Magazine ads for prescription drugs are high on emotional appeal, but short on evidence that they work.

Urging consumers to help their children fight allergies or to question whether their memory lapses might be Alzheimer's, most drug ads favor "vague" claims over clinical data.

Looking at ads in 70 issues of 10 leading US consumer magazines, researchers found that 87% chose "vague, qualitative terms" to describe the medication's benefits rather than providing research evidence.

These advertisements rarely quantify a medication's expected benefit, and instead make an emotional appeal. This strategy probably leaves many readers with the perception that the drug's benefit is large and that everyone who uses the drug will enjoy the benefit.

The authors also argue that a key danger is that many of these ads may "medicalize" run-of-the-mill problems in the public's mind. A runny nose all of a sudden becomes allergic rhinitis.

The first direct-to-consumer advertisement for a prescription drug appeared in Reader's Digest in 1981 in USA. Over the next few years, other such advertisements were published, and the US Food and Drugs Administration (FDA) became worried that little was known about the potential effect of such advertisements on the public.

Consequently, in 1983, the FDA initiated an advertising moratorium while it studied the issues and considered the regulatory options. Although they concluded that "direct to the public prescription advertising was not in the public interest," the FDA lifted the moratorium in 1985 because of concerns about freedom of speech and a general consensus that regulations already in place were sufficient to protect the consumer.

After the moratorium had been lifted, direct- to-consumer advertising was permitted provided that the advertisements met certain criteria; specifically, that they presented true and balanced information about the side-effects of the drugs, and their contraindications and effectiveness. The FDA monitors compliance with these criteria. However, prior approval of drug advertisements is not required.

Opponents of direct-to-consumer advertisements are worried that direct-to-consumer advertisements might inappropriately increase patient demand for specific, and generally costly, agents, and that this demand might have a negative effect on medical practice and on the physician-patient relationship.

Pharmaceutical companies spent $1.8 billion on direct-to-consumer advertisements for prescription drugs in 1999.

Concurrently, many pharmaceutical companies have reduced the amount spent on direct-to-physician advertising, which suggests a tactical shift in their focus from physicians to patients. Last year, for example, drug companies spent more on advertisements in newspapers and popular magazines than they did in medical journals ($685 million vs $473 million, respectively) (www.imshealth.com accessed on Aug 25, 1999).

Direct-to-consumer advertisements are common in popular magazines, particularly in those aimed at women. Furthermore, they all share a similar structure: they link the advertised product with its target condition and invite consumers to share in their own health management.

Although most advertisements addressed the relief of common symptoms that many consumers would normally treat themselves with over-the-counter remedies (eg, runny nose), a substantial number targeted more complex treatment decisions usually made by physicians (eg, choice of antibiotic or type of insulin).

Additionally, many of the advertisements presented quantitative data about potential side-effects, but very few provided any such data about benefit.

In a nationally representative survey, two thirds of adult Americans recalled seeing a prescription advertised, and about 10% asked their doctor for that prescription (of these, 73% said the prescription was made).

Direct-to-consumer advertisements for prescription drugs undoubtedly help to educate consumers about available options. At the same time they encourage consumers to believe that a problem might exist where they previously would not and that a pharmacological solution is the appropriate way to deal with it.

The Lancet October 6, 2001;358:1141-1146