When it comes to drug advertising on television, what you see is not necessarily what you get

Advertisements for Opdivo+Yervoy, a combination of immunotherapies to treat metastatic melanoma and lung cancer, play triumphant music while cancer patients camp, garden and watch fireworks. Advertisements for Skyrizi, a drug to treat psoriasis and other diseases, show patients snorkeling and biking – showing off their rash-free elbows. People with type 2 diabetes dance and sing in their office cubicles and tip their hats to Jardiance. Drugs are now endorsed by celebrities: Wouldn't you fancy the migraine medication Nurtec ODT, endorsed by Lady Gaga?

Drug advertising has been ubiquitous on television since the late 1990s and has also spread to the internet and social media. The US and New Zealand are the only countries where direct-to-consumer drug advertising is legally permitted. (The European Union was furious when Lady Gaga's Instagram post promoting the migraine drug was seen on the continent, noting that it was a blatant violation of the ban on direct-to-consumer advertising.)

In recent years, manufacturers have spent over a billion dollars a month on advertising. Last year, three of the five largest advertisers on television were pharmaceutical companies.

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Such advertising was banned until 1997, when the FDA reluctantly allowed drug advertisements on television as long as they accurately described the true benefits and risks of a drug and included a list of possible side effects.

Given these guardrails, few believed the advertising would prevail. But the FDA underestimated the cunning of the pharmaceutical industry, which invented a new art form: finding ways to portray its products as joyful, indispensable treatments while often downplaying their lack of effectiveness and risks.

A 2023 study found that among the best-selling drugs, those with the least added value tend to spend more on advertising to patients than doctors. “I am concerned that direct-to-consumer advertising can be used to drive demand for marginally effective drugs or for drugs with cheaper or less expensive alternatives,” study author Michael DiStefano, a professor of clinical pharmacology at the University of Colorado, said in an email.

In fact, more than 50% of Medicare drug spending from 2016 to 2018 was for advertised drugs. Half of the 10 drugs the Joe Biden-Kamala Harris administration has targeted for price negotiations this year are among those with the highest advertising spending for direct-to-consumer sales.

The government has tried in recent years to ensure that prescription drug advertising presents a more accurate and understandable picture of benefits and harms, but the results have been disappointing. For example, when President Donald Trump's administration tried to force drug companies to list the price of all drugs over $35 in their television ads, the drug industry sued in federal court, arguing that the requirement violated drug companies' First Amendment rights. The drug industry won.

Last November, the FDA issued regulations requiring ads to give consumers a “non-misleading overall impression of the drug being advertised.” The agency stated that information must be presented in a “clear, concise, and neutral” manner. Ads must “avoid audio or visual elements that could interfere with consumer understanding,” and “text information must be presented in a way that is easy to read.”

But the wording is disappointingly vague: What does “neutral” and “not misleading” mean? Do the banned audiovisual elements feature people walking or dancing to cheerful music? How fast or slow can the chyrons listing side effects flash across your screen? There is no FDA police force to decide how the wording should be interpreted.

I asked the agency for an interview to learn more about their plans, but instead received a three-page email that made me, well, worry that the flood of drug advertising was here to stay.

It said ads are not reviewed before airing unless manufacturers submit them voluntarily because it is “the responsibility of drug manufacturers to ensure they comply with regulations.” How do they identify ads that are not compliant? Often through consumer complaints or when an agency employee sees a booth with misleading information at a conference, the email said.

The FDA has two offices whose job it is to review drug advertisements for compliance. One is the Advertising and Promotional Labeling Branch of the Center for Biologics Evaluation and Research, which employs nine full-time staff members, and the other is the Office of Prescription Drug Promotion, which employs about 70 people. If ads are found to be noncompliant, the FDA can notify the manufacturer by sending them an “untitled or warning letter.” From 2019 to 2024, it sent a total of only 32 such letters.

The FDA created the Bad Ad Program to help physicians identify false and misleading advertising targeted at them. It created a one-hour course with case studies and gave physicians an easy way to report abuse by calling 855-RX-BADAD. The Bad Ad Program has received more than 3,200 reports of potentially false or misleading advertising since 2010, and 24 of FDA's compliance letters included a reference to a Bad Ad complaint.

The FDA has created a parallel website designed to teach consumers how to better identify whether an ad complies with the rules and help them determine whether a drug is “right for you,” but this requires medical knowledge that most people don’t have.

The Federal Trade Commission, which oversees advertising in other sectors — from banking to contact lenses — is more active in suing ads it deems deceptive or misleading. In recent years, it has filed lawsuits to stop unproven claims about stem cell treatments for arthritis and false or misleading information about some health insurance plans. But it has no jurisdiction over direct-to-consumer drug advertising, a commission spokesman said.

In a bygone era when remedies were mostly sold by “quacks,” 19th-century psychologist William James derided “the hideousness of medical advertising” and wrote that “the authors of these advertisements should be treated as enemies of the state and shown no mercy.” Of course, as scientific understanding has matured and today's medicines alleviate suffering and even save lives, a more nuanced approach is in order.

Common sense and the kind of standards of truth in advertising that we apply in other sectors might be an appropriate first step. Take, for example, ads that promise patients with advanced cancer “a chance of living longer.” A more truthful ad might say that studies are inconclusive, or, as the widower of a patient who was lured by an ad wrote in an opinion piece, “a small chance for people with advanced lung cancer to live just a few months longer.” And during that time, they're unlikely to go hiking or to the beach.

With a little common sense and enforcement of truth in advertising, many of the ads could disappear. The FDA's email told me it is working with the Duke-Margolis Institute for Health Policy and others to “further evolve” its policies and guidelines.

Gerard Anderson, a professor of health policy at the Bloomberg School of Public Health at Johns Hopkins University, suggests that drug advertisements should at least include prominent warnings about risks, like those found on cigarette packets. “If you see it on TV or social media, it's probably not as good as something else,” he added. Or at least more expensive.

It is important to remember that cigarette advertising was ubiquitous in the media before it was banned by Congress in 1971 because it was considered a dangerous product. Pharmaceutical advertising is more difficult because some of these products harm many people through their side effects (and cost) but can be very helpful to some.

But as I watched the Democratic National Convention last month, I thought: Couldn't someone in politics make these endless drug ads go away, like they do in almost every other developed country? When companies urge patients to “ask their doctor” when they need drugs they may not need, it's not just about truth in advertising or breaking government and private budgets. It's a public health issue.

KFF Health News is a national newsroom that produces in-depth journalism on health issues and is one of the core programs of KFF – the independent source for health policy research, surveys and journalism.

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