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Direct-to-consumer advertising — selling drugs or diseases?

Direct-to-consumer advertising — selling drugs or diseases?

Picture of Martha Rosenberg

DTC advertising debuted at the same time as the World Wide Web and both had the immediate effect of giving the patient information, often too much information, about diseases, symptoms and drugs. As a tongue-in-check affliction called “cyberchondria” quickly developed, rare conditions were "sold" to a wide population like “restless legs” or made more serious like GERD -- which was generally considered to be heartburn before DTC advertising. Risks of diseases were peddled, notably the risk of high cholesterol or thinning bones, producing millions of new drug takers who did not worry about the risks until DTC advertising. Drugs treating “risks” were especially lucrative because patients couldn’t know if the drug was working, if they needed the drug now or if they ever needed the drug.

Finally, through its symptom and disease awareness, DTC advertising and the Web helped to sell expensive and dangerous drugs when milder and cheaper drugs would work just as well. One example, of course, was Vioxx, which was billed as a “super-aspirin” for everyday arthritic or menstrual pain but ended up causing thousands of heart attacks and sudden cardiac deaths. Another example was a string of expensive antidepressants and psychiatric medications for conditions like depression or bipolar disorder that lacked blood and lab tests and were often self-diagnosed on the basis of aggressive and suggestive ads. 

"Are there periods of time when you have racing thoughts? Fly off the handle at little things? Spend out of control? Need less sleep? Feel irritable? You may need treatment for bipolar disorder," read print ads in major magazines for Seroquel when it was first approved for bipolar disorder. Of course the person with racing thoughts could also just be drinking too much coffee or be experiencing stress at work.

There also emerged a lucrative "add-on" drug market for depression when people did not respond to the first drug, possibly because they did not have the original condition to begin with. The popular “add-on” drug for depression, Abilify, sold for over a $1000 a month.

Cagey drug marketers also raised awareness for extremely rare conditions like shiftwork sleep disorder, excessive sleepiness, and adult ADHD that had not affected large parts of the population until DTC advertising.

Even a rare condition that almost exclusively affects blind people is promoted in direct to consumer advertising. "You can't see me because of radio... and I can't see you because I'm totally blind." So begins a high-saturation radio campaign that launched in 2013 to boost "awareness" of an obscure circadian rhythm disorder called Non-24 Hour Sleep Wake Disorder. How obscure is Non-24? There are only 146 citations for the disorder in the entire U.S. National Library of Medicine. By comparison, there are 8,463 citations for the plague.

The narrator says his blindness doesn't "hold me back" but he often "struggles to keep up" because he is not "sleeping through the night." He then says, "Sound familiar? You're not alone!" The ads are from the Washington, DC-based drug company Vanda who is marketing a drug for people who are blind and have Non-24.

Clearly DTC advertising has made a lot of money for drug companies by raising awareness of diseases and the risks of disease. But has it improved public health? 

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