The United States is one of the few countries in the world that allows direct-to-consumer advertising of prescription drug products. Chances are you have seen these commercials on TV. They often feature a celebrity spokesperson discussing a particular drug or an actor playing the role of a satisfied patient.

When it comes to advertising and other types of drug promotion, FDA oversees prescription drug products under the Federal Food, Drug, and Cosmetic Act, and related regulations. The Federal Trade Commission has jurisdiction of over-the-counter drug advertising. 

FDA ensures that drug product advertising is truthful, balanced, and accurately communicated. This is accomplished through a comprehensive surveillance, enforcement, and education program, and by fostering better communication of labeling and promotional information to both health professionals and consumers.

What is prescription drug promotion?

Pharmaceutical companies promote their products to consumers and health care professionals through advertisements appearing in magazines and newspapers, on radio and television, or online.  For decades, prescription drug makers promoted products exclusively to health care professionals, who were expected to interpret drug information for their patients. In the early 1990s, some drug manufacturers began targeting consumers. Since then, consumer advertising has become a popular promotional tool.

Drug promotion also includes the use of products such as brochures, notepads, pens, and videos that display drug names or product information. You may have seen these items in your doctor’s office. They are often distributed at medical conferences or by pharmaceutical sales reps visiting physicians.

Types of promotion

There are several different types of drug promotion. A reminder promotion is designed to increase product name recognition; it does not mention the drug’s uses or make any medical claims. Help-seeking promotion talks about a disease or medical condition, not a particular drug, and encourages consumers to see their doctor if they think they have the condition. A full product promotion describes a specific drug, including information about its uses, benefits, and risks.

What can and cannot be done in drug promotion

Drug advertisements and other promotions must be truthful, accurately communicated, and balanced in presenting a drug’s risks and benefits. “We look for the information presented in drug promotions to be accurate and balanced, and consistent with FDA-approved labeling for the drug,” says Thomas Abrams, director, Office of Prescription Drug Promotion. “Companies must be able to back up any claims made in an ad with substantial evidence from clinical trials or other valid sources,” adds Abrams.

Drug promotion is considered false or misleading if it:

• promotes the drug as being better or more effective than actually demonstrated
• implies that a drug is safer or has fewer or less severe side effects than demonstrated
• claims, without substantial evidence, that its product is better than a competitor’s drug
• gives a false, misleading or unbalanced presentation of risk information about a drug product
• promotes the product as being able to treat conditions not approved by FDA

FDA’s role

A drug company can submit draft ads or other promotional materials to FDA for feedback before using them. For the most part, pharmaceutical companies are not required to submit promotional materials to FDA before they are actually used. But materials must be sent to the agency for review once they are put into use to promote the drug.

Not all promotional materials are submitted to the agency as required. FDA monitors drug promotion in various ways. For example, the agency closely monitors promotional materials available at professional meetings and conferences. In addition, FDA receives many complaints from competing drug companies, health professionals, and consumers.

If FDA finds that a drug advertisement or other promotion is false or misleading, it can take enforcement action. The most common FDA action is a warning letter or a notice of violation sent to the company. Other enforcement actions, though rare, include product seizures, criminal actions, injunctions, and consent degrees.

A drug is "prescription only" when medical professionals must supervise its use because patients are not able to use the drug safely on their own. Because of this, Congress laid out different requirements for prescription and non-prescription or "over-the-counter" drugs. Congress also gave the Food and Drug Administration (FDA) authority to oversee prescription drug ads.  In turn, the FDA passed regulations detailing how it would enforce those requirements. These regulations are also known as "rules." However, while the FDA oversees ads for prescription drugs, the Federal Trade Commission (FTC) oversees ads for over-the-counter (non-prescription) drugs.

Product Claim Advertisements

Product claim ads are the only type of ads that name a drug and discuss its benefits and risks. However, these ads must not be false or misleading in any way. We encourage companies to use understandable language throughout product claim ads that are directed to consumers.

