Journal of General Internal Medicine

, Volume 29, Issue 1, pp 110–118 | Cite as

Content Analysis of False and Misleading Claims in Television Advertising for Prescription and Nonprescription Drugs

  • Adrienne E. FaerberEmail author
  • David H. Kreling



False and misleading advertising for drugs can harm consumers and the healthcare system, and previous research has demonstrated that physician-targeted drug advertisements may be misleading. However, there is a dearth of research comparing consumer-targeted drug advertising to evidence to evaluate whether misleading or false information is being presented in these ads.


To compare claims in consumer-targeted television drug advertising to evidence, in order to evaluate the frequency of false or misleading television drug advertising targeted to consumers.


A content analysis of a cross-section of television advertisements for prescription and nonprescription drugs aired from 2008 through 2010. We analyzed commercial segments containing prescription and nonprescription drug advertisements randomly selected from the Vanderbilt Television News Archive, a census of national news broadcasts.


For each advertisement, the most-emphasized claim in each ad was identified based on claim iteration, mode of communication, duration and placement. This claim was then compared to evidence by trained coders, and categorized as being objectively true, potentially misleading, or false. Potentially misleading claims omitted important information, exaggerated information, made lifestyle associations, or expressed opinions. False claims were factually false or unsubstantiated.


Of the most emphasized claims in prescription (n = 84) and nonprescription (n = 84) drug advertisements, 33 % were objectively true, 57 % were potentially misleading and 10 % were false. In prescription drug ads, there were more objectively true claims (43 %) and fewer false claims (2 %) than in nonprescription drug ads (23 % objectively true, 7 % false). There were similar numbers of potentially misleading claims in prescription (55 %) and nonprescription (61 %) drug ads.


Potentially misleading claims are prevalent throughout consumer-targeted prescription and nonprescription drug advertising on television. These results are in conflict with proponents who argue the social value of drug advertising is found in informing consumers about drugs.


direct-to-consumer advertising over-the-counter drug advertising over-the-counter drug false or misleading advertising content analysis 



Mike Endries, Scott Falk and Matt Mattila, University of Wisconsin School of Pharmacy, assisted in developing the coding method, coding ads, and resolving coding discrepancies. They were paid an hourly wage for their work. We thank Drs. Betty Chewning, Robert Drechsel, Albert Gunther, and Henry Young for their valuable input on the design and analysis of this research. Dr. Faerber was supported by the Joseph P. Wiederholt Distinguished Graduate Fellowship from the University of Wisconsin-Madison, and the American Foundation for Pharmaceutical Education Postdoctoral Fellowship, This research study was supported by a dissertation grant from The Sonderegger Research Center, No funding bodies had any role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. This work was presented, in part, at the Midwest Social and Administrative Sciences in Pharmacy Conference in August 2012.

Conflict of Interest

Dr. Faerber declares she has no conflict of interest. Dr. Kreling reports that he has served as a consultant for local law firms in four legal cases regarding projecting future drug costs.

Supplementary material

11606_2013_2604_MOESM1_ESM.pdf (135 kb)
ESM 1 (PDF 134 kb)


