I have written a couple of previous articles regarding pharmaceutical advertisements on TV and in print. I noted that they used glitz to sell their products, and that this was not helpful for patients, especially as many new products had potentially more severe side effects than older ones and were often of no greater effectiveness. The only significant difference was that newer products were more expensive.

The safety issue is of increased concern at present, as the current FDA has decreased the requirements for product safety testing before a drug’s approval. Safety is now determined on an after-market basis through the public’s use of the product. That is, people are used as test subjects without the safeguards that were used in the past. This saves a company money and, to a certain extent, reduces its liability if the medication causes significant damage or death.

In March, a representative for the association of pharmaceutical companies, a lobbying organization, claimed that ads were a public service as they alerted people to the availability of drugs they might otherwise not know about. If so, then why do they use the same marketing strategies as were used for cigarettes for decades and are now used for other tobacco products (e.g., vapes, pouches)?

Health education materials presented on TV for vaccines and other prevention measures are structured on a more advisory basis, not as entertainment. Of course, drug companies have a greater budget than those who sponsor health education. Also, the goal of health education is not to generate profit, but to provide information.

Drug advertisements are not honest. They emphasize their products’ possible benefits while minimizing their potential negatives. These are either flashed on the screen briefly, in tiny print, while a speaker rapidly mentions them. How many people catch the phrase “that can lead to death” or “may be fatal” that is mentioned at least once? Of course, the image on the screen has nothing to do with the side effects and distracts the viewer’s attention from the text and the speaker. Equally given short shrift is “these are not all the side-effects.”

Before the present administration, it was routine for the Federal Trade Commission to fine pharmaceutical companies for their misleading commercials. This was of little concern to the companies, as they considered the fines a routine operating expense. These fines were not small, but they were factored into a drug’s price.

I also find it hard to consider a medication ad as a public service when the manufacturer profits from it. The companies contend that the high price is necessary to recoup the expense of researching and developing (R&D) the drug for the market. They do not disclose the amount they spend on marketing and lobbying, which the consumer pays for. Also, they neglect to disclose how much money the U.S. government provides, even to foreign manufacturers, for drug R&D. These costs should be deducted from final pricing calculations. For example, taxpayers invested millions in the development of Wegovy, yet it was extremely expensive initially; so much so that it not only paid for the manufacturer’s R&D for its development, but for the company’s entire R&D budget for the year it was introduced to the U.S. market! In effect, we pay twice for a medication: first with our taxes and second with our purchase.

If the advertisements were public service, as claimed, the companies would not only mention their drug, but also viable alternatives, and possibly a cost comparison. In other words, they would provide sufficient information for a consumer to make an informed choice. This, of course, is fantasy, and because the ads offer only a single medication, they cannot be considered educational.

Especially pernicious is that pharmaceutical companies have moved onto the internet and social media. The problem is that the regulations that govern their advertising on traditional media do not yet apply to these. Thus, the internet/social media ads can make claims and avoid mentioning the ill effects that are prevented on older media.

Research on medications performed by those unaffiliated with drug manufacturers is often published in medical journals, making them inaccessible to most consumers. Whether these reports influence clinician medication choice more than the rewards drug developers provide for prescribing their products has not been assessed. These emoluments are illegal, but the regulation is poorly enforced, and when companies are fined, they again adjust a medicine’s price to cover the penalty.

Consumer organizations, like the Health Research Group of Public Citizen, Drugs.com, or Consumer Reports, are valuable as they report these independent findings to the public. Consumers can use this information to ask their clinicians not for specific drugs as manufacturers desire, but if an advertised medicine being prescribed for them is the best one for their condition or if an older, more established alternative might be better.

M. Bennet Broner is a medical ethicist.