Researchers from Johns Hopkins University recently published an article in JAMA that highlights rising concern around the effects of direct-to-consumer advertising (DTC) on health care. Their work shows that DTC advertising might have direct harm on patients. They studied drug characteristics and total advertising expenditures for the 150 top-selling branded prescription drugs in the United States, finding that total promotional spending by the manufacturer was associated with a significantly lower added clinical benefit for the drug. In fact, companies spent nearly 15% more on DTC advertising for drugs that had demonstrated lower added benefit. Even more troubling, each 1.5% increase in spending was associated with a 10% increase in sales. Simply put, pharmaceutical companies spent more money on DTC advertising when medical research found that the drug was less effective, and this spending directly led to more sales for those inferior drugs.
As the U.S. is one of only two countries in the world that still allows direct-to-consumer (DTC) advertising, it is important to understand the implications of DTC on patients and society at large. Aside from the fact that millions of dollars are annually spent on DTC prescription drug advertising, numerous previous studies have demonstrated that this practice has tangible impacts on prescription rates and patient requests for particular drugs. Pharmaceutical companies appear to be allocating a larger portion of their marketing budget towards those drugs which have demonstrated lower clinical benefit, hoping that patients will request prescriptions for these drugs, since providers who know the evidence are less likely to prescribe them. Conversely, companies do not need to spend marketing dollars on proven, effective drugs that providers will prescribe anyway.
Aside from increased pressure on providers to prescribe particular drugs which may not be the best option, there are other downsides to DTC. The data show that DTC advertising leads to increased drug costs overall, adding to the already skyrocketing costs of medical care in America. Additionally, DTC advertising tends to reduce use of generic medications, which are often equally effective but significantly cheaper for patients.
Certainly, there are proponents of DTC advertising. Pharmaceutical companies and their supporters argue that DTC messaging allows a more informed consumer and patient, one who can better engage in discussions with their doctor. However, the state of affairs today allows for deception and misleading messaging by pharmaceutical companies. The JAMA study appears to support this notion, as DTC advertising is causing inferior drugs to be prescribed at disproportionately higher rates.
This brings us to the key question: how should prescribing decisions be made? We argue that this important decision should be based on shared decision-making, considering goals that are agreed upon between the provider and the patient. The provider should use their medical knowledge and training to recommend an option that aligns with the patient’s values. DTC advertising only seems to bias these important conversations, erode the patient-provider relationship, and ultimately, harm patient outcomes.
The tried and true approach of having your provider be the person who informs decisions to begin medications—if and when indicated—is a safer and more judicious approach to patient care. Such decisions should not be informed or promoted by DTC advertising.
Case in point: the explosive demand for weight loss medications such as Ozempic and Wegovy have their origins in DTC advertising, which laid the foundation for patients to request—and ultimately influence—provider prescriptions for off-label use of such medications. The resulting black market for acquiring these weight loss medications subsequently developed as a result of this supply-demand imbalance.
In recent decades, there have been significant changes to limit how the pharmaceutical industry interacts with providers. There have been significant limitations to how pharmaceutical companies can bias doctors to prescribe certain products. Similar changes are needed in the DTC setting so companies do not bias patients.
Future reforms should focus on the lack of regulations of DTC advertising and need for guardrails which prevent misleading messages or bias. Moreover, the U.S. lacks robust analysis of relative clinical benefit for drugs in their post-marketing phase, although this is intended to change in 2026 with recent reforms requiring Medicare to evaluate comparative effectiveness. Hopefully, with this coming reform, consumers and providers will have more access to data regarding the benefits and risks of different treatment options. Ultimately, although an informed consumer is vital to effective health care, we need to ensure that the information that is publicly spread is unbiased, accurate, and supported by the advanced training that providers receive.
It is vital that patients remain aware about the larger factors in play in the pharmaceutical industry until systemic reforms can be achieved in the U.S. Patients who are informed about the pitfalls of DTC advertising can more critically evaluate drug advertisements to arrive at the best decisions for their own health, in partnership with their provider’s advice to take into account evidence based practice.
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