All product claim ads, regardless of the media in which they appear, must include certain key components within the main part of the ad:

• The name of the drug (brand and generic)
• At least one FDA-approved use for the drug
• The most significant risks of the drug

Product claim ads must present the benefits and risks of a prescription drug in a balanced fashion.

Print product claim ads also must include a "brief summary" about the drug that generally includes all the risks listed in its approved prescribing information.

• Under the Food and Drug Administration Amendments Act of 2007, print advertisements need to include the following statement: "You are encouraged to report negative side effects of prescription drugs to the FDA. Visit MedWatch or call 1-800-FDA-1088."

Broadcast product claim ads (TV, radio, telephone) must include the following:

• The drug's most important risks ("major statement") presented in the audio (that is, spoken) AND
• Either all the risks listed in the drug's prescribing information or a variety of sources for viewers to find the prescribing information for the drug

This means that drug companies do not have to include all of a drug's risk information in a broadcast ad. Instead, the ad may tell where viewers or listeners can find more information about the drug in the FDA-approved prescribing information. This is called the "adequate provision" requirement.  For broadcast ads, we have said that including a variety of sources of prescribing information fulfills this requirement.

We have suggested that broadcast ads give the following sources for finding a drug's prescribing information:

• A healthcare provider (for example, a doctor)
• A toll-free telephone number
• The current issue of a magazine that contains a print ad
• A website address

Reminder Advertisements

Reminder ads give the name of a drug, but not the drug's uses. These ads assume that the audience already knows the drug's use.

A reminder ad does not have to contain risk information about the drug because the ad does not say what the drug does or how well it works. Unlike product claim ads, reminder ads cannot suggest, in either words or pictures, anything about the drug's benefits or risks. For example, a reminder ad for a drug that helps treat asthma should not include a drawing of a pair of lungs, because this implies what the drug does.

Reminder ads are not allowed for certain prescription drugs with serious risks. Drugs with serious risks have a special warning, often called a "boxed warning," in the drug's FDA-approved prescribing information. Because of their seriousness, the risks must be included in all ads for these drugs.

Help-Seeking Advertisements

Help-seeking ads describe a disease or condition but do not recommend or suggest a specific drug treatment. Some examples of diseases or conditions discussed in help-seeking ads include allergies, asthma, erectile dysfunction, high cholesterol, and osteoporosis. The ads encourage people with these symptoms to talk to their doctor.  Help-seeking ads may include a drug company's name and may also provide a telephone number to call for more information.

When done properly, help-seeking ads are not considered to be drug ads. Therefore, we do not regulate true help-seeking ads, but the FTC does regulate them.  If an ad recommends or suggests the use of a specific drug, however, it is considered a product claim ad that must comply with FDA rules.

Other Product Claim Promotional Materials

Other types of promotional materials than advertisements are used to promote the use of a drug. These are called "promotional labeling" and include brochures, materials mailed to consumers, and other types of materials given out by drug companies. If these materials mention the drug's benefit(s) they must also include the drug's prescribing information.

Risk Disclosure Requirements for Different Types of Advertisements

Different advertisements require different amounts of benefit and risk information.

Reminder ads do not have to include any risk information because they cannot include any claims or pictures about what a drug does or how it works.  Reminder ads are only for drugs without certain specified serious risks.

Print product claim ads may make statements about a drug's benefit(s). They must present the drug's most important risks in the main part of the ad ("fair balance"). These ads generally must include every risk, but can present the less important risks in the detailed information known as the "brief summary."

Also, print product claim and reminder ads must include the following statement:

"You are encouraged to report negative side effects of prescription drugs to the FDA. Visit MedWatch or call 1-800-FDA-1088."

Broadcast product claim ads may make statements about a drug's benefit(s). They must include the drug's most important risk information ("major statement") in a way that is clear, conspicuous, and neutral.  In addition, they must include either every risk or provide enough sources for the audience to obtain the drug's prescribing information ("adequate provision").

