Why is advertising for medication requiring prescription allowed?

Question

Recently I have seen on local media (mainly TV within an Eastern European country) multiple ads for medication that requires prescription. It looks to be much more regulated than vitamins as it requires to display a ad visa number (no/year) and a long text describing potential side effects.

I know that all this medication is previously officially approved and quite safe, but I thought prescription requirement is a sign that the treatment must allows go through an M.D. who should objectively (cost/benefit) choose the appropriate medication.

This article describes this phenomenon in USA.

Drug commercials as you know them really only began in 1997, when constraints were further loosened, and new meds began to feature in television commercials. For its part, the FDA notes that no federal law has ever outlawed drug ads, justifying its progressively lax regulation.

There seem to be some opposition to this is US, but I have not heard anything like this in my country (probably due to this practice being too young):

Pharmaceutical advertising has spiraled so far out of control that the American Medical Association last year proposed an outright ban on it, arguing that "a growing proliferation of ads is driving demand for expensive treatments despite the clinical effectiveness of less costly alternatives."

Question: Why is advertising for medication requiring prescription allowed (legal)?

Answer 1

A Variety of Historical Reasons

This article, published in Pharmacy and Therapeutics (a peer-reviewed pharmacist's publication), summarizes the history of direct-to-consumer prescription advertising in the United States.

Here are the reasons they cite:

1. No law in the United States makes it illegal, so the Food and Drug Administration never banned it out-right.
2. The first regulations regarding advertising were published in 1969. At that time, the Administration's policy was that advertising couldn't be misleading and had to address both the risks and benefits of medication.
3. During the 1980s a few shifts occurred that made it more palatable. First, the general U.S. population became more comfortable with medications. There was also a push for individuals to be more involved with their treatment plans than in the past, so educating consumers, rather than doctors, made more sense.
4. Since then regulations have become more lax. One particular industry innovation was changing some ads from outright advertisements for their products ("buy pill x!") to instead promote seeking help from a doctor ("do you have y? Talk to your doctor about pill x!"). The Administration decided that these ads do not require the same degree of regulation, because they overtly ask a consumer to contact their doctor.

The same article also mentions that the Administration asked pharmaceutical companies to help write the regulations for this advertising. Although the result was not radically different from their previous policy.

But there is some movement

The National Conference of State Legislatures prepared a report summarizing state-level laws and regulations for pharmaceutical advertising. It shows that 10 states have laws regulating this advertising. The most important reason appears to be concerns regarding soaring drug costs and the idea that advertising may contribute to those costs, rather than a concern for medical choices.

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Ventola, C. Lee. “Direct-to-Consumer Pharmaceutical Advertising: Therapeutic or Toxic?” Pharmacy and Therapeutics 36.10 (2011): 669–684. Print.

Answer 2

an M.D. who should objectively (cost/benefit) choose the appropriate medication.

How do you plan to enforce this? How would a doctor even know this? Are there any countries where doctors actually purchase the medication they prescribe for patients?

We can hope that doctors have some idea of the benefits of a medicine that they may prescribe. But the cost? That's outside their purview. They might try to estimate it, but it's not something over which they have direct control. In countries like the United States, the doctor may have no idea how much each medicine costs. Deals between pharmaceutical companies and insurers may make the costs radically different for different patients. And the price to the patient may be the same for drugs with very different producer prices.

It's also not singular. One person might be willing to pay $1000 a month for a medicine with a specific impact. Another person might be willing to pay only $100 or $10,000. That's patient dependent, not doctor dependent. Traditionally my doctors haven't even considered this unless I specifically asked them. Which I'm unlikely to do before the prescription. So only medicine that I might take long term.

Consider the case of a doctor who just wants to skate by. That doctor could just continue prescribing the same medications. Doesn't have to prescribe anything new. Patients coming in and asking for medications helps get such doctors to expand to new medications.

Or consider the case of Jennifer Esposito. As it turns out, she has celiac disease. She found that out after years of misdiagnosis, including a stint committed to a mental hospital because she insisted that there was something physically wrong with her. Doctors are not infallible.

Some of the advertising that I've seen is directed at people who may be managing illness (unsightly skin markings, intestinal problems, etc.). So they aren't going to a doctor for new treatment. They're just sort of skimming along the way that they are. Viagra is an example of a treatment that a person may not have realized was possible and thus may not request treatment. The advertising gets them into the doctor's office to ask about a specific possible diagnosis. It's much easier if the focus is limited like that. And of course for new medicines, the patient's last doctor's visit may predate the release of the medicine.

Both advertiser and patient can come out ahead. The advertiser gets the patients started sooner and so enjoys more of the profitable patented period. The patients start sooner and presumably prefer taking the medicine to having the money that they pay.