As modern Western medicine has grown over the years, the tactics with which new ideas and findings are introduced to consumers have grown as well. One method that has sparked controversy across the country—even possibly the world—is that of Direct To Consumer (DTC) advertising. While this may not be an entirely new concept, it is one of the most rapidly growing and most heard of in the American prescription drug world. Instead of allowing consumers to find medicines and prescriptions solely through their doctors, drug companies have made it possible for them to play the role of their own ‘physician’, providing information with which consumers can essentially ‘diagnose’ themselves and find medicines on their own. As this entirely new step in the medical system is added, the rest of the world has not welcomed it with such open arms as the United States has. In fact, besides the U.S., New Zealand is the only other country in the world to work with this type of prescription drug advertising (Lo). This statistic has led many researchers to criticize the DTC movement as a whole, highlighting its negative effects on the medical system. This piece will delve into the reasons why DTC advertising does deserve the scrutiny and criticism it has come under, and how its negative influences are greater than its perceived positive ones. Through a closer look at the history of DTC advertisements and prescription medicine, examples of its negative effects, and the de-bunking of its so-called benefits, the reasons why the rest of the world does not allow DTC advertising (and why the U.S. should stop), will be made clearer. 

Since the late 1990s (Donahue), Direct to Consumer advertising has slowly been taking over U.S. television and website ads. No longer do consumers solely hear about different medicines by word of mouth or through doctor’s appointments, but they are now exposed to prescription drugs just about every time they turn on their televisions, computers, phones, and the like through ads. While some claim that all of this exposure is for the better, the fact of the matter is that the Unites States is among the highest users of prescription opioids in the world (Griffiths), and around “47,000 Americans fatally overdosed in 2014, a 7 percent increase over the previous year” (The Week). This information alone should create cause for concern among Americans, but yet DTC advertising is currently at its peak. So when did this all spiral out of control? In 1997, the FDA released statements that alleviated some of the requirements of drug advertising companies when choosing what could and could not appear in commercials and advertisements. For example, companies no longer had to include a complete list of the risks and side effects of their product—only the ones they deemed ‘major’. From this, “expenditures on DTC ads nearly tripled between 1997 and 2001, and the percentage accounted for by television increased by 25 to 64 percent”, Marcia Angell, M.D. points out in her novel criticizing the DTC movement. While not a direct push to create an easier outlet for prescription drug advertisements, this move by the FDA is arguably one of the most crucial and influential in this epidemic. Another issue that the Administration was beginning to face was that there were not enough people to review these advertisements for correct content. Angell writes that the FDA “only had thirty reviewers to cull through 34,000 DTC ads submitted to it in 2001” (Angell). Again, although there was not an intended advantage given to these companies, they were benefitted far more than what they could have asked for, simply due to a failing system. 

From this system came more advertisements of this kind than the world had ever seen. Doctors were suddenly flooded with patients who wanted the products they were being bombarded with on television, and they felt pressured to abide by their patients’ wishes. One survey conducted by the FDA revealed that sixty five percent of physicians surveyed “believe DTC ads confuse patients about the relative risks and benefits of prescription drugs” and that “about 75 percent of physicians surveyed believe that DTC ads cause patients to think that the drug works better than it does” (FDA). The issue of consumers becoming more skeptical of their own health and wellness also became relevant, due to the influx of advertisements about ‘relatable’ aches and pains, causing them to visit their physicians more frequently. One study conducted by the HealthAffairs organization showed that there was a positive correlation between DTC advertisement increase for Vioxx, an arthritis medicine (now discontinued), and the amount of patients that went into their physicians’ offices inquiring about it. From these statistics, it is becoming more obvious that doctors are skeptical of this DTC epidemic, and that maybe a closer look should be taken at what the companies are doing to achieve this fast growth.

The infamous line “ask your doctor” at the end of prescription drug advertisement is not to be taken lightly, and is not only serving the purpose of covering prescription companies’ tracks, either. Doctors are more or less the ‘keys to the kingdom’ when it comes to obtaining a prescription, and drug companies and their representatives know this. Drug representatives have come under the spotlight in recent years for their questionable efforts to sell their products to doctors’ offices. From main stream platforms, such as the movie “Love and Other Drugs”, to detailed medical investigations, the stereotype of the sleazy ‘drug rep’ has become well-known. So just how much truth is there behind the accusations? In a news segment from British anchor John Oliver, he discusses this issue somewhat lightly but informatively. He brings up the fact that drug representatives work the system in many different ways in order to gain influence with doctors, while questioning the ethics behind it all. 

