Why the US and NZ Are the Only Countries With Drug Ads on TV
Drug ads that name a condition and a brand are banned nearly everywhere in the world. Here's how the US and New Zealand ended up as the two exceptions.
Almost every country that can afford a pharmaceutical industry has decided the same thing about drug commercials: don't let companies advertise prescription medicines straight to the people who might ask a doctor for them. The United States decided otherwise. So did New Zealand. That makes two.
Direct-to-consumer drug advertising — the ads that name a condition, name a brand, and end with a fast-talking list of side effects — is banned across nearly every high-income country. The European Union has resisted repeated industry lobbying to allow it. Canada allows only a watered-down version. The U.S. and New Zealand are, according to pharmaceutical policy researchers writing in The Conversation, the only two high-income countries that allow unrestricted direct advertising of branded medicines, complete with the drug's name and the condition it treats.
Why Is This Only Legal in the US and New Zealand?
Neither country set out to create this arrangement through deliberate policy. Direct advertising took root in both nations in the 1990s largely in the absence of any law specifically banning it, according to the same analysis, by researchers David Menkes, Barbara Mintzes and Joel Lexchin. In the U.S., prescription drug marketing has technically been legal since 1962 under the Federal Food, Drug and Cosmetic Act, but companies mostly kept it to doctors and pharmacists until the 1980s, according to a University of Wisconsin-Madison pharmaceutical policy analysis. What changed the volume wasn't new legislation — it was the FDA loosening its own broadcast-advertising requirements in 1997, which made TV-friendly ads with abbreviated risk disclosures commercially viable for the first time.
The results were immediate and durable. Spending on direct-to-consumer drug ads climbed from roughly $17.7 billion in total pharmaceutical marketing in 1997 to $29.9 billion by 2016, with consumer-facing ads accounting for close to a third of that — an increase north of 400% over two decades, driven by an industry that has found few marketing channels as effective at moving branded, expensive drugs.
Why Do Other Countries Ban It?
The near-universal prohibition elsewhere is treated as a patient-safety measure, not a marketing preference. In a review of 109 newly approved U.S. drugs, most had been tested in pre-market trials involving fewer than 500 patients — nowhere near enough to catch rare but serious side effects that surface only once a drug reaches millions of people. Regulators in Europe and elsewhere argue that advertising a drug directly to patients before its real-world safety profile is established invites exactly the wrong kind of pressure on doctors: patients asking for a specific brand by name, rather than describing symptoms and letting a clinician choose the treatment.
The case regulators point to most often is Vioxx. The arthritis drug was one of the most heavily advertised medicines of its era during its five years on the U.S. market, pitched directly to consumers even as internal company data pointed to an elevated risk of heart attacks; it was pulled from shelves worldwide after the risk became impossible to ignore. The episode remains a reference point in the argument that advertising can outrun the safety evidence behind a drug, particularly in its first few years on the market.
Is New Zealand About to Change This?
New Zealand's version of this story has been unusually unstable. The country never passed a law banning direct advertising, but it also never formally legalized it — until 2023, when the previous government folded explicit legal recognition of direct ads into the new Therapeutic Products Act. The current coalition government campaigned on repealing that act entirely, for reasons mostly unrelated to drug advertising, and has moved to do so without yet specifying what regulatory framework — if any — would take its place. Whether that repeal ends up closing New Zealand's version of the loophole or simply resets it to the same ambiguous status quo that let direct advertising flourish in the first place remains an open question in Wellington.
What the Rules Actually Require Now
The FDA's newest requirement, finalized in late 2023 and enforced starting in November 2024, forces drug ads to present risk information in "consumer-friendly language," matched in volume and pacing to the rest of the ad, rather than buried in a rapid-fire voiceover over unrelated visuals. It's a narrower fix than a ban: the rule changes how side effects are presented, not whether the ad can run, or whether it can name a condition a viewer has never heard of and suggest they ask a doctor about a specific brand. That distinction — regulating the disclosure rather than the practice — is the same one that separates the U.S. approach from every large economy except one, several thousand miles away in the South Pacific, currently deciding what its own approach is even going to be.
Compare that to how the FDA handles the drug itself rather than its advertising: American sunscreen and American melatonin are both regulated more conservatively than their European counterparts precisely because the FDA treats the underlying product as the risk to manage. Advertising has gone the opposite direction — the product stays tightly regulated, but what's said about it on television has, for three decades now, been left almost entirely to the industry writing the script.
