Why the United States and New Zealand Are the Only Countries Allowing Drug Ads on TV

The Politics of Pharmacology and Public Health Implications: “Drug Ads Spending Surged 460% from 1997 to 2016.”

Health, Science, and Politics

I published a version of this story on Medium and my website for further awareness.

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My Perspectives on a Crossroads of Free Speech, Public Health, and Consumer Protection

Medication can be life-saving when used correctly, yet when misused, neglected, or uncontrolled, it can turn deadly. One powerful example I discussed before is the devastating effects of serotonin syndrome, a global issue with potentially fatal consequences if left unchecked.

As a seasoned science and technology consultant, I have examined the impact of regulatory policies on public health. One area of interest is the politics of pharmacology, particularly the direct-to-consumer (DTC) advertising of prescription drugs — a practice permitted only in the United States and New Zealand yet banned nearly everywhere else.

Recently, I encountered discussions on my X Premium criticizing Robert F. Kennedy Jr.’s push to restrict drug advertising on American television, which some say could “take America backward.” However, understanding why the U.S. and New Zealand permit these ads and why other countries do not might shed light on an overlooked area of healthcare policy.

In Australia, where I live, direct-to-consumer (DTC) advertising of prescription medications is prohibited under the Therapeutic Goods Act 1989 and the Competition and Consumer Act 2010. This restriction aims to prevent potential public health risks associated with such advertising

I have been following this issue for a long time in scientific literature. The most informative and eye-opening one was a systematic review by Gilbody et al. (2005) in BMJ examining 2853 citations, which found that direct-to-consumer (DTC) pharmaceutical advertising, though heavily used, offers no demonstrated benefits for health outcomes.

The paper informed that DTC advertising drives increased prescriptions for advertised drugs, primarily influenced by patient requests, and affects physician prescribing confidence.

This review informed and supported concerns over the potential negative impact of DTC advertising, aligning with the rationale behind legislative bans in most countries. It also highlighted the need for further research on its clinical and economic effects.

After 2005, the scale of direct-to-consumer (DTC) pharmaceutical advertising grew significantly. A 2021 review published in Springer reported that spending on drug advertising rose from $17.7 billion in 1997 to $29.9 billion by 2016, with approximately 32% (~$10 billion) allocated to DTC advertising.

Although a larger portion of advertising funds still targets healthcare professionals, DTC spending surged by 460% from 1997 to 2016. This shift highlights that directly informing consumers about drug products, rather than solely relying on medical professionals, has become a strategic priority for pharmaceutical manufacturers.

While consumer outreach has historical precedents, the influence of modern media — such as television, radio, and digital platforms like social media — has expanded the reach of these advertisements to an unprecedented level. The differences in regulatory approaches have led to some international friction.

For example, when U.S. singer Lady Gaga promoted a migraine drug sponsored by Pfizer on Instagram, the ad became visible to her millions of followers, including those in the European Union — where DTC drug advertising is illegal.

This incident drew sharp criticism from European regulators, who viewed it as violating their strict advertising laws. Despite the singer’s disclaimer that the ad was “for U.S. audiences only,” its accessibility across borders highlighted the difficulty of enforcing advertising restrictions in a digital world.

The paper highlighted that these advertisements may result in inappropriate prescribing, create undue economic strain on an already overburdened healthcare system, and undermine the patient-physician relationship.

Moreover, a 2019 review in JAMA Network pointed out that despite the increase in marketing over the past twenty years, regulatory oversight remains limited.

Another study published in JAMA in 2023 asked the research question, “What drug characteristics are associated with larger proportions of promotional spending allocated to direct-to-consumer advertising?”

This study found that among the 150 top-selling U.S. prescription drugs in 2020, those with lower added clinical benefits spent a larger portion of their promotional budget on direct-to-consumer advertising than drugs with higher clinical benefits.

Additionally, drugs with higher sales are also devoted more to consumer ads. The findings suggest a pattern where drugs with less effectiveness focus heavily on consumer advertising, though further research is needed to assess the impact on treatment choices and healthcare costs.

Why the U.S. Allows Pharmaceutical Advertising: Empowerment or Overreach?