Secondary Logo

Journal Logo


Discussion of recent JCR articles, PANLAR issues, controversies, and special areas of interest. We encourage readers of JCR, as well as PANLAR members, to participate and extend the dialogue.

Friday, June 13, 2014

Why is the United States one of only two countries in the world allowing direct to consumer marketing of prescription medications, hospitals, and physicians?

Hasn’t anyone who reads newspapers or periodicals, watches TV, listens to radio or surfs the web been alarmed enough to create enough stir to get more attention to direct to consumer health advertising in the U.S.?  Certainly there have been reports about this (1-3) but seemingly to no avail.

How do other countries get along without such ads?  Many of them have what are generally conceded to be better overall health outcomes by various measures (and lower total costs of health care).  We have queried Latin American rheumatologists in PANLAR from the JCR editorial board and the several who have responded have all confirmed that there are no such commercials except for some over the counter products. There are obviously other very different cultures in other countries and different health care systems in other ways making it seemingly impossible to assess what impact these ads or their absence is having.

Ads purported to be public services are suspiciously almost always focused on high cost activities or medications.  My own university health system seems to publicize the most lucrative procedure requiring services such as orthopedics on radio and TV and has not yet emphasized the cognitive strengths of our rheumatologic diagnosticians.

Physicians have recently been involved in a “choosing wisely” campaign directed to our role as “stewards of finite health care resources”. Interestingly societies often named other specialties services as of low value and rarely identified their own expensive and frequently publicized services (4). The ACR list did include a slightly qualified admonition to use methotrexate (or other DMARDS) for at least 3 months before adding a biologic (5).  How do (or will) direct to patient advertisements from physicians and hospitals impact our role?  I especially am interested in by the increasing television ads often for an effective but extremely costly biologic agent used for rheumatoid or other arthritis.  Potential side effects are listed but with continued pleasant, distracting images on screen and certainly not with any image appropriate to side effects.  Is there any information about what impacts these ads have?  Presumably they are increasing the use of the advertised products.  However, is that at the expense of less use of less costly alternatives or even in appropriate use?


1. Ventola C. Lee.  Direct-to-Consumer Pharmaceutical Advertising. Therapeutic or Toxic? Pharmacy & Therapeutics Oct 2011; 36(10) 669-674, 681-684.

2. Oxman D. Hospital Advertising. The Hospitalist, January 2007. Is it time for a closer look?

3. Larson RJ, Schwartz LM, Woloshin S, et al. Advertising by academic medical centers.  Arch Intern Med 2005; Mar e8;165(6):645-51.