The role of drug promotion in the prescription of hormone replacement therapy in the United States.

Prior to 1980, almost all drug advertising was direted to physicians, the parties responsible for prescribing medications to patients. Beginning in 1980, however, drug companies began advertising directly to patients by various means, specifically television and print adversisements and sponsorship of sports and similar events. During the last decade, as computers have become a common household item, the Internet is now another source of advertising for drug manufacturers. This change in advertising has been effective, since research has demonstrated that physicians' prescribing decisions are, in fact, influenced heavily by patients' requests for specific medications. In 1997, the US Food and Drug Administration devised specific guidelines for the television advertising of drugs produced by pharmaceutical manufacturers. Since youth and beauty have long been valued feminine qualities in the US, where menopausal women are assumed to suffer most from the effects of aging, pharmaceutical companies targeted women for the promotion of hormone-containing drugs that were purported to minimize the effects of menopause and ensure better health. As a result, advertising has played a key role in the prescribing of hormone replacement therapy in the US for the last 60 years. Since many of the advertised benefits of hormone replacement therapy are never realized by the patient, and the hazards of treatment are often minimized, it remains the responsibility of clinicians to safeguard their patients' health by basing the decision to prescribe on valid scientific evidence rather than the message of an advertising pitch.