These are some frequently asked questions about direct-to-consumer (DTC) advertising. FDA requirements, as well as activities of the Office of Prescription Drug Promotion (OPDP), are shown in this section.

Does the FDA control advertisements for all drugs?

• No. The FDA does not oversee the advertising of over-the-counter (OTC) drugs. The Federal Trade Commission (FTC) is responsible for regulating OTC drug ads. The FDA regulates advertising only for prescription drugs. We also oversee the advertising for certain kinds of medical devices, such as hearing aids, the lasers used in LASIK procedures, and contact lenses.

Does the FDA review and approve all advertisements for drugs before their release?

• No. In most cases, federal law does not allow the FDA to require that drug companies submit ads for approval before the ads are used. We see many ads at about the same time the public sees them. Many drug companies voluntarily seek advice from us before they release TV ads. However, if we believe that an ad violates the law, we send a letter to the drug company asking that the ads be stopped right away.

Does Federal law ban ads for drugs that have serious risks?

• No. Federal law does not bar drug companies from advertising any kind of prescription drugs, even ones that can cause severe injury, addiction, or withdrawal effects. However, companies cannot use reminder ads for drugs with certain serious risks (drugs with "boxed warnings").

Does the FDA require drug companies to use hard-to-understand medical language in ads directed to consumers?

• No. We encourage drug companies to use language that is clear and understandable to the general public. The law requires that all risks be communicated. However, it is sometimes difficult to express scientific and medical language in simpler terms without changing the meaning.

Can the FDA limit the amount of money spent on prescription drug ads?

• No. We do not have any authority to affect the amount of money drug companies spend on ads.

Does the FDA work with drug companies to create prescription drug ads?

• We do not help create any prescription drug ads. Drug companies create these ads themselves, often with help from advertising agencies.

Does the FDA approve ads for prescription drugs before they are seen by the public?

• No, generally we do not. Except in unusual instances, we cannot require drug companies to submit ads for approval before they are used. Drug companies must only submit their ads to us when they first appear in public. This rule is the same whether the ads are aimed toward healthcare providers or consumers. This means that the public may see ads that violate the law before we can stop the ad from appearing or seek corrections to the ad. Consumers should know that they may not necessarily be able to tell whether any specific DTC ad includes false or misleading information.

What must product claim ads tell you?

• At least one approved use for the drug
• The generic name of the drug
• All the risks of using the drug
  • Under certain circumstances, ads can give only the most important risks
  • For more detail, see brief summary and adequate provision

What are ads not required to tell you?

• Cost
• If there is a generic version of the drug (a drug with the same active ingredient that might be cheaper)
• If there is a similar drug with fewer or different risks that can treat the condition
• If changes in your behavior could help your condition (such as diet and exercise)
  • Sometimes this information is required. It depends on the prescribing information for the particular drug
• How many people have the condition the drug treats
• How the drug works (its "mechanism of action")
• How quickly the drug works
  • However, if the ad claims that the drug works quickly, the ad must explain what "quickly" means
• How many people who take the drug will be helped by it

How do the "brief summary," "prescribing information," "major statement," and "adequate provision" differ?

• These terms refer to different rules for how risk information must be included with materials that advertise prescription drugs. We require different types of benefit and risk disclosures for different types of promotions.
• "Prescribing information" (also called product information, product labeling, package insert, and the PI) includes the most complete information about a prescription drug. It includes technical information about the chemistry of the drug, its proper use overall and in specific types of patients, and details about possible side effects. It is written for healthcare providers. When we approve a drug for marketing, we also approve the prescribing information.
• The "brief summary" includes all the risk information about a prescription drug and is generally based on the prescribing information. The brief summary may leave out non-risk information, such as the chemical description of the drug, how it works in the body, and directions for using it. For DTC ads, we recommend that brief summaries be written in language that consumers can understand.
• A "major statement" is required only for broadcast (TV, radio and telephone) ads. It consists of the drug's most important risks. The major statement must be presented in a clear, conspicuous, and neutral manner. The risks are generally similar to the risks required for "fair balance" in print ads.
• "Adequate provision" applies only to broadcast ads. Broadcast ads must include either the "brief summary" or make "adequate provision" for the audience to find the drug's prescribing information. This requirement can be met by offering a variety of sources, including a healthcare provider, a toll-free telephone number, the current issue of a magazine containing a print ad for the drug, and a Web site address.

