The US and New Zealand are the only industrialized countries that allow direct-to-consumer advertising (DTCA) of prescription drugs, although New Zealand is planning a ban. Is it time for the US to also ban the practice? In a debate in the open access medical journal PLoS Medicine, authors with divergent viewpoints lay out the possible public health benefits and harms from such advertising.

Richard Kravitz (University of California, Davis), lead author of a recent study on DTCA, argues that DTCA should be regulated, rather than banned. Kravitz argues that DTCA could be used to promote the use of life-saving medicines, such as beta-blocker drugs for people who have had a heart attack. "On a population basis," he says, "underuse of effective therapies may cause more deaths per year than overuse."

DTCA could deliver net public health benefits, says Kravitz, provided it was used only to advertise safe, effective, underused drugs for serious medical conditions. "The question for US policymakers is not whether DTCA should be banned," he says, "but how can its benefits be maximized and risks minimized within our free enterprise system."

Elizabeth Almasi and Randall Stafford (Stanford University) hypothesize that DTCA might in fact produce a valuable placebo effect. They argue that such advertising is likely to raise patients' expectations about a medicine's benefits, which "may increase the effectiveness of medications beyond that which is expected from their purely biological mechanisms."

And such raised expectations, they argue, might even motivate patients to collaborate with their physicians, and thereby increase the quality of their care.

But although there may be some evidence of benefits from DTCA, argues Peter Mansfield (Director of the nonprofit organization Healthy Skepticism, at www.healthyskepticism.org), there is stronger evidence of harms.
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Contact: Andrew Hyde
ahyde@plos.org
44-122-346-3330
Public Library of Science
27-Mar-2006