Some examples Oliver gives of this ‘influencing’ include drug companies buying meals for doctors’ offices, taking potential clients out for lavish dinners, and sometimes even flying prospects overseas to ‘discuss things further’, all for the purpose of essentially buying their loyalty to the company, though no one will outright call it that. This is a frightening revelation—doctors being bought out to push certain drugs to consumers—and can lead to dangerous results. For instance, the video shows a segment of an interview with a former Chief Counsel of the HHS Office of Inspector General stating that the drug company AstraZeneca was prescribing medicine primarily used for bipolar disorder and schizophrenia to people with insomnia or dementia—two completely different disorders than the previous. This tactic, known as “off-labeling”, is something that has become more prominent since the introduction of DTC advertising (Oliver). Essentially, companies that spend money on advertising on every platform possible are then turning to doctors and pushing them to prescribe their most profitable product, despite the question of whether or not it is always the product needed. This alarming and intrusive method then leads to the question of where our doctors’ loyalties lie—one that certainly defies the position that physicians were originally meant for. Oliver also mentions a website that has now been put into place where consumers of any kind can retrieve information on just how much their doctors have been receiving from these drug companies. Upon looking at the site, doctors are receiving anywhere from a ten dollar meal to a few thousand dollars for a speech (OpenPaymentsData.CMS.gov)—assumingly one promoting a certain drug or company to other physicians. While this information being made available is a step in the right direction, it does not negate the fact that these transactions are still taking place, and still affecting the lives of consumers at the most basic level. So, the question is: Why is America allowing this to happen? Other countries across the world other than New Zealand do not think that this system is ethical or needed—why does the United States?

As previously mentioned, the Unites States has the highest rate of prescription drug abuse in the world, and consumers also pay the most for them. This fact seems to contradict itself, in that usually when prices rise for certain goods their sales fall because consumers are not able to accommodate. In the United States, however, while prices have risen, so has consumption. For example, the founder of Turing Pharmaceuticals, Martin Shkreli, has recently come under fire for pricing one of the lesser-known medicines, toxoplasmosis, at around $750 from its original price of $13.50 (Thomas). Other companies have been found to be doing this as well, and are being investigated by the federal government. The medical industry has become what some would describe as more of a business than a service for the consumers—which is what it was originally meant to serve as. 

Just before the era of DTC advertising began, the country was swarmed with the slogan that consumers should “Just Say No” to drugs—we all remember the D.A.R.E. badges we donned in elementary and middle school. Yet while the country was overrun with the idea that there was a ‘war on drugs’ at hand, there would unknowingly be the biggest drug boom this nation had ever seen start not too long after. Officials were concerned with the use of marijuana, heroin, etc., yet the substances they should have actually been worried about were those being handed out like candy in the local physician’s office. 

One of the many subjects of controversy that has overtaken the United States in especially the last decade is that of marijuana legalization. The way that most adult figures and school specials talk about the plant that has been around for centuries would make people think that it causes severe problems for its consumers, when the real problem is the drugs that are legal. To put it into statistical terms, in a study done by the Center for Disease Control, over 18,000 people died in the United States from prescription drug overdose in 2014, while the number of people who died of marijuana overdose was, in fact, none (CDC). While one of these substances has been deemed that of delinquents and drug abusers, the one that now has a higher death rate than car crashes or shootings in the U.S. (Christensen) is not only legal, but is being pushed on citizens to consume and sell every day, and a higher price than they are worth. Drug companies have taken all of this into account, preying upon America’s growing prescription interest and, in some cases, addiction, and using it to further their success. 

Through the analyzation of prescription drug companies and their tactics of selling to consumers, there is still the question left asking how people could still support this method of advertising. One website mentions an article written by “The Huffington Post” which works to tell the public that DTC advertising is beneficial to consumers because it helps to “develop a consumer base that is more informed about certain diseases or disorders and how medication may help” (Huebsch). In reality, these advertisements may cause consumers to look at their health more closely, but there is also the idea that these advertisements and their skewed information may confuse consumers due to the lack of detail provided. In one article written by Pharma Marketing News, the author discusses a statement released by the FDA on this matter. The Administration states that because of these advertisements, “consumers may mistakenly assume that the drug will address all of the potential consequences mentioned in the ad by making inferences that go beyond what is explicitly stated in an advertisement” (Mack). Summed up, the FDA is referring to the fact that many drug commercials target an entire group of people associated with a disease that has a wide range of symptoms, and consumers may believe that the drug being advertised is meant to cure all of the symptoms and side effects—due to poor relaying of information. For example, Pfizer’s drug Lyrica is intended to prevent nerve pain that may stem from long-term diabetes. However,  one popular advertisement about the drug leads consumers to believe that Lyrica is meant to heal already-damaged nerves—an assumption that could lead to the misuse of the drug due to misleading advertisement. While the small benefit of DTC ads may include making consumers question symptoms of diseases advertised, the risk of drug misuse and consumer confusion outweighs it in the end. 

While DTC advertising has become a sort of staple experience in today’s society, there has also been a growth in its criticism in recent years. Although there have been regulations put in place by the FDA to monitor drug companies and their advertising and networking methods, there are simply not enough people to maintain track of the extreme influx that has come with this advertising. The United States has quickly become the highest consumer of prescription drugs, bringing with it death counts like never before and addictions that affect families and communities in monumental ways. Through a deeper look into examples of how drug companies and their constituents have gone ‘under the radar’ to achieve success, confusing and sometimes falsely prescribing patients all for personal gain, researchers and concerned consumers are now able to bring the risks that come with DTC advertising to light. The United States tends to pride itself on its fight against illegal drugs, but the real fight needs to be with those that are legal, and are being given to consumers every day, hundreds of times a day. This piece will hopefully shed light onto the growing prescription pill epidemic that America is facing, and cause its citizens to question whether or not they should support and take part in it. Direct to Consumer advertising is proven to cause more harm than good through research and analysis, and it is time to put an end to this harmful movement. 
