INTRODUCTION

In the United States, the rapid rise of prescription drug spending, coupled with exorbitant prices for new drugs have generated concern over the value and sustainability of the level of pharmaceutical spending. In the midst of this period of rapid spending growth, in which prescription drugs outpaced all other components of personal health spending, another highly visible trend has emerged: prescription drug advertising (see Figure 10.1). Many believe that the simultaneous burgeoning of prescription drug advertising and sales of high-priced drugs is more than coincidence and is cause for alarm.

Proponents of direct-to-consumer advertising (DTCA) claim that it may increase awareness and/or reduce the stigma associated with seeking care (in the case of mental health problems and sexually transmitted diseases, in particular), both of which may yield substantial gains in health. Further, advocates of DTCA argue that advertising may improve adherence to medication therapy for chronic conditions. Opponents of DTCA argue that the informational content of advertisements and the types of drugs that are advertised make it highly unlikely that public health has benefited, whereas spending has surely increased. This perception is no doubt influenced by the high visibility of national broadcast advertising campaigns and the prevalence of lifestyle drugs such as Viagra and Levitra among the advertised drugs.

From a public health perspective, concerns about DTCA have focused on three potential types of negative effects. First, DTCA may lead to inappropriate treatment of patients.