Does the law say anything about the design of ads for prescription drugs?

• Yes. The layout of an ad — the way information is presented — can affect whether an ad meets the fair balance requirement. For example, ads must present side effect information in a manner similar to that used for the benefit information. Various ways of presenting information that can affect fair balance include type size, bulleting, amount of white space, and headlines.

Has FDA done research on DTC advertising?

• Yes. The Office of Prescription Drug Promotion (OPDP) of the FDA's Center for Drug Evaluation and Research (CDER) conducts research on direct-to-consumer (DTC) advertising. This includes telephone surveys of DTC-related patient and physician attitudes and behaviors. This research helps OPDP make decisions about DTC advertisements.

How can an ad violate the law?

• These are a number of ways in which an ad may violate the law. For example, the ad could:
  • State or imply that the drug can treat a condition when the FDA has not approved the drug for such use
  • Make claims that are not supported by adequate evidence
  • Misrepresent data from studies
  • Overstate the drug's benefits
  • Suggest that the drug can be used in patients with specific characteristics when the drug hasn't been shown to work or to be safe in such patients
  • Leave out or downplay risk information
    • Fail to present a "fair balance" of information relating to the drug's risks and benefits (required for "product claim ads" and "promotional labeling")
    • Leave out a "brief summary" (required for "product claim ads")
    • Fail to attach the drug's prescribing information (required for "promotional labeling")
    • Fail to include sources to help the audience find the "prescribing information" for the drug (for product claim ads on TV, radio, or by telephone)
    • Fail to include the required information about where negative side effects can be reported
  • Appear to be a "reminder ad" but make a claim about the drug
  • Appear to be a "reminder ad" but is about a drug that has certain very serious risks (one with a boxed warning) — reminder ads are not allowed for such drugs
  • Appear to be a "help-seeking" or disease awareness ad but recommend or suggest a particular prescription drug

Who should I tell if I think that a prescription drug ad violates the law?

• Contact FDA's Office of Prescription Drug Promotion (OPDP) about prescription drug ads you believe violate the law by being false, misleading, or lacking in "fair balance". Consumers can call OPDP at 301-796-1200. Or, consumers may submit their complaint in written form to OPDP at:
   
  • Food and Drug Administration
    Center for Drug Evaluation and Research
    Office of Prescription Drug Promotion
    5901-B Ammendale Road
    Beltsville, MD 20705-1266

What does FDA do if it determines that an ad violates the law?

• We have different ways to enforce the laws that apply to advertisements for prescription drugs. The simplest and most common way is to send a letter to the drug company. The letter explains how the ad has violated the law. It generally asks the drug company to remove the ad and stop the unlawful behavior.
• In some cases, we will ask the drug company to fix the misimpression made by the violative ad. The fix could include publishing a corrective ad. We are most likely to take this action when the misimpression poses a serious threat to public health.
• We post the enforcement letters issued by OPDP on the Warning Letters web page.
• Sometimes we take additional enforcement action. This may include taking drug companies to court and even taking ("seizing") supplies of the drug. Court actions can include asking for an injunction (court-enforced ban of specific activities) and bringing criminal charges against the drug company.

Think about the following questions when you see an ad for a prescription drug. Also, think about asking these questions when you talk to your doctor or pharmacist about a drug.

