The Dissonance in Pharma DTC Erodes Credibility — and Limits Its Potential

The future of DTC should foster understanding, trust, and improve clinical conversations.

Prescription-drug commercials have been a recognizable part of American TV for nearly 30 years. Their production values have kept up with the rest of the advertising world, and in the costliest broadcast spaces, they now look almost identical to ads for consumer tech, cars, and sports betting. As The New York Times reported, spending on direct-to-consumer drug advertising is rising again, driven by competition in high-profile therapeutic areas – a reminder that DTC advertising is not fading but growing in scope and influence.

I have been writing about DTC pharmaceutical ads for nearly 20 years, and the dissonance – cavorting cartoon characters or people climbing mountains while vital information is voiced over – has remained remarkably consistent. Patients and clinicians often start the clinical conversation inside a narrative that the advertising has already shaped.

DTC advertising is the biggest untapped resource for public health education in the country. The concern isn't about the presence of risk information; it's whether the overall experience helps people understand what those risks mean and how they should affect treatment choices.

An ad for Vanda Pharmaceuticals’ antipsychotic Fanapt highlights this disconnect: a calm voice lists stroke risk, cardiac complications and sudden death while smiling, anime-style characters move through bright, cheerful scenes. The disclosure follows regulations but trivializes the seriousness of the condition and distracts from the importance of the adverse-event information.

Regulators have started to recognize the gap between mere compliance and actual understanding. The FDA’s letter to Novo Nordisk about a TV commercial for oral Wegovy criticized how the ad implied broader emotional and lifestyle benefits than the evidence supports. In another letter concerning a commercial for argenx’s Vyvgart Hytrulo, the agency noted that “attention-grabbing visuals, frequent scene changes and background music” might hinder understanding of the major risk statement. That language matters because it acknowledges that production techniques influence how risk is perceived. However, it stops short of addressing the core creative decision in most branded campaigns – whether the story enhances the safety message or competes with it.

Direct-to-consumer advertising grew rapidly after the FDA relaxed its broadcast guidance in 1997 and finalized the approach in 1999. Drug names became part of everyday conversation. Awareness increased, but public trust in the industry did not follow the same trajectory. The American Medical Association’s 2015 call for a ban on DTC advertising reflected ongoing concerns that brand narratives can influence the clinical encounter before a diagnosis is made. Physicians interviewed by The Times this week described spending valuable visit time recalibrating expectations created by advertising – explaining why a widely promoted therapy may not be suitable or why its risks and benefits are more complicated than the commercial suggests. That debate is unfolding at a time when trust in health institutions remains fragile.

The conversation still tends to frame DTC as a choice between maintaining the current model and eliminating it. But this overlooks a bigger issue. The pharmaceutical industry now controls some of the most influential health-communication platforms in the country – including television, streaming, social media, search, and digital video. How this multi-channel infrastructure is used has huge implications for how patients understand their health.

That reach is most visible during the Super Bowl. In 2024, Pfizer chose not to promote a specific therapy but to “celebrate science” on its 175th anniversary. Instead, the message was muddled and abstract. Pfizer missed an opportunity – not because its creative execution was weak, but because the platform’s power far exceeded the depth of what it chose to say.

That same media moment has also shown what a different objective looks like. Novartis’ Super Bowl LX screening initiatives and Bayer’s heart-health risk campaign used the industry’s most expensive media real estate to encourage early detection and informed action. They are not simply creative templates for branded advertising; the regulatory environment is different. They demonstrate that when education takes priority, storytelling shifts – and viewers leave with knowledge rather than just an impression.

Branded advertising operates within stricter regulatory constraints, but it still makes choices about tone, pacing, and imagery. These choices determine whether safety information is incorporated into the story or hidden beneath it. The issue is not about fair balance. It's whether the surrounding narrative trivializes the disease and distracts from the risks that should influence treatment decisions.

In many product campaigns, the narrative reassures, while the safety information warns. The viewer receives two emotional signals at the same time and must reconcile them. This split may work well for recall, but it weakens the credibility on which long-term brand success now depends.

Eliminating DTC would remove a source of awareness that has encouraged patients to seek care earlier and discuss stigmatized conditions with their physicians. The opportunity is to use it more effectively. A better approach would replace distraction with decision support – focusing on the moments when a patient and clinician weigh options, reassess progress, and adjust the course if a therapy is not suitable. In this model, safety information is not an interruption; it becomes part of the narrative.

This isn't a call for longer risk language or more data on the screen. It's a call for creative alignment. When tone, imagery, and narrative support the medical reality instead of competing with it, the advertising sets the stage for the clinical conversation rather than pre-empting it.

That shift has business implications. The industry has long argued that informed patients achieve better outcomes. In a crowded and scrutinized market, credibility remains one of the few durable advantages for brands. Creative work that distracts from risk might boost short-term recall, but creative approaches that aid decision-making builds trust with patients, clinicians, and regulators.

Direct-to-consumer advertising has become a permanent feature of American culture. Its future credibility will rely more on whether it bridges the gap between marketing and medicine than on disclosure adherence. In a medium where a 30-second story can reach tens of millions, aligning the message with medical truth is no longer optional; it is essential for understanding.

Good - Not Great - News on Pharma Reputation

Hold the Champagne for Now

You may have read of the recent Harris Interactive Reputation Study that showed that "the overall reputation of Corporate America has never been worse in the eyes of the general public." The bright spot in the report? Surprise! It's the pharmaceutical industry.

Pharmaceuticals posted their highest rating in five years -- up to 31% in 2008 from 26% in 2007. Is this the beginning of a turnaround? Is the public perceiving more value in the discoveries and treatments from this critical industry? Maybe, maybe not.