  1. 1.
    Kornfield R, Donohue J, Berndt ER, Alexander GC. Promotion of prescription drugs to consumers and providers, 2001–2010. PLoS ONE. 2013;8(3):e55504. doi: 10.1371/journal.pone.0055504.PubMedCentralPubMedCrossRefGoogle Scholar
  2. 2.
    Gagnon M, Lexchin J. The cost of pushing pills: a new estimate of pharmaceutical promotion expenditures in the United States. PLoS Med. 2008;5(1):e1.PubMedCentralPubMedCrossRefGoogle Scholar
  3. 3.
    Mintzes B, Morgan S, Wright JM. Twelve years’ experience with direct-to-consumer advertising of prescription drugs in Canada: a cautionary tale. PLoS ONE. 2009;4(5):e5699. doi: 10.1371/journal.pone.0005699.PubMedCentralPubMedCrossRefGoogle Scholar
  4. 4.
    DeLorme D, Huh J, Reid L, An S. The state of public research on over-the-counter drug advertising. Int J Pharm Healthc Mark. 2010;4(3):208–231.CrossRefGoogle Scholar
  5. 5.
    Frosch DL, Kaplan RM. Shared decision making in clinical medicine: past research and future directions. Am J Prev Med. 1999;17(4):285–294.PubMedCrossRefGoogle Scholar
  6. 6.
    Elwyn G, Edwards A, Kinnersley P. Shared decision-making in primary care: the neglected second half of the consultation. Br J Gen Pract. 1999;49(443):477–482.PubMedCentralPubMedGoogle Scholar
  7. 7.
    Charles C, Gafni A, Whelan T. Shared decision-making in the medical encounter: what does it mean? (or it takes at least two to tango). Soc Sci Med. 1997;44(5):681–692.PubMedCrossRefGoogle Scholar
  8. 8.
    Soller RW. Evolution of self-care with over-the-counter medications. Clin Ther. 1998;20(Suppl C):C134–C140.PubMedCrossRefGoogle Scholar
  9. 9.
    Kennedy A, Rogers A, Bower P. Support for self care for patients with chronic disease. BMJ: Br Med J. 2007;335(7627):968–970. doi: 10.1136/bmj.39372.540903.94.CrossRefGoogle Scholar
  10. 10.
    Levin LS, Idler EL. Self-care in health. Annu Rev Public Health. 1983;4:181–201. doi: 10.1146/annurev.pu.04.050183.001145.PubMedCrossRefGoogle Scholar
  11. 11.
    Aikin KJ, Swasy JL, Braman AC. Patient and physician attitudes and behaviors associated with direct-to-consumer promotion of prescription drugs. Food and Drug Administration. 2004:1–112. Available at: Accessed July 10, 2013.
  12. 12.
    Brownfield ED, Bernhardt JM, Phan JL, Williams MV, Parker RM. Direct-to-consumer drug advertisements on network television: an exploration of quantity, frequency, and placement. J Health Commun. 2004;9(6):491–497. doi: 10.1080/10810730490523115.PubMedCrossRefGoogle Scholar
  13. 13.
    Lo A, Ryder K, Shorr RI. Relationship between patient age and duration of physician visit in ambulatory setting: Does one size fit all? J Am Geriatr Soc. 2005;53(7):1162–1167. doi: 10.1111/j.1532-5415.2005.53367.x.PubMedCrossRefGoogle Scholar
  14. 14.
    Geraghty EM, Franks P, Kravitz RL. Primary care visit length, quality, and satisfaction for standardized patients with depression. J Gen Intern Med. 2007;22(12):1641–1647. doi: 10.1007/s11606-007-0371-5.PubMedCentralPubMedCrossRefGoogle Scholar
  15. 15.
    Blumenthal D, Causino N, Chang YC, et al. The duration of ambulatory visits to physicians. J Fam Pract. 1999;48(4):264–271.PubMedGoogle Scholar
  16. 16.
    Brody H, Light DW. The inverse benefit law: how drug marketing undermines patient safety and public health. Am J Public Health. 2011;101(3):399–404. doi: 10.2105/AJPH.2010.199844.PubMedCrossRefGoogle Scholar
  17. 17.
    Frosch D, Krueger P, Hornik R, Cronholm P, Barg F. Creating demand for prescription drugs: a content analysis of television direct-to-consumer advertising. Ann Fam Med. 2007;5(1):6–13. doi: 10.1370/afm.611.PubMedCentralPubMedCrossRefGoogle Scholar
