Direct-to-consumer (DTC) advertising of prescription medications has rapidly become one of the most contentious issues facing the medical profession in the United States. Prior to the early 1980s, pharmaceutical companies promoted their prescription products exclusively to physicians, who were expected to act as "learned intermediaries" interpreting drug information for the general public.1 During the past 2 decades, however, changes in the political and regulatory climate, cultural shifts emphasizing the patient's role in making medical decisions, and expanding profits from drug sales have encouraged the industry to pursue more direct marketing strategies.2
Today, advertisements for prescription drugs dot the pages of popular magazines and punctuate television programs. A survey of 18 diverse lay magazines from 1989 to 1998 revealed a total of 320 distinct DTC ads, representing 101 brands and 14 categories of medical conditions.3 This year, pharmaceutical companies will spend more than a billion dollars marketing their drug products directly to consumers, compared to only $55 million in 1991.4 According to a recent survey, more than one third of patients have asked their physicians for information on drugs they have seen in a DTC ad, and nearly one fourth have asked for the drug itself.5 Perhaps more significantly, three quarters of the patients requesting drug prescriptions received them from their physicians.
Proponents argue that DTC promotion provides a service by increasing public awareness of medical conditions and encouraging informed communication between patients and providers. Furthermore, DTC ads encourage consumers to act as autonomous decision-makers, able to weigh the benefits and risks of their health choices.6 At the same time, critics fear that drug companies will trade on the public's lack of medical knowledge to obscure products' risks and adverse effects. Physicians complain that they must devote increasing amounts of scarce time to dissuading patients from taking drugs that advertising has led them to believe are unproblematic.
This month, MSJAMA explores some of the issues raised by the growth of DTC advertising of pharmaceutical products in the United States. How does DTC marketing affect the relationship between patients and physicians? What is the role of the government in ensuring that DTC advertisements are accurate and complete? Should the rise of DTC advertising change physicians' liability in suits brought by drug consumers? How does the rise of DTC advertising change our perspective on drug companies' traditional practice of marketing drugs to physicians?
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