It would seem logically impossible to be both exquisitely subtle and affrontingly obvious at the same time. However, a widely viewed television commercial managed to do just that. The ad displayed the name of the product as a smiling, middle-aged man threw a football through the center of a car tire. We are not told what kind of product is being promoted. Subtle, it would seem, until one learns that the product being advertised is a drug – for erectile dysfunction. In retrospect, knowing what the product purports to do, the ad seems appallingly suggestive. Indeed, one feels pretty dumb for not getting it in the first place. Another recent ad eschews subtlety and goes right for the jugular. An impossibly thin, glamorous woman suddenly falls to the floor. Her cholesterol level is flashed on the screen along with the name of the drug.

With clever and hard-hitting ads peddling drugs as one might sell soap or beer, it is no wonder that many are concerned about the effects of direct-to-consumer advertising. Such suspicions are further fueled by the fact that this seemingly ubiquitous advertising is coming at a time when overall drug spending is rising and new drug prices climb ever higher. That much of direct-to-consumer advertising (DTCA) is for so-called “lifestyle” drugs – for erectile dysfunction or hair loss, for example – only serves to add to the tawdry image of the drug companies.