Living Ethics Journal

By Steven Zhang.

Should Pharmaceutical Advertising be Legal? The ethical implications of Direct-to-Consumer Pharmaceutical Advertising (DTCPA) have long been subjects of discussion, involving arguments over influence on patient choices, the balance between information and manipulation, and the impact on healthcare costs. But it seems that, at least in the United States, pharmaceutical advertisements are a cornerstone of the healthcare industry. To Americans, it might be surprising to hear that in the world, there are only two countries that allow Direct-to-Consumer Pharmaceutical Advertising: The United States and New Zealand. Why is it, then, that what is seemingly an essential component of healthcare in America is illegal in most of the world? 

When the European Union voted against DTCPA in 2008, a frequently cited rationale for the ban was the ethics of granting corporations influence over a patient’s health. In a traditional healthcare system, doctors have a duty to act in the best interest of the patient. Therefore, when a doctor prescribes a drug, it can be reasonably expected that they are doing so with the intention of benefitting the patient’s wellbeing. However, in a survey by the FDA conducted in 2004, most physicians reported that pharmaceutical ads had an effect on their medical practices and patient interactions. Advertising prescription drugs directly to consumers bypasses the traditional doctor-patient relationship and places pressure on healthcare providers to prescribe medications based on patient requests rather than clinical judgment. Patients may request specific drugs based on advertisements, even when they may not be necessary or suitable for their condition. This can lead to inappropriate prescribing practices and unnecessary medication use, potentially causing adverse effects and unnecessary healthcare expenditures. 

Another concern of product claim ads is the risk of drug overuse. Overrepresentation of a drug’s intended purpose can cause the drug to be administered in a variety of situations where its use is unnecessary or detrimental. During the 1970s, when the FDA began approving a variety of advertisements for sleep-inducing drugs, profits for pharmaceutical companies surged, coinciding with a spike in cases of overdosing. This is a part of a larger concern that the proliferation of pharmaceutical advertising contributes to the medicalization of normal conditions, turning everyday experiences and minor ailments into medical problems. This can lead to the unnecessary use of medications and the reliance on pharmaceutical solutions for issues that could be managed through lifestyle changes or non-pharmacological approaches. Furthermore, critics contend that pharmaceutical advertising tends to focus on treating symptoms rather than addressing the root causes of diseases. This approach may undermine efforts to promote prevention, healthy lifestyle choices, and non-pharmacological interventions, which could have a more significant impact on public health outcomes.

Critics of DTCPA commonly cite the risk of misinformation caused by pharmaceutical advertisements. Despite calls for regulation, the FDA’s regulations regarding pharmaceutical advertisements have consistently been relaxed over the years, resulting in the minimal requirement for transparency today. It is no longer necessary for companies to provide a detailed description of “major risks”, instead allowing for a “simplified brief summary”. Because of this, it is common for ads to deliberately downplay any potential risks, oftentimes by listing them rapidly at the end of advertisements in a manner that is intentionally difficult to comprehend. In such cases, phrases such as “Just ask your doctor for a prescription” work to absolve a company of legal responsibility, instead shifting blame to the doctor prescribing the drug when potential complications occur. 

Likewise, corporations are only required to provide a description of the broad symptoms a drug is meant to treat, and precise prescribing information, including the exact conditions that match a drug’s intended purpose, needs not be included. While pharmaceutical companies argue that this allows them to present information in a simplified manner that is easier for the average consumer to understand, critics instead contend that this allows pharmaceutical companies to greatly exaggerate the range of situations in which a drug may be applicable or offer only intentionally vague and general descriptions of the conditions that a drug meant to treat so as to appeal to as wide of an audience as possible. As a result, certain vulnerable groups, such as elderly consumers, are disproportionately targeted, as they are more prone to multiple chronic health conditions, and are therefore more likely to associate with the symptoms described in advertisements. For patients looking for advice about treatment, relying on the information presented in pharmaceutical ads, rather than the opinions of medical professionals, can result in ineffective treatment and the potential incurring of unnecessary risks. 

Pharmaceutical advertising can create additional financial burdens on the patient as well. Presently, over-the-counter (OTC) drugs, such as cough medicine, are one of the largest sources of revenue for pharmaceutical companies. OTC drugs are among the most suitable drugs for advertising, as they require no prescription, and can be purchased freely by consumers. However, critics argue that, in the age of soaring healthcare costs, ads for OTC drugs push consumers toward more expensive name-brand drugs when less expensive generic alternatives that achieve the same purpose exist. Compounding this, in 2021 alone, pharmaceutical companies spent $6.88 billion dollars on direct-to-consumer ads. This forces pharmaceutical companies to charge more for drugs so as to recuperate the extra costs, ultimately transferring the cost of advertising to consumers. 

Despite this, supporters of Direct-to-Consumer Pharmaceutical Advertising maintain that DTCPA plays a crucial role in empowering patients, fostering informed decision-making, and advancing medical progress. Pharmaceutical ads have the potential to promote patient empowerment and informed decision-making by educating consumers about conditions and treatments they were previously unaware of. In addition, studies have shown that patients who frequently see pharmaceutical ads are more likely to regularly see a doctor, thus increasing the likelihood of unrelated diseases being detected. Furthermore, pharmaceutical ads, even if they do not cause the consumer to purchase any drugs, can passively benefit public health by reducing the stigma around conditions such as mental illnesses. As such, supporters of DTCPA argue that by promoting greater medical efficacy, pharmaceutical ads have a net positive impact on public health. 

The objective of pharmaceutical ads is to promote a product, and therefore, cannot replace the role of doctors in recommending treatment. To ensure the responsible use of pharmaceutical advertising, it is crucial that robust consumer protection laws and regulations are in place—a process that requires patients to be educated on the details and risks of the treatment they receive. This is a process that requires open communication and effective engagement between medical professionals and patients. Ultimately, it is the duty of patients to collectively decide which regulations are needed so that their rights as both patients and consumers are sufficiently protected.