Editor’s Note: This perspective was originally published in JAMA Health Forum on Nov. 14, 2025.
Recently, a growing number of voices, including public officials from across the political spectrum and the American Medical Association, have called for banning direct-to-consumer (DTC) advertising of prescription drugs.1 In 2025, Senators Bernie Sanders and Angus King introduced a bill to ban pharmaceutical advertisements outright, while the Trump administration is considering policies that would raise the cost of drug advertising, potentially reducing its use.2 Critics argue that DTC advertisements are misleading and promote low-value and high-cost drugs, leading to inappropriate use and encouraging patients to choose advertised medications vs cheaper, similarly effective generics. There are also concerns that DTC advertising undermines trust in the physician-patient relationship by creating disagreements over treatment choices.
Given these concerns, banning DTC advertising might appear to be good public policy. However, we think that the case for such a ban is not as strong as it may initially appear. In this Viewpoint, we critically assess arguments on the quality of information provided by DTC advertisements and the effect of DTC advertising on prescription use and physician-patient interactions.
Quality of Information in DTC Advertisements
We begin by evaluating the critique that DTC advertisements are misleading. This claim is often based on studies that rely on the subjective judgement of researchers. One such study found that roughly 43% of DTC advertisements reviewed were “objectively true” and 2% were “false,” while a substantial 55% fell into a gray area of “potentially misleading.”3 This raises concerns about ambiguous messaging, but these studies did not establish a causal link between DTC advertising and actual harm to patients, which is the critical question at the heart of the policy debate. To our knowledge, evidence of widespread patient harm is limited. As we discuss later, many studies using rigorous quasi-experimental designs suggest that advertising can have positive effects, including increased initiation of clinically beneficial medications, improved medication adherence, and reduced work absenteeism.4-6
Meanwhile, DTC campaigns are often more accessible, engaging, and up to date than information from neutral sources, such as public health agencies and medical associations. Drug companies have the resources and incentive to reach patients where they are and the expertise to communicate product features effectively. Pharmaceutical advertisements are the most heavily regulated form of advertising. When drug companies are following current regulations, their advertisements provide information based on scientific evidence (ie, information consistent with the US Food and Drug Administration–approved product label) and must present a balanced view of benefits and risks. This is a high standard that is not applied to any other consumer market. Compared with pharmaceutical marketing directed to physicians, which often occurs face to face, DTC advertisements are more transparent due to their public-facing nature, which may increase compliance with rules against misleading advertising. Nevertheless, some companies have violated these rules, resulting in fines or withdrawal of advertisements. These cases highlight the need for better enforcement and regulation of advertising content rather than a complete ban on DTC advertising.
Effect of DTC Advertisements on Prescription Use and Physician-Patient Interactions
Next, we consider the critique that DTC advertisements lead to wasteful spending by encouraging overuse of drugs or pushing patients to take expensive branded drugs vs lower-cost alternatives. While this is a valid concern, it overlooks the multiple layers of gatekeepers in the health care system (eg, physicians and insurers) who can potentially limit inappropriate use. Patients cannot simply get a prescription for a drug they saw advertised on television. Unless the patient, physician, and insurer are aligned, the prescription will not get filled. When a patient requests an advertised drug, physicians can prescribe an alternative they deem more beneficial, such as another brand or lower-cost generic drug. Similarly, the patient’s insurance formulary may steer them to a lower-cost option. A caveat is that physicians themselves are a target of pharmaceutical advertising through detailing, which can also contribute to prescribing decisions.
A strong body of quasi-experimental evidence shows that DTC advertising increases use of advertised and nonadvertised drugs. For example, we found that advertising not only increased use of promoted drugs, but also led to higher use of nonadvertised generic competitors.4 While these spillover effects can result in increased use of more effective or lower-cost products, this is not always the case.7 Research also shows that DTC advertising can benefit patients by increasing treatment initiation and improving medication adherence. Our analysis showed that 70% of increased utilization due to advertising came from new prescriptions and 30% from improved adherence.4 New initiation was largely driven by market expansion rather than brand switching. Similarly, a study on a heavily advertised class of statins found that advertising led to brand substitution and an increase in statin users.5 Given the high value of statins, the study concluded that advertising can be cost-effective.
While treatment initiation benefits many patients who would have otherwise gone without therapy, it may also lead to some overuse. We found that patients who initiated treatment after seeing advertisements had lower adherence rates, suggesting some unnecessary treatment. A randomized clinical trial showed that standardized patients (ie, trained actors) who requested an antidepressant were much more likely to receive a prescription than patients who did not request treatment. This was true for major depression, for which underuse is common, and adjustment disorder, for which treatment is more clinically marginal.8 Together the evidence suggests that although DTC advertisements may lead to some overuse, they substantially increased patients’ access to beneficial and potentially lifesaving medications. Thus, banning DTC advertisements may reduce drug expenditures by decreasing overuse, but it could also exacerbate underuse, underdiagnosis, and nonadherence, which add substantial costs to the health care system.
Finally, we consider the concern that DTC advertising negatively affects physician-patient interactions. Because filling a new prescription requires a visit to the physician’s office, studies have found an increase in physician visits due to advertising. These visits not only result in a prescription for the advertised drug, but also often lead to diagnoses of unrelated health issues or initiation of nonpharmaceutical treatments. They also lead to follow-up visits and sustained engagement with physicians that can last for years after the initial visit.9 A systematic review of patient and physician perceptions suggests potential benefits of DTC advertising, including enhanced information seeking by patients, increased appropriate prescription requests, and improved patient perceptions of physician interactions.10 Most prescribers reported a neutral influence of DTC advertising on the quality of patient interactions.
Restricting DTC advertising could also have downstream effects well beyond marketing. It may affect how drug companies set prices and invest in research and development. For example, by expanding demand, advertising could theoretically give drug companies more leverage in rebate negotiations with pharmacy benefit managers, potentially driving up drug prices. However, credible empirical evidence of this is limited because researchers lack access to data on net-of-rebate prices. Finally, if advertising restrictions reduce drug sales and profits, they could also potentially dampen investments in research and development.
In summary, restricting advertising is not a well-targeted solution for reducing inappropriate prescription drug use. It would also reduce treatment initiation for appropriate drugs and adherence to chronic disease medications. While advertisements may encourage some patients to request unnecessary or low-value drugs, this effect is mitigated by physician and insurer gatekeepers, who often steer patients to more appropriate or lower-cost alternatives. If DTC advertising were to go away, what would take its place? Would increased advertising of other heavily marketed products, such as fast food or unregulated supplements, do more harm than the drug advertisements they replaced? The body of evidence we referenced suggests that policymakers should exercise caution when considering policies restricting DTC advertising.
Article Information
Published: November 14, 2025. doi:10.1001/jamahealthforum.2025.5325
Open Access: This is an open access article distributed under the terms of the CC-BY License. © 2025 Alpert A et al. JAMA Health Forum.
Corresponding Author: Abby Alpert, PhD, University of Pennsylvania, 3641 Locust Walk, Philadelphia, PA 19104 ([email protected]).
Conflict of Interest Disclosures: Dr Sood reported being a visiting scholar at Amazon outside the submitted work. No other disclosures were reported.
References
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