To place this in perspective, we can look at what else transpired in this time frame. With bank failures, AIG, home foreclosures, executive bonuses and Bernie Madoff, the financial services industry has fallen into the reputation cellar with the tobacco industry. Both share an 11% positive rating by the public. And, there's the auto industry. It suffered the largest decline (22%) in the survey's history. So, while there may indeed be some reason to cheer, the uptick for pharma may be a case of looking good by comparison. And, remember, 31% good means 69% not good.

I'll hold on to some hope, though. This increase in Harris' "Reputation Quotient" was observed during a time of high-profile drug withdrawals, the Presidential election (which included industry bashing from both sides) and the largest average price increase in five years. Something went right for the industry.

During this time, also, was a steep decline in DTC advertising -- a drop-off of 8% in 2008, which followed a 4% decline in 2007. Is less DTC advertising inversely proportional to pharma reputation? Or, is this pure coincidence? I wish I had some data to share -- this would be an interesting phenomenon to study.

What I can tell you is that I have a hunch that these facts do have an association. I've been saying for years that, while some efforts do a great job of informing and educating, DTC advertising can trivialize side effects, create false hope and interfere with an individual's calculus of risk/benefit. In addition, the pervasiveness of some ads has fueled the perception that increases in promotional spending come at the expense of research and development. Indeed, at the end of last year Roche CEO Bill Burns said, "DTC advertising has been the worst decision for the drug industry. When industry says we're spending all the money on R&D, but actually it's spending it on TV advertising to preserve margins, it doesn't get much credibility." And, more recently, concerns have been escalating over the appropriateness of some ads (e.g., ED spots during "family hour").

Here's a case where less really could mean more. Fewer shot-gun approaches to advertising and fewer goofy stunts in an attempt to start a discussion may lead us back to more effective communications that improve relationships with stakeholders and enhance industry reputation.

?-to-Face Communication

Let's Not Waste Opportunities to Make a Personal Connection

Every now and then I see an advertisement where a faceless or headless person is given the task of pitching a particular product. Some recent examples include AstraZeneca’s Symbicort (R) and HP’s personal computers.

My message to these and other companies that use this technique is to please reconsider. Do it for my benefit – I find this approach dehumanizing and off-putting. Do it for your own benefit – you’re missing the mark on building trust and empathy with your audience.

For a drug company that has done an excellent job in increasing its transparency, why communicate important medical information with a silhouette? For a PC manufacturer whose motto is “the computer is personal again,” why showcase the product with a decapitated presenter?

Perhaps the ads scored creative points with the client or tested well in a focus group. Maybe we, the viewers, are supposed to be engaged by trying to guess which celebrity is talking from a disembodied, off-camera head. Or, is it that they want us to “insert yourself here”?

I’ll admit that there are certain circumstances where this can work. Apple’s i-Pod comes to mind. But Apple has always been associated with design and creativity. There is a definite “cool” factor that’s communicated when they use those blacked-out dancing figures with the signature white ear buds bouncing and waving to popular tunes. Cachet is being built not questioned.

For the vast majority of communications using faceless or headless persons, though, how are we supposed to make a connection to the person, the product or the company? If, as Herman Melville said, “The eyes are the gateway to the soul,” then we’re being denied the opportunity to make some important judgments. How do we bond? How do we believe? How do we trust?

This isn’t just about advertisements. These are the reasons why the phone is better than email, why a video conference better than the phone, and why face-to-face communication is better than a video conference. Face-to-face allows us to observe all the nuances and evaluate the visual cues. With these additional inputs, we’re able to assemble a more accurate picture of the particular circumstance. The bottom line is that it’s the job of the communicator to provide the most appropriate pieces of information and ensure that they are received by the intended audience.

Let's Get a Little More Serious

Enhancing Corporate Reputation By Playing It Straight

I held a session on risk preparedness, issues management and crisis communications, last week in my Strategic Communication class at NYU. One of the truisms I talked about was how, so often, damage to reputation, morale, operations and financial performance is self-inflicted.

The pharmaceutical industry, unfortunately, serves as a prime example. In my view, some of the fights to differentiate products and gain market share have fanned the flames of antipathy toward the industry. DTC advertising has helped a number of brands become household names but these efforts have not always enhanced the public trust. We’re not making our best effort to properly set expectations or adequately communicate the balance between risk and benefit when animated characters or claymation body parts are used to sell medicines. I’m sure these ads test well in focus groups but this environment calls for a more serious approach to marketing and education.

This doesn’t mean that we can’t or shouldn’t be creative. We just need to redefine what creative means. The default definition of “creative” can’t be hosting big events or using celebrity spokespersons. It has to be more encompassing and it has to involve real analysis – a clear link to the needs of stakeholders.

Pfizer represents an interesting yin and yang on this subject. On the one side, they have Chantix(R), the smoking cessation product, with its ads using the tortoise and the hare to illustrate the importance of perseverance and compliance. But how seriously should we take the safety warnings when we see a petting zoo on TV? On the other side is the retooled Lipitor(R) campaign featuring an actual heart attack survivor who now takes the cholesterol reducer. If this guy is giving me the good and the bad, I’ll pay attention.

But what really interests me is the Company’s recently launched Medicine Safety Education web site. I don’t have any knowledge about how well this has been promoted, received or utilized, but this site looks like a good start in both communicating and collecting information on drug safety. And, beyond the attempt at putting safety in perspective, there’s another critical element – a step toward educating the public on risk perception. It’s a small but worthy – and creative – step toward rebuilding trust and reputation.