Spending on direct-to-consumer advertising in the USA has risen 330% in the last decade despite criticisms that it drives up health spending and encourages medicines to be used inappropriately, and in light of several high-profile drug withdrawals following safety concerns, according to a new report in this week’s New England Journal of Medicine entitled A Decade of DTC Advertising of Prescription Drugs.

Ten years ago a change in Food and Drug Administration policy permitted drugs to be advertised on television in the USA, and during this time spending on DTC advertising has almost tripled from $11.4 billion to $29.9 billion (1996 to 2005) – an average annual rate of 10.6%. The percentage of sales spent on promotion rose from 14.2% to 18.2% over this time. Yet, the report points out, this is overshadowed by the pharmaceutical industry’s spending on promotion to professionals, with only 14% of the sector’s entire expenditure devoted to this sort of advertising.

After the withdrawal of Merck & Co’s Vioxx (rofecoxib) in 2004, there were calls for DTC advertising to be restricted - particularly for new drugs – and this was reinforced recently in an Institute of Medicine report on the safety of medicines. Yet the NEJM report notes that 10 of the top 20 drugs – which themselves represent 55% of total industry outlay on DTC advertising – were introduced onto the market in 2000 or later. In addition, 17 of the 20 campaigns for these drugs began within one year after approval by the FDA.

The FDA also comes under fire in the report, as it did earlier this year when the Government Accountability Office heavily criticised the agency’s enforcement of advertising. In constrast to the growing number of DTC campaigns, the number of letters declaring a violation fell from 142 in 1997 to 21 in 2006, which the authors put down to the agency's weakened capacity to enforce the regulations.

Powerful lobbyist the AIDS Healthcare Foundation called the spending rise “astronomical,” adding: “This despite the fact that the drug industry and the FDA have come under fire over major missteps such as the Vioxx debacle and others in which heavily advertised drugs have turned out to have serious, unknown health risks.” AHF is a proponent of advertising only when it educates the public about a specific medical condition for which treatment in available, rather than directly promoting a specific drug or brand.

But as the authors of the NEJM report put it, calls for a moratorium on advertising for new drugs would “represent a dramatic departure from current practices.” However, such a move could improve the industry's image; a recent study by TNS Healthcare found that almost two-thirds of US doctors favour a moratorium on direct-to-consumer advertising, with half supporting a one-to-two year wait before manufacturers can begin promoting their drugs.