When it comes to TV drug ads, what you see isn’t always what you get

by Elisabeth Rosenthal

Victorious music plays as cancer patients go camping, gardening and watch fireworks in ads for Opdivo+Yervoy, an immunotherapy combination for metastatic melanoma and lung cancer. Ads for Skyrizi, a drug for plaque psoriasis and other conditions, show patients snorkeling and riding bikes — showing off their rash-free elbows. Type 2 diabetics dance and sing in their office cubicles, doffing their hats to Jardiance. Drugs are now being endorsed by celebrities: Don’t you wish Lady Gaga was endorsing Nurtec ODT, a migraine treatment?

Drug ads have been ubiquitous on TV since the late 1990s and have spread to the internet and social media. The United States and New Zealand are the only countries that legally allow direct-to-consumer drug ads. (The European Union was furious when Lady Gaga’s Instagram post promoting a migraine drug was seen on the continent, noting that it blatantly violated a ban on direct-to-consumer advertising.)

Manufacturers have spent more than $1 billion a month on ads in recent years. Last year, three of the five biggest TV ad spenders were pharmaceutical companies.

This type of promotion was banned until 1997, when the FDA reluctantly allowed drug ads on television as long as they contained accurate information about the actual benefits and risks of the drug, including a list of potential side effects.

With these guardrails in place, few thought the ad would catch on. But the FDA underestimated the cunning of the pharmaceutical industry, which had invented a new art form: finding ways to make its products seem like happy, necessary cures, often minimizing poor efficacy and risk.

A 2023 study found that among the best-selling drugs, those with the lowest levels of additional benefits spent more on advertising to patients than to doctors. “I am concerned that direct-to-consumer advertising may be used to drive demand for drugs with average efficacy or for drugs with more affordable or more cost-effective alternatives,” study author Michael DiStefano, a professor of clinical pharmacology at the University of Colorado, said in an email.

Indeed, more than 50% of Medicare’s drug spending from 2016 to 2018 was for advertised drugs. Half of the 10 drugs that the Joe Biden-Kamala Harris administration has included in price negotiations this year are among the drugs with the highest direct-to-consumer advertising spend.

The government has tried in recent years to make sure that prescription drug advertising paints a more accurate and easy-to-understand picture of benefits and harms. But the results have been disappointing. For example, when President Donald Trump’s administration tried to force drugmakers to list prices of any treatment costing more than $35 in television ads, the industry took the case to federal court, arguing that the order violated drugmakers’ First Amendment rights. Big pharma won.

Last November, the FDA issued requirements that ads give consumers a “not misleading overall impression of the drug being advertised.” The agency said the information must be presented in a “clear, conspicuous, and neutral manner.” Ads must avoid “audio or visual elements that could interfere with the consumer’s understanding,” and “textual information must be presented in a manner that is easy to read.”

But the language is disappointingly vague: What do “neutral” and “not misleading” mean? Do the prohibited audiovisual elements include people wandering around or dancing to upbeat music? How fast or slow can the chyrons with lists of adverse reactions scroll across the screen? There is no FDA police force to decide how this language should be interpreted.

I asked the agency for an interview to learn more about its plans, but instead got a three-page email that, well, made me fear the blizzard of drug ads would continue.

I was told that ads are not vetted before they air unless manufacturers voluntarily submit them, because “it is the drug manufacturers’ responsibility to make sure they are compliant.” How do they catch ads that aren’t compliant? Often through consumer complaints or when an agency employee sees a booth with misleading information at a conference, the email said.

The FDA’s oversight branch, the Advertising and Promotional Labeling Branch, “currently has nine full-time employees, and a small percentage of their work involves reviewing DTC promotional communications, as well as other activities,” according to an agency email. If ads are found to be noncompliant, the FDA can notify the manufacturer by sending it an “untitled or warning letter.” Between 2019 and 2024, only 32 such letters were sent.

The FDA launched a Bad Ad Program to help doctors recognize false and misleading ads aimed at them. It created a one-hour course with case studies and gave doctors an easy way to report abuse by calling 855-RX-BADAD. But it’s too early to tell whether doctors who also dislike such ads will use the hotline, and the agency is woefully understaffed to monitor it.

The FDA has set up a parallel website to teach consumers how to better distinguish whether advertising complies with the rules and to help them distinguish whether a drug is “right for you.” But that requires medical knowledge that most people don’t have.

The Federal Trade Commission, which oversees ads in other sectors—from banking to contact lenses—has been more active in lawsuits to stop those it deems deceptive or misleading. In recent years, it has sued to prevent unsubstantiated claims about stem-cell arthritis treatments 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.

Long ago, when medicines were sold largely by “miracle cure” salesmen, the 19th-century psychologist William James ridiculed “the abomination of medical advertising” and wrote that “the advertisers of such advertisements should be treated as public enemies, and no mercy should be shown them.” As scientific knowledge matures and today’s drugs alleviate suffering and even save lives, a more nuanced approach is obviously necessary.

Common sense and the standard of truth in advertising that we apply in other sectors may be an appropriate first step. Take ads that promise patients with advanced cancer a “chance to live longer.” A more truthful ad might say that the research is ambiguous, or as the widower of a patient caught up in the ad wrote in an editorial: “an outside chance for people with advanced lung cancer to live a few months longer.” And they’re not likely to be hiking or going to the beach while they do it.

With a little common sense and enforcement of the Truth in Advertising Act, many of the ads would disappear. The FDA email told me it was working with the Duke-Margolis Institute for Health Policy and others to help “further develop” its policy and guidance documents.

Gerard Anderson, a professor of health policy at the Bloomberg School of Public Health at Johns Hopkins University, suggests that drug ads should at least be required to carry visible risk warnings, like those on cigarette packages. “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.

Remember, cigarette ads were ubiquitous in the media before they were banned by congressional legislation in 1971 because they were considered to be promoting an unsafe product. Yes, it’s harder to do that with pharmaceutical ads, some of which harm many people with their side effects (and costs), but can certainly help some people.

But as I watched the Democratic National Convention last month, I thought: Can’t someone in politics make these endless drug ads disappear, as they have in almost every other developed country? Companies telling patients to “ask their doctor” about drugs they may not need is not just a matter of truth in advertising or cutting into government and personal budgets. It’s a matter of public health.

Elisabeth Rosenthal, senior health news analysis editor, joined KFF Health News in 2016 as editor-in-chief after 22 years as a correspondent for The New York Times.