  18. 18.
    Macias W, Pashupati K. A wonderful life or diarrhea and dry mouth? Policy issues of direct-to-consumer drug advertising on television. Health Commun. 2007;22(3):241–252.PubMedCrossRefGoogle Scholar
  19. 19.
    Avery RJ, Eisenberg M, Simon KI. Fair balance in direct-to-consumer antidepressant print and television advertising, 1995–2007. J Health Commun. 2011:1–28. doi: 10.1080/10810730.2011.585698.
  20. 20.
    Kaphingst K, DeJong W, Rudd R, Daltroy L. A content analysis of direct-to-consumer television prescription drug advertisements. J Health Commun. 2004;9(6):515–528.PubMedCrossRefGoogle Scholar
  21. 21.
    Tsai W-HS, Lancaster AR. Message strategies in direct-to-consumer pharmaceutical advertising: a content analysis using Taylor’s six-segment message strategy wheel. Health Mark Q. 2012;29(3):239–255. doi: 10.1080/07359683.2012.705708.PubMedCrossRefGoogle Scholar
  22. 22.
    Tsao J. Informational and symbolic content of over-the-counter drug advertising on television. J Drug Educ. 1997;27(2):173–197.PubMedCrossRefGoogle Scholar
  23. 23.
    Greene JA, Choudhry NK, Kesselheim AS, Brennan TA, Shrank WH. Changes in direct-to-consumer pharmaceutical advertising following shifts from prescription-only to over-the-counter status. JAMA. 2012;308(10):973–975.PubMedCrossRefGoogle Scholar
  24. 24.
    Faerber AE, Kreling DH. Now you see it. Now you don’t: fair balance and adequate provision in advertisements for drugs before and after the switch from prescription to over-the-counter. Health Commun. 2012;27(1):66–74. doi: 10.1080/10410236.2011.569001.PubMedCrossRefGoogle Scholar
  25. 25.
    Faerber AE, Kreling DH. Content analysis of television advertising for drugs that switch from prescription to over-the-counter: balancing information and appeals. Drug Info J. 2012;46(2):226–234. doi: 10.1177/0092861512438765.Google Scholar
  26. 26.
    Wilkes M, Doblin B, et al. Pharmaceutical advertisements in leading medical journals: experts’ assessments. Ann Intern Med. 1992;116(1):912–919.PubMedCrossRefGoogle Scholar
  27. 27.
    Othman N, Vitry A, Roughead EE. Quality of pharmaceutical advertisements in medical journals: a systematic review. PLoS ONE. 2009;4(7):e6350. doi: 10.1371/journal.pone.0006350.PubMedCentralPubMedCrossRefGoogle Scholar
  28. 28.
    Korenstein D, Keyhani S, Mendelson A, Ross JS. Adherence of pharmaceutical advertisements in medical journals to FDA guidelines and content for safe prescribing. PLoS ONE. 2011;6(8):e23336. doi: 10.1371/journal.pone.0023336.PubMedCentralPubMedCrossRefGoogle Scholar
  29. 29.
    Sansgiry, Sharp W, Sansgiry S. Accuracy of information on printed over-the-counter drug advertisements. Health Mark Q. 1999;17(2):7–18.PubMedCrossRefGoogle Scholar
  30. 30.
    Abel G, Neufeld E, Sorel M, Weeks J. Direct-to-consumer advertising for bleeding disorders: a content analysis and expert evaluation of advertising claims. J Thromb Haemost: JTH. 2008;6(10):1680.PubMedCentralPubMedCrossRefGoogle Scholar
  31. 31.
    Drug Advertising: is this good medicine? Consumer Reports. 1996;61(6):62–63.Google Scholar
  32. 32.
    Kesselheim AS, Mello MM, Studdert DM. Strategies and practices in off-label marketing of pharmaceuticals: a retrospective analysis of whistleblower complaints. PLoS Med. 2011;8(4):e1000431.PubMedCentralPubMedCrossRefGoogle Scholar
  33. 33.
    The Federal Trade Commission. FTC Policy Statement on Deception. Federal Trade Commission Reporter 103. 1984;110:174–174.Google Scholar
