’ nightly newscasts. Twenty-nine out of the thirty advertisers were pharmaceuticals; the 30th was for an affordable car — I think it was a Hyundai.


Only physicians can prescribe drugs. If DTC results in wasteful prescriptions, then it must be the case that physicians are not doing a good job dispensing medical advice and acting as gatekeepers. That is the root cause of the problem.

DTC is not the cause of "high healthcare costs". Costs were rising steeply prior to use of DTC.


One thing is clear and that is that DTC raises the awareness of certain drugs to a position where they doctors are forced to prescribe a branded drug over an equally effective generic version (Nexium springs to mind).


The counter to this is that many Doctors are not aware of the latest options for treatment of various diseases. Although the internet and patient groups have helped a lot, the DTC information can at least make sure people are aware of their options. If their Doctor is not a quack, he/she will inform the patient whether the branded med is suitable or not, based on specific characteristics and price. The DTC model is probably more fair than the old reps bribing the Doctor approach of the past.
Note that most Doctors know if a generic is available (or can check) and are usually aware of the insurance policy of the patient. Any patient can ask the Doctor if there is a generic available. Also, many prescriptions indicate that a generic is OK, so the pharmacist will select the generic.
The real story here is that patients can and should get more involved in their own treatment, with or without DTC marketing.



Man those poor TV Execs, they wouldn't be able to buy any more Asheras!


Every Sunday I manage my parents' medications; a combined total of 30 prescribed drugs. My sister and I have noticed that there is a direct correlation between advertising and expense. Not only are generics often available but unprescribed, but older drugs are often just as effective, if not as profitable.

By the way, every Monday I'm a supporter of socialized medicine. You can call single-payer a redistribution of wealth, but taking an 80 year old man's life savings to pay an incompetent pharmaceutical company CEO's eight-figure severance package is also a redistribution of wealth.


I stopped watching network tv a few years ago becauseof all the Drug ads. This sound like something that a liberal dreamed up. The funny thing is it will hurt liberal leaning media the hardest . So i am all for it .

The main reason for the skyrovesting cost of health care . Ith that massive increase in the number ofmedication people are on and the fact that younger people are on more and more medications.


I beg to differ, DHH- as pkimelma points out, the democratization of medicine is underway, both for ethical and cost reasons- so it is no longer the case that MDs dictate what medicine the pt. is on- the marketing of drugs (never innocuous) like candy is clearly unethical and there is ample precedent for the FDA to ban it, thereby lessening the cost of the drugs by circa 4.2 billion$


I don't see how this would be unconstitutional considering that congress banned tv and radio tobacco ads in the 70s.


We are spared the vast majority of medical TV adds in the UK largely I imagine because of our National Heatlh Service. Pharmaceuticals probably spend most of their marketing budget targeting the health providers rather than UK consumers directly.


I have mixed thoughts on this. Drug DTC sales were outlawed not long ago. I remember when the debate was going on. Those opposed said that it would result in confusion and unnecessary sales to the ignorant public.

Well, I guess it did. The Ron Paul in me just wants to ask if this is just another tax on the stupid? Sort of like the lottery? Free choice and all of that.

But deanzat's comments give me pause. This whole doctors/drug companies/insurance compainies triad is getting to be like a one payer system without any controls.


"There is a big difference, of course, in ads for “drugs that had safety problems” and all the rest."

The only difference is that the rest did not have the safety problem yet. You will in the end always find somebody who has an unforseen reaction to a certain kind of treatment, especially when you cannot exclude any possible combination of circumstances. True, some drugs may have more severe safety problems than other but where to draw the line?

Bruce Hayden

Coincidently right now, I am reading a book on this, and the example given is Claritan. It was apparently advertised as being nondrowsy. The problem was that it was nondrowsy only in the dosages that were often ineffective. At dosages that worked as well as the competition, it was caused just as much drowsiness. The manufacturer was able to suppress 4 of 5 studies, and the fifth was recast to show the benefits.

Apparently though the advertising worked, because the manufacturer made huge amounts of money on having patients ask for the drug, despite its much higher cost.

The other side though is that physicians are most often fairly ignorant about most drugs. There are so many of them out there right now, and patient loads are so high that they just don't have time to keep up.

One solution that a friend of mine is pushing is putting PharmDs in medical practices to keep up with this. The PharmDs know more about most drugs than the sales people who come calling, and can spend the time to be experts here. They can also provide help in preventing drug interactions. Of course, the big problem is how to get them paid.