• What condition does this drug treat?

• Why do I think that I might have this condition?

• If I have the condition, am I part of the population the drug is approved to treat?

• Should I take this drug if I have a certain condition?

• Should I take this drug if I am taking certain other drugs?

• Which of the drug's possible side effects am I concerned about?

• How will this drug affect other drugs I am taking?

• Will foods, beverages (alcoholic or non-alcoholic), vitamins, or other supplements affect how this drug works?

• Are there other drugs that treat my condition?

• Is there a less costly drug I could use to treat my condition?

• What else can I do to help deal with my condition? For example, should I exercise or change my diet?

• Do other drugs for my condition have different side effects?

• How can I learn more about this condition and this drug?

Adequate Provision

An alternative way for drug companies to provide risk information about a drug in a broadcast ad. Drug companies generally must include all of a drug's risk information in a product claim ad. In print ads, they usually do this in the "brief summary." This brief summary would take many minutes to read or scroll down a TV screen. The law allows broadcast ads to include only the most important risk information if the ads tell viewers or listeners how to get the full FDA-approved prescribing information, which has all the drug's risks. To meet the "adequate provision" requirement, the broadcast ad must provide ways to find the drug's FDA-approved prescribing information.

Broadcast ads can meet the "adequate provision" requirement by giving a number of sources for finding a drug's prescribing information. These include:

• A healthcare provider (for example, a doctor)
• A toll-free telephone number
• The current issue of a magazine that contains a print ad
• A Web site address

Advertisement

Federal law treats advertisements and promotional labeling differently. Advertisements generally appear in:

• Print periodicals, such as journals, magazines, and newspapers
• Broadcast media, such as television and radio, as well as through telephone systems

Advertising and Promotional Labeling Branch (APLB)

The APLB is the group within the Center for Biologics Evaluation and Research (CBER) that regulates the promotion of biological products, including vaccines, tissues, and blood-related products, including allergenics, and cellular and gene therapy.

Benefit

A benefit is help provided by a drug for the person who is taking it. For example, the benefit of a drug used to treat cholesterol is that it lowers the levels of bad cholesterol (low-density lipoprotein, or LDL, cholesterol). A drug could also raise the levels of good cholesterol (high-density lipoprotein, or HDL, cholesterol). This is another possible benefit. The law does not allow drug companies to advertise benefits unless they are related to the FDA-approved use. Also, advertised benefits must be supported by "substantial evidence" or substantial clinical experience. However, healthcare providers can prescribe a drug for uses other than its FDA-approved use.

Boxed Warning

Drugs that have special problems, particularly ones that may lead to death or serious injury, may have this warning information displayed within a box in the prescribing information.  This is often referred to as a "boxed" or "black box" warning.  Drugs that have such boxed warnings are not permitted to have reminder ads.

Brand Name

A drug's common name, which is the generally advertised name. Drugs that have the same underlying active substance may be made by different companies and can have different brand names.

Brief Summary

This is the technical name for the detailed information that appears in ads for prescription drugs. The law requires that print ads making claims about a drug (product claim ads) include a "brief summary" with all the risks listed in the drug's "prescribing information" and at least one FDA-approved use of the drug. The brief summary generally includes:

• Who should not take the drug
• When the drug should not be taken
• Possible serious side effects of the drug and, if known, what can be done to lower the chance of having them
• Frequently occurring, but not necessarily serious, side effects

The "brief summary" includes a lot of information, so it is usually presented on its own page of a print ad. When the "brief summary" is part of an ad directed at the consumer, the FDA encourages drug companies to use language consumers can easily understand.

Claim

A claim says something about the advertised drug or what it does. Claims usually relate to benefits. Claims can be made directly by stating, for example, "Brand X treats heartburn." Claims also can be made indirectly by the use of pictures or other graphics. For example, an ad with a picture of a playground full of children may suggest a claim that the advertised drug treats children.

