Should Drug Companies Be Advertising to Consumers?

Tamar Abrams has had a few bad years in 2022 and 2023. Both of her parents are dead; a relationship has ended; she retired from communications consulting. She moved from Arlington, Virginia, to Warren, Rhode Island, where she knew two people.

“I was kind of a mess,” Abrams, 69, recalled. Trying to get out of it, “I was eating myself into oblivion.” As his weight reached 270 pounds and his blood pressure, cholesterol and blood sugar levels rose, “I knew I had health problems.”

What came to mind? “Oh, oh, oh, Ozempic!” – the melodious ditty from television commercials promoting the diabetes drug GLP-1. The advertisements also emphasized that patients who took it lost weight.

Abrams remembered the commercials as “happy” and sometimes found himself humming the jingle. They depicted Ozempic takers cooking omelets, repairing bikes, playing pickleball — “doing everyday activities, but with verve,” she said. “These people were enjoying life to the fullest.”

So, as these ads often suggest, even though she had never been diagnosed with diabetes, she asked her doctor if Ozempic was right for her.

It’s no wonder Abrams remembered these ads. Novo Nordisk, which makes Ozempic, spent about $180 million on direct-to-consumer advertising in 2022 and $189 million in 2023, according to MediaRadar, which monitors advertising.

Last year, the sum — including radio and television ads, billboards, and print and digital ads — reached about $201 million, and total spending on direct-to-consumer advertising for prescription drugs exceeded $9 billion, according to MediaRadar calculations.

Novo Nordisk declined to respond to these figures.

Should it be legal to market drugs directly to potential patients? This controversy, which has been brewing for decades, is beginning to receive renewed attention from the Trump administration and lawmakers.

The issue is particularly relevant to older adults, who face more medical problems than younger people and are more likely to take prescription medications. “Part of aging has to do with developing health problems and becoming a target for drug advertising,” said Steven Woloshin, who studies health communication and decision-making at the Dartmouth Institute.

The debate over direct-to-consumer ads dates back to 1997, when the FDA eased restrictions and allowed television ads for prescription drugs as long as they included a quick summary of major risks and provided a source of additional information.

“That really opened the door,” said Abby Alpert, a health economist at the Wharton School of the University of Pennsylvania.

The introduction of Medicare Part D in 2006 brought “a huge expansion in prescription drug coverage and, as a result, a large increase in pharmaceutical advertising,” Alpert added. A study she co-authored in 2023 found that pharmaceutical advertisements were much more prevalent in areas with a high proportion of residents 65 and older.

Industry and academic research has shown that advertising influences prescription rates. Patients are more likely to make an appointment and request medications, either by brand or category, and doctors often comply. Several follow-up visits may follow.

But does this benefit consumers? Most developed countries are having a difficult time. Only New Zealand and, despite decade-long opposition from the American Medical Association, the United States allow direct-to-consumer advertising of prescription drugs.

Public health advocates say such advertisements encourage the use and overuse of expensive new drugs, even when existing, cheaper drugs work just as effectively. (Drug companies no longer bother to advertise once patents expire and generic drugs become available.)

In a 2023 study in JAMA Network Open, for example, researchers analyzed the “therapeutic value” of the drugs most advertised on television, based on assessments from independent European and Canadian organizations that negotiate the prices of approved drugs.

According to the analysis, nearly three-quarters of the most heavily advertised drugs did not perform significantly better than older drugs.

“Often, really good drugs sell themselves,” said Aaron Kesselheim, lead author of the study and director of the Program on Regulation, Therapeutics and Law at Harvard University.

“Drugs without added therapeutic value should be encouraged, and direct-to-consumer advertising does that,” he said.

Opponents of a ban on this advertising say it benefits consumers. “It provides information and education to patients, makes them aware of available treatments and leads them to seek care,” Alpert said. This is “particularly important for underdiagnosed illnesses,” such as depression.

Additionally, she wrote in a recent JAMA Health Forum commentary, direct-to-consumer advertisements lead to increased use not only of brand-name drugs but also of unadvertised substitutes, including generics.

The Trump administration entered this debate last September, with a presidential memorandum calling for a return to pre-1997 policies severely restricting direct-to-consumer drug advertising.

This position was repeatedly emphasized by Health and Human Services Secretary Robert F. Kennedy Jr., who blamed “pharmaceutical advertisements for hooking this country on prescription drugs.”

At the same time, the FDA said it was issuing 100 cease-and-desist orders over misleading drug ads and sending “thousands” of warnings to drug companies to remove misleading ads. Marty Makary, the FDA commissioner, blasted drug ads in an essay in The New York Times.

“There’s a lot of chatter,” Woloshin said of these actions. “I don’t know if we’ll see anything concrete.”

This month, however, the FDA informed Novo Nordisk that the agency found its television spot for a new oral version of Wegovy to be false and misleading. Novo Nordisk said in an email that it was “in the process of responding to the FDA” to address these concerns.

Meanwhile, Democratic and independent senators, who rarely align with the Trump administration, have also introduced legislation banning or limiting direct-to-consumer pharmaceutical ads.

Last February, independent Sen. Angus King of Maine and two other sponsors introduced a bill banning direct-to-consumer advertisements for the first three years after a drug gains FDA approval.

King said in an email that the law would better inform consumers “by ensuring that newly approved drugs are not allowed to immediately flood the market with advertisements before we fully understand their impact on the general public.”

Then, in June, he and independent Sen. Bernie Sanders of Vermont proposed legislation banning such ads altogether. That could prove difficult, Woloshin said, given the Supreme Court’s decision. Citizens united decision protecting corporate speech.

Additionally, direct-to-consumer advertisements represent only part of the industry’s promotional efforts. Pharmaceutical companies actually spend more money on advertising to doctors than to consumers.

Although TV still accounts for the majority of consumer spending because it is expensive, Kesselheim pointed to the “largely unregulated expansion of direct-to-consumer advertisements on the Web” as a particular concern. Drug sales themselves are bypassing doctor’s offices by moving online.

Woloshin said “disease awareness campaigns” – from shingles to restless legs – do not mention any specific medication but are “often disguised as education.”

He advocates more effective educational campaigns, he said, “to help consumers become more savvy and skeptical and able to recognize reliable and unreliable information.”

For example, Woloshin and Lisa Schwartz, a late colleague, designed and tested a simple “drug information box,” similar to nutrition labeling on packaged foods, that summarizes and quantifies the benefits and harms of medications.

For now, consumers should try to educate themselves about the drugs they see advertised on television.

Abrams has read extensively about Ozempic. Her doctor agreed it made sense to try.

Abrams was referred to an endocrinologist, who decided her blood sugar was high enough to warrant treatment. Three years later and 90 pounds lighter, she feels able to keep up with her 2-year-old grandson, enjoys Zumba classes and no longer needs blood pressure or cholesterol medications.

So Abrams isn’t sure, she said, what she should think about a possible ban on direct-to-consumer ads for drugs.

“If I hadn’t asked my new doctor about it, would she have suggested Ozempic? » Abrams wondered. “Or would I still weigh 270 pounds?”

The New Old Age is produced through a partnership with The New York Times.