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Direct-to-consumer advertising: a modifiable driver of overdiagnosis and overtreatment
  1. David B Menkes1,
  2. Barbara Mintzes2,
  3. Joel Lexchin3
  1. 1Psychological Medicine, University of Auckland, Hamilton, New Zealand
  2. 2University of Sydney, Sydney, New South Wales, Australia
  3. 3School of Health Policy and Management, York University, Toronto, Ontario, Canada
  1. Correspondence to Associate Professor David B Menkes, Psychological Medicine, University of Auckland, Hamilton, New Zealand; david.menkes{at}

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The USA and New Zealand (NZ) are the only high-income countries that allow unrestricted direct-to-consumer advertising (DTCA) of prescription medicines, including both the name of the drug and its indications. Many other countries allow companies to conduct unbranded ‘disease-oriented’ advertising, which falls outside the scope of pharmaceutical advertising regulations (see Table 1).

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Table 1

Regulation of direct-to-consumer promotion of prescription medicines

DTCA is effective in promoting prescription of branded, usually expensive medicines and represents a key marketing strategy of the pharmaceutical industry, particularly in the USA, with prescription drug and associated disease awareness advertising accounting for US$6.5 billion, or 22% of the US$30 billion spent on promotion in 2016.1 Because of its effectiveness, companies have lobbied to extend DTCA to other countries, including the European Union. Thus far, these efforts have been successfully resisted by medical associations and health authorities concerned about various harms associated with practice. The exception is Canada, which introduced partial (reminder advertising) DTCA in 2001, in response to industry pressure.

Although most studies of DTCA focus on high-income countries, there is evidence the practice also occurs in low-income and middle-income countries, even when technically prohibited. For example, Sri Lankan newspapers carried an advertisement in August 2000 on the health effects of obesity, financed by Roche but co-sponsored by the Sri Lanka Medical Association. Consumers responding to the provided phone contact were given information about orlistat, a prescription-only antiobesity drug, and encouraged to ask their doctors about it. Further information sent to respondents discussed orlistat but scarcely mentioned non-drug weight reduction measures.2 In Turkey, following widespread advertising of the prescription-only smoking cessation drug bupropion, the drug’s license was suspended for 3 months in 2002.3 These authors also called attention to the marketing agenda implicit in drug company-sponsored lipid and bone density …

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  • Contributors All authors jointly conceived the project and contributed to the analysis. DM drafted the manuscript. All authors edited and approved the final version.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests David Menkes is a paid member of the Mental Health Advisory Committee, PHARMAC, New Zealand Government. He was paid by Atai Life Sciences for sessional supervision of a Phase One trial of dimethyltryptamine, a psychedelic drug, in healthy volunteers (2022). He is a coinvestigator in two clinical trials, neither of which is industry funded, both commencing in 2023: MDMA-assisted psychotherapy in terminal illness (charity funded); Low dose LSD in adult major depression (Health Research Council funded). Barbara Mintzes has acted as a paid expert witness for Health Canada in a legal case involving marketing of an unapproved drug product. Between 2019 and 2023, Joel Lexchin received payments for a writing brief on the role of promotion in generating prescriptions for a legal firm. He is a member of the Board of Canadian Doctors for Medicare. He receives royalties from University of Toronto Press and James Lorimer & Co. Ltd. for books he has written. He is participating in research funded by the Canadian Institutes of Health Research.

  • Provenance and peer review Commissioned; externally peer reviewed.