As a senior citizen, I was greatly annoyed by an email video advertisement featuring a joyful, good-looking, older couple biking through a scenic park, smiling grandchildren in tow. At the same time, a soothingly mellow voice speedily drones a list of side effects like “internal bleeding,” “hallucinations,” or “death.”

If this sounds absurd, it should.

However, only two countries worldwide, the United States and New Zealand, allow direct-to-consumer (DTC) pharmaceutical advertising. Everywhere else, drug companies are required to promote medications only to healthcare professionals, not the public. Yet in the U.S. alone, drug companies spend tens of billions of dollars each year on advertising, not just to consumers, but across every major media channel, from television and online platforms to magazines and even news outlets.

Why? Because the real product isn’t the drug. It’s the narrative.

Most people believe the short answer is: because drug advertising works, and when ailing people see a drug ad, they are more likely to ask their doctor about it.

However, under pressure to satisfy patient demand, physicians may prescribe medications that aren’t necessarily the best treatment. Advertising doesn’t just inform—it shapes expectations and defines “normal” health experiences as problems that require pharmaceutical interventions.

But there’s a deeper, more insidious motive; drug companies aren’t just selling pills—they’re selling a narrative.

The story you’re being told is that your chronic illness, discomfort, or mental unease is a permanent condition, but there is good news! Your debilitating condition can be “managed” indefinitely with a daily pill, injection, or wearable device. The implication is that you’re broken, but Big Pharma has a fix.

What this narrative avoids, of course, is that many chronic illnesses have root causes linked to diet, lifestyle, trauma, environment, or inequality, factors that pharmaceutical treatments rarely address, as the convenience of a quick fix is preferable to the hard work of a lifestyle commitment. Nor does this story leave room for the possibility that drugs themselves might lead to serious complications or dependency.

Instead, the ad ends with a montage of smiling faces, golden-hour lighting, and reassuring music, while a legal disclaimer rushes through a litany of terrifying side effects.

Media Silence Bought with Ad Dollars

Here’s where the narrative gets ethically challenged; as much of the media you trust to inform and protect you is financially dependent on pharmaceutical advertising.

When Big Pharma is one of your largest advertisers, criticism becomes bad business. Entire news organizations have reason to downplay investigative reporting on drug harms or bury studies that challenge blockbuster medications. The incentive to stay quiet is built into the media business model.

What’s worse is that this uncritical repetition of the pharmaceutical narrative shapes public discourse. It narrows the range of acceptable questions. It vilifies skepticism. It reframes health as something purchased and managed, rather than something understood and healed.

Blame the Democrats

Direct-to-consumer (DTC) prescription drug advertising in the United States wasn’t always the norm. In fact, until the mid-1990s, such advertising was limited and tightly controlled. That all changed under Bill Clinton’s administration.

In 1997, the U.S. Food and Drug Administration (FDA), itself the beneficiary of regulatory capture by Big Pharma, relaxed its guidelines, allowing pharmaceutical companies to advertise directly to consumers without listing all the risks and side effects, as long as the ad directed viewers to another source for the complete prescribing information—such as a website or toll-free number.

This regulatory shift was quietly monumental. It didn’t require an act of Congress. Instead, it was a re-interpretation of existing FDA rules, which effectively opened the floodgates for a new era of pharmaceutical marketing. Drug commercials, once rare, quickly became a staple of American television.

“The FDA’s 1997 decision marked a seismic shift in the pharmaceutical industry, enabling a multi-billion-dollar advertising boom.”
— Donohue, J.M., Cevasco, M., & Rosenthal, M.B. (2007). A Decade of Direct-to-Consumer Advertising of Prescription Drugs. New England Journal of Medicine, 357, 673-681.

Within just a few years, ad spending soared. By the early 2000s, Big Pharma had spent more on marketing than research and development. The Clinton-era policy change, while perhaps seen as a modernization of communication standards, helped cement the U.S. as one of only two countries where this kind of marketing is even legal.

Big Pharma Doesn’t Want to Know the Root Causes—It Might Kill the Billion—Dollar Business Model

• Keytruda – $25 billion (2023) -- cancers 
• Humira – $14.4 billion (2023) -- inflammation
• Ozempic – $13 billion (2023) -- diabetes and obesity
• Dupixent – $11.8 billion (2023)  -- inflammation
• Comirnaty – $11.2 billion (2023)  -- Covid-19
• Biktarvy – $11 billion (2023) -- HIV-1
• Eliquis – $11.6 billion (2023) -- blood thinner/heart protection
• Stelara – $10.9 billion (2023) -- autoimmune conditions
• Gardasil – $7.2 billion (2023) -- human papillomavirus
• Enbrel – $7 billion (2023) -- autoimmune conditions
• Entresto – $6 billion (2023) -- heart failure

In a rational world, the goal of medicine would be to understand and eliminate the root causes of chronic illness. But in the pharmaceutical world, that kind of thinking is not just inconvenient—it’s threatening.

Chronic illnesses like diabetes, heart disease, depression, autoimmune disorders, and obesity account for the majority of healthcare spending in developed nations. They are complex, often preventable, and deeply connected to diet, environment, stress, inequality, trauma, and lifestyle. Addressing those root causes takes time, education, structural reform, and accountability—things that don’t fit easily into a pill bottle.

From a pharmaceutical standpoint, a chronic illness is far more profitable when managed than when cured. A daily pill or injection that must be taken indefinitely is the ideal product: recurring revenue for life. A patient who heals or no longer needs medication? That’s a lost customer.

So instead of asking “Why is this person sick?” the industry asks, “How can we keep this person stable enough to function—and keep paying?”

This isn’t conspiracy—it’s incentive structure. When a company’s profits are tied to disease management, not disease resolution, there’s no financial upside to prevention. Research into root causes—especially those pointing to food systems, pollutants, socioeconomic stress, or medical overreach—is often underfunded, ignored, or drowned out by marketing budgets promoting pharmaceutical “solutions.”

Meanwhile, symptoms are pathologized, conditions are medicalized, and new “disorders” are routinely created to expand drug markets. In this system, the sicker the population stays (but not too sick), the better the balance sheets look.

“Chronic disease is the goose that lays the golden egg for Big Pharma. No one wants to kill the goose.”
— Dr. Marcia Angell, former editor-in-chief of The New England Journal of Medicine

Bottom Line

Is Big Pharma Selling Drugs or Selling Belief?

We are not living in a world where medications are merely prescribed—they are marketed. And they are marketed not as tools, but as lifelines, solutions, and symbols of modern hope. The actual drug is incidental. What’s truly being sold is belief in the system, in the pill, in the idea that health is just a prescription away.

But when media outlets, doctors, and consumers all buy into the same narrative, we risk suppressing the conversations we most need to have: about root causes, systemic health failures, and the actual cost of depending on drugs whose side effects may be worse than the condition itself.

Next time you see a drug ad promising a better life, ask yourself: Is this health, or is this a story crafted to sell you something more profitable than wellness?

Until we rewire the incentives and start valuing actual health outcomes over pharmaceutical sales, the system has no reason or desire to look upstream for solutions.

We are so screwed.

-- Steve

Disclaimer: Many miracle drugs are exceptionally beneficial, but we only refer to those with marginal utility, replace older, effective generic drugs, or are tweaks of existing products for marketing purposes.