  34. 34.
    The Federal Trade Commission, The Food and Drug Administration. Memorandum of Understanding Between the Federal Trade Commission and the Food and Drug Administration. The Food and Drug Administration. 2012:1–3. Available at: Accessed July 12, 2013.
  35. 35.
    Prescription Drug Advertising. Code of Federal Regulations. Chapter 21. Section 202.1(e):(6–7).Google Scholar
  36. 36.
    The Food and Drug Administration, Division of Drug Marketing Advertising and Communication. Brief summary: disclosing risk information in consumer-directed print advertisements. Food and Drug Administration. 2004. Available at: Accessed July 12, 2013.
  37. 37.
    The Food and Drug Administration, Division of Drug Marketing Advertising and Communication. Presenting risk information in prescription drug and medical device promotion. Food and Drug Administration. 2009. Available at: Accessed July 12, 2013.
  38. 38.
    The Food and Drug Administration, Division of Drug Marketing Advertising and Communication. Consumer-directed broadcast advertisements. Food and Drug Administration. 1999:1–6. Available at: Accessed July 12, 2013.
  39. 39.
    Sheehan K. Balancing acts: an analysis of food and drug administration letters about direct-to-consumer advertising violations. J Public Policy Mark. 2003;22(2):159–169.CrossRefGoogle Scholar
  40. 40.
    Benson EB, Alfors SN. Prescription drug advertising and promotion: Learnings from recent Food and Drug Administration warning letters. Drug Info J. 2007;41(3):281–289.Google Scholar
  41. 41.
    Salas M, Martin M, Pisu M, McCall E. Analysis of US food and drug administration warning letters: false promotional claims relating to prescription and over-the-counter medications. Pharm Med. 2008;22(2):119–125.CrossRefGoogle Scholar
  42. 42.
    Prescription Drug Advertising. Code of Federal Regulations. Chapter 21. Section 202.1(e):(5).Google Scholar
  43. 43.
    Prescription Drug Advertising. Code of Federal Regulations. Chapter 21. Section 202.1(k).Google Scholar
  44. 44.
    Prescription Drug Advertising. Code of Federal Regulations. Chapter 21. Section 202.1(e)(1).Google Scholar
  45. 45.
    Thompson Medical Co Inc vs Federal Trade Commission. 104 F.T.C. 648, 839 (1984), aff’d, 791 F.2d 189 (D.C. Cir. 1986), cert. denied, 479 U.S. 1086 (1987).Google Scholar
  46. 46.
    FTC Policy Statement Regarding Advertising Substantiation. Appended to Thompson Medical Co., 104 F.T.C. 648, 839 (1984), aff’d, 791 F.2d 189 (D.C. Cir. 1986), cert. denied, 479 U.S. 1086 (1987).Google Scholar
  47. 47.
    Faerber AE. Systematic assessment of true, misleading and false claims in advertisements for prescription and nonprescription drugs on television. Unpublished Doctoral Dissertation, University of Wisconsin. 2012.Google Scholar
  48. 48.
    McGuire WJ. McGuire’s Classic Input-Output Framework for Constructing Persuasive Messages. In: Rice RE, Aikin CK, eds. Public Communication Campaigns. 4 ed. Thousand Oaks, CA: Sage Publications: 133–146.Google Scholar
  49. 49.
    Percy L, Rosenbaum-Elliott R. Strategic advertising management. Oxford: OUP; 2012.Google Scholar
  50. 50.
    Shimp T. Social psychological (mis) representations in television advertising. J Consum Aff. 1979;13(1):28–40.CrossRefGoogle Scholar
  51. 51.
    Landis JR, Koch GG. The measurement of observer agreement for categorical data. Biometrics. 1977;33:159–174.PubMedCrossRefGoogle Scholar
  52. 52.
    Preston I. The Tangled Web They Weave: Truth, Falsity and Advertisers. Madison: The University of Wisconsin Press; 1994.Google Scholar
