In 1997, the FDA opened the flood gates on direct-to-consumer advertising, thus allowing drugmakers to promote their products on television. DTC has raised awareness of disease and prompted consumers to talk to their doctor about often sensitive topics, but it has also aroused some controversy.

In a recent editorial, Ian Spatz, a former vice president for global health policy at Merck, says doctors feel pressured to prescribe the drugs patients request. And critics say the ads push consumer to ask their doctors for expensive branded drugs, driving up the cost of healthcare.

He suggests drugmakers collaborate on disease-focused campaigns that raise awareness of certain conditions and urge patients to talk to their doctors for treatment options. Doing so would cut companies' advertising budgets, end the ridiculous laundry list of frightening side effects mandated by the FDA, and deliver important information to patients.

While TV proved the dominant medium for DTC in the early 2000s, things might be changing, as Gregory Aston pointed out recently in a blog post for Marketing: Health. In 2010, TV investment fell 17 percent, more than twice the rate of the total category. GSK and six other major pharmaceutical companies significantly reduced their TV investment. Meanwhile, there was a growth seen print (plus 13 percent in 2010, Aston points out). He doesn't see this as a surprise, as it is a tried and tested method to getting the industry's point across.

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DTC advertising

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UPDATED: My bathtub or yours? How a panned Cialis ad became promotional gold

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Litany of side effects in DTC ads 'a waste of time' for patients, top FDA official says

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GSK pumps out big bucks for Flonase OTC launch

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The top 10 advertisers in Big Pharma

While the list of the top spending DTC ad spenders changes every year, there are always a few certainties and a few surprises.

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Afrezza wasn't expected to be the spinach that would give Sanofi's diabetes business instant, superhuman strength. But the inhaled insulin, launched in February under a marketing deal with MannKind, was supposed to help fuel sales growth.