The U.S. and New Zealand are the only countries in the world that have legal consumer advertising. There is a reason. These advertisements are often significantly misleading and the FDA basically doesn't regulate them...then when people talk about banning them to protect the public health, it's "unconstitutional."

Funny, it was fine to keep these advertisements banned until 1997....

And the author is very correct that your chances of seeing good journalism aimed at critiquing Big Pharma goes down with every dollar spent advertising on network news...


My doctor, if he is representative, gives a good economic case for prescribing the DTC drugs. Patients come in and INSIST on whatever they saw on TV. He has tried numerous times to steer people to generics, or to a more appropriate medication, but, he sighed, "it often takes 20 minutes to talk them out of their conviction."

Do the math. It is economically practical to take two minutes to attempt to dissuade the patient, then cave in and "write the scrip." TV, especially with heavy repetition, and especially with older people (the evening news audience) has more credibility than a real live physician.

Note: as an advertising professional, I'm not particularly proud of this....


DTC is fine. It raises awareness of new medications, giving patients access to them quicker than they otherwise might have.

The real problem here is the insurance. If you want people to take generics instead of the branded pill, you'll need to give them an incentive. Right now, the choice is between a $25 generic or a $30 co-pay on the stuff they saw on TV. Meanwhile, the insurance pays $500 to the drug company for a pill that costs a quarter to make.

And at the same time, it's definitely not in the physician (or pharmacist's) interest to waste their own time dissuading patients of taking drugs; if your doctor doesn't give you what you want, you can go to another doctor!

Anyhow, the problems people bring up in relation to DTC are really problems of our medical system as a whole. There's some pretty interesting literature out on DTC. For example, DTC advertising tends to be market-expanding rather than predatory. This indicates that it's not so much an issue of stealing market share from other competing (or generic) drgus but rather to get more people buying drugs. Whether "more people buying drugs" is necessarily a good thing is debatable, but on the surface at least, it would seem that DTCA gets people medications that they and (presumably) their physician think they need.

What we need is a complete system overhaul to healthcare in the US, not a ban on DTCA.



DTCA is not "fine" when you realize how many people were pulled into taking Vioxx through the commercials, and for many of these folks, non-prescription pain relievers would have worked just fine.

Who knows how many people drawn to Vioxx through DTCA died or had serious adverse effects as a result.

Shouldn't they at least be banned from advertising their products until it is clear they are safe?


By the way, there are apparently lots of people out there who are pro-DTCA.

I wonder how many are working for Phrma or large pharmaceutical companies?


A Question we should be asking besides "is DTC ok?" is "When is DTC ok?" In cases of things like viagra, I think it is perfectly fine to walk into your Doctor's office and ask for it.

As a student/researcher of psychology, something I find to be rather disturbing is DTC with regards to psychopharmaceuticals. Hypochondria is bad enough when it comes to mainline medicine, but even then one can often objectively judge what is wrong with them. This is why we have medicine cabinets. But the thing about said cabinets is that we don't stock them with antidepressants if we're having a bad day or ADD meds for when we need to pull an all nighter (well, some people do that albeit illegally). And there is a good reason for that, which is that psychoactive medications are meant for long term use and carry many, if not more side effects than those meant for the body.

A professor pointed out to me the other day that some pharma companies have FAR less advertising than others, to which I replied "well, its not like you can market haldol..." The same logic can be applied to cancer drugs, and so on. The purpose of drugs is to help people with problems, be they physical or mental. Not to make money.



"The purpose of drugs is to help people with problems, be they physical or mental. Not to make money."

Really, I don't think objects have a purpose. Instead, all we have are the decisions and intentions of people, and objects can affect them. Isn't that the point of Freakonomics?

Drugs, for drug companies, are for making money, mostly. Some employees may have the intention of improving man's lot via their drugs, but most probably make drugs to earn a salary doing something that they like (e.g. chemistry, biology). There's nothing wrong with making money by making things people want or need. We all do. If no one wanted or needed what we could do, none of us would have jobs or get paid.


"There's nothing wrong with making money by making things people want or need. We all do. If no one wanted or needed what we could do, none of us would have jobs or get paid."

Of course people have to do things to make money. Ther eare just certain businesses where one would hope that intrinsic motivation and purpose would be prioritized.