  53. 53.
    McDonagh M, Hefland M. Drug Effectiveness Review Project (DERP). Available at: Accessed July 12, 2013.
  54. 54.
    McDonagh M, Helfand M. Drug effectiveness review project systematic review methods and procedures. Oregon Health and Science University. 2011. Available at: Accessed July 12, 2013.
  55. 55.
    Braun RP, Lockhart EA, Bruno P. Delayed-Onset Muscle Soreness (DOMS)—A new pain model to compare OTC analgesics. Med Sci Sports Exerc. 1994;26:S14.CrossRefGoogle Scholar
  56. 56.
    Cooper SA, Schachtel BP, Goldman E, Gelb S, Cohn P. Ibuprofen and acetaminophen in the relief of acute pain: a randomized, double-blind, placebo-controlled study. J Clin Pharmacol. 1989;29(11):1026–1030.PubMedCrossRefGoogle Scholar
  57. 57.
    Hersh EV, Levin LM, Cooper SA, et al. Ibuprofen liquigel for oral surgery pain. Clin Ther. 2000;22(11):1306–1318.PubMedCrossRefGoogle Scholar
  58. 58.
    Olson NZ, Otero AM, Marrero I, et al. Onset of analgesia for liquigel ibuprofen 400 mg, acetaminophen 1000 mg, ketoprofen 25 mg, and placebo in the treatment of postoperative dental pain. J Clin Pharmacol. 2001;41(11):1238–1247.PubMedCrossRefGoogle Scholar
  59. 59.
    Packman B, Packman E, Doyle G, et al. Solubilized ibuprofen: evaluation of onset, relief, and safety of a novel formulation in the treatment of episodic tension-type headache. Headache. 2000;40(7):561–567.PubMedCrossRefGoogle Scholar
  60. 60.
    Schachtel BP, Furey SA, Thoden WR. Nonprescription ibuprofen and acetaminophen in the treatment of tension-type headache. J Clin Pharmacol. 1996;36(12):1120–1125.PubMedCrossRefGoogle Scholar
  61. 61.
    Schachtel BP, Fillingim JM, Thoden WR, Lane AC, Baybutt RI. Sore throat pain in the evaluation of mild analgesics. Clin Pharmacol Ther. 1988;44(6):704–711.PubMedCrossRefGoogle Scholar
  62. 62.
    Lamb E. Top 200 Drugs of 2008. Pharmacy Times. 2009:1–6. Available at: Accessed June 17, 2013.
  63. 63.
    Bayer Aspirin Products. Archived on January 7, 2010. Available at: Accessed June 17, 2013.
  64. 64.
    Bayer Aspirin Products. Archived on February 5, 2009. Available at: Accessed June 17, 2013.
  65. 65.
    Alka-Seltzer Plus Fast Crystal Packs. Available at: Accessed June 17, 2013.
  66. 66.
    Formula 44 Custom Care Cough & Cold PM Medicine. Available at: Accessed June 17, 2013.
  67. 67.
    Bean L. Nad Reviews Advertising for Bayer’s “Aleve” liquid gels, finds claims substantiated by Bayer’s evidence. ASRCReviewsorg. 2009:1–4. Available at:
  68. 68.
    NIH Consensus Development Panel on Osteoporosis Prevention, Diagnosis, and Therapy. Osteoporosis prevention, diagnosis, and therapy. In: Vol 285. 2001:785–795.Google Scholar
  69. 69.
    PhRMA. PhRMA Guiding Principles Direct to Consumer Advertisements about Prescription Medicines. Pharmaceutical Manufacturers of America. Pharmaceutical Manufacturers of America; 2008:1–16. Available at:
  70. 70.
    Edmonds R, Appelbaum J, Morgan J, et al. The State of the News Media 2012. The pew project for excellence in journalism. 2012. Available at: Accessed August 7, 2013.

Copyright information

© Society of General Internal Medicine 2013

Authors and Affiliations

  1. 1.Center for Medicine and the MediaThe Dartmouth Institute for Health Policy and Clinical PracticeLebanonUSA
  2. 2.Division of Social and Administrative Sciences in PharmacyUniversity of Wisconsin-Madison School of PharmacyMadisonUSA
  3. 3.Sonderegger Research CenterUniversity of Wisconsin-Madison School of PharmacyMadisonUSA

Personalised recommendations