Direct-to-consumer advertising with interactive internet media: global regulation and public health issues.

DIRECT-TO-CONSUMER ADVERTISING (DTCA) IS LEgal only in the United States and New Zealand and has been linked with drug overutilization, public health concerns, and higher costs. Despite global proscriptions, DTCA is the most rapidly increasing form of pharmaceutical marketing, with approximately $4 billion in US expenditures, outpacing physician marketing and research and development. The Internet has rapidly developed, with users moving from passive information using read-only “Web 1.0” technology to interactive tailored relationships using “Web 2.0” technology. This includes social networking sites and other interactive systems, resulting in new online DTCA marketing opportunities that transcend geopolitical borders. Currently, the US Food and Drug Administration (FDA) has not issued guidelines on this form of DTCA marketing. Yet electronic DTCA with Web 2.0 technology already has the potential for significant presence and may have unrealized public health effects.