The law says that ads for prescription drugs can only make claims that are consistent with the drug's "prescribing information." Further, the truthfulness of claims must be supported by "substantial evidence" or substantial clinical experience.

Direct-to-Consumer (DTC) Advertisements

DTC ads are published in magazines and newspapers that are distributed to a general audience rather than to healthcare providers such as doctors, nurses, and pharmacists. DTC ads can also be broadcast through television or radio. Other types of materials, such as brochures, booklets, or pamphlets distributed to patients, caregivers, or other non-healthcare providers are considered DTC promotions. While many people would think these are ads, they are technically considered a different category, called promotional labeling.

Fair Balance

The law requires that product claim ads give a "fair balance" of information about drug risks as compared with information about drug benefits. This means that the content and presentation of a drug's most important risks must be reasonably similar to the content and presentation of its benefits.

This does not mean that equal space must be given to risks and benefits in print ads, or equal time to risks and benefits in broadcast ads. The amount of time or space needed to present risk information will depend on the drug's risks and the way that both the benefits and risks are presented.

Generic Name

A drug's generic name is one that a non-government organization assigns to the drug's active ingredient. Different "brand names" can be used for the same generic name ingredient. For example, the active ingredient in Synthroid^® is levothyroxine. Levothyroxine is also the active ingredient in Levoxyl^®. Levothyroxine is the generic name for both of the brand names Synthroid^® and Levoxyl^®.

Interaction

Drugs sometimes interact with other drugs (prescription and non-prescription), supplements, foods, or beverages. These interactions may affect how the drug works, or may cause side effects. To avoid problems, a person thinking about taking a drug should know its possible interactions. They should also tell their healthcare provider about all the drugs and supplements they take.

Major Statement

The "major statement" is a term that is relevant only to broadcast (TV or radio) ads for prescription drugs. It refers to the presentation of the drug's most important risks. This presentation must be spoken. It also can be included in the video part of TV advertisements.

The amount and type of included risk information will vary by drug because different drugs have different risks.

Office of Prescription Drug Promotion (OPDP)

OPDP regulates the promotion of prescription drugs within the FDA's Center for Drug Evaluation and Research (CDER).

Prescribing Information

Prescribing information is also called product information, product labeling, or the package insert ("the PI"). It is generally drafted by the drug company and approved by the FDA. This information travels with a drug as it moves from the company to the pharmacist. It includes the details and directions healthcare providers need to prescribe the drug properly. It is also the basis for how the drug company can advertise its drug.

The prescribing information includes such details about the drug as:

• Its chemical description
• How it works
• How it interacts with other drugs, supplements, foods, and beverages
• What condition(s) or disease(s) it treats
• Who should not use the drug
• Serious side effects, even if they occur rarely
• Commonly occurring side effects, even if they are not serious
• Effects on specific groups of patients, such as children, pregnant women, or older adults and how to use it in these populations

Sometimes, manufacturers draft prescription drug information designed for patients that the FDA approves. These are often called "Patient Package Inserts," "Patient Product Information," or "PPIs." When the information is for an especially risky or difficult to use drug, it is called a Medication Guide. Patients should be given this information when they fill their prescription. Patients may also get information that is produced independently of the FDA and the drug company.

Product Labeling

see: Prescribing Information

Promotional Labeling

Promotional labeling and advertising are both used to help sell prescription drugs. Promotional labeling differs from advertising in the way it is distributed. Ads are usually broadcast on TV or radio, or are published in newspapers or magazines. Promotional labeling includes additional types of materials and ways to get them to the consumer, for example:

• Brochures and booklets
• Mailed materials, including letters to patients
• Videotapes
• Refrigerator magnets, cups, and other giveaways that show a drug's name

Promotional labeling about a drug is said to "accompany" that drug, even if the promotional labeling is not physically attached to a drug container. Promotional labeling must be accompanied by the drug's prescribing information.

Risks/Side Effects

The risks of a drug refer to what can go wrong when the drug is used. A drug's prescribing information states these risks, which can include:

• What groups of patients should not use the drug because it may do them more harm than good
• When the drug should not be used
• Serious side effects
• Side effects seen in special populations, such as children, pregnant women, or older patients
• Commonly occurring side effects
• The chance of the drug causing abuse or dependence
• The chance of the drug causing withdrawal effects

Substantial Evidence (Substantiation)

Substantial evidence refers to the data needed to support claims about an advertised drug. Before the FDA approves a drug for marketing, drug companies must complete studies to show that the drug does what they say it does. These studies are also required to support advertising claims about the drug. Drug companies need to have at least two studies to support these claims.

When it comes to advertising prescription drugs on radio and television and in magazines, doctors say that, for the most part, the ads have both positive and negative effects on their patients and practices. Results of a Food and Drug Administration survey, released in 2004, also indicate that most physicians view direct-to-consumer (DTC) ads as one of many factors that affect their medical practices and their interactions with patients.

For decades, prescription drug makers promoted their products exclusively to health care professionals, who were expected to interpret drug information for their patients. Beginning in the early 1990s, some drug manufacturers began targeting consumers due, in part, to the aging baby boomers and to an increase in the number of patients participating in their own health care decisions. Since then, DTC advertising has become a popular promotional tool.

The FDA oversees the advertising of prescription drug products under the Federal Food, Drug, and Cosmetic Act and related regulations. That means the agency must ensure that prescription drug information provided by drug firms is truthful, balanced, and accurately communicated. This is accomplished through a comprehensive surveillance, enforcement, and education program, and by fostering better communication of labeling and promotional information to both health professionals and consumers. The 500-physician survey, released in November 2004, is the third in a series of evaluations that the FDA is using to understand better how DTC prescription drug promotion affects the patient-doctor relationship.

The physician survey and two previous consumer surveys indicate that awareness of DTC ads is increasing. For example, 81 percent of consumer respondents in 2002 reported seeing or hearing an ad for a prescription drug. This figure is up from 72 percent in 1999. But 58 percent agreed strongly that DTC ads make the drugs seem better than they really are.

The results of all three surveys will help the agency decide whether advertising rules need to be changed to ensure better consumer understanding of a prescription drug's risks and benefits.

"Much of our compliance and enforcement activity is spent trying to ensure that companies don't low-ball risks in the ad and provide inflated expectations of benefit," says Janet Woodcock, M.D., deputy FDA commissioner for operations.

Other highlights of the surveys include:

• Most physicians agreed that because their patient saw a DTC ad, he or she asked thoughtful questions during the visit. About the same percentage of physicians thought the ad made their patients more aware of possible treatments.

• Many physicians thought that DTC ads made their patients more involved in their health care.

• Physicians thought the ads did not convey information about risks and benefits equally well. Seventy-eight percent of physicians believe their patients understand the possible benefits of the drug very well or somewhat, compared to 40 percent who believe their patients understand the possible risks, and 65 percent believe DTC ads confuse patients about the relative risks and benefits of prescription drugs. In addition, about 75 percent of physicians surveyed believed that DTC ads cause patients to think that the drug works better than it does, and many physicians felt some pressure to prescribe something when patients mentioned DTC ads.

• Eight percent of physicians said they felt very pressured to prescribe the specific brand-name drug when asked.

• DTC ads help patients have better discussions with their physicians and provide greater awareness of treatments. The study demonstrated that when a patient asked about a specific drug, 88 percent of the time they had the condition that the drug treated. And 80 percent of physicians believed their patients understood what condition the advertised drug treats.

• Doctors believe that patients understand that they need to consult a health care professional about appropriate treatment. Eighty-two percent responded either "very well" or "somewhat" when asked whether they believe that their patients understand that only a doctor can decide whether a drug is right for them.