With Merck's recent withdrawal of arthritis medication Vioxx from the market, prescription drug promotions of all kinds are likely to come under new scrutiny as patients, researchers and consumer groups question both their honesty and their ultimate public cost.

Direct-to-consumer prescription drug advertising is acknowledged as helping boost Vioxx sales to its astounding height of $2.55 billion dollars in 2003. From January 2004 to July 2004, Merck spent $49 million on ads for the drug.

The drug industry's direct to consumer ad spending increased from $791 million to $3.2 billion between 1996 and 2003. 1996 was the year prior to FDA's relaxing of TV and radio prescription drug ad rules, according to IMS Health.

In 2003, the industry spent over $25 billion in industry promotional spending, including consumer advertising, no-cost drug samples, "educational" trips and drug representative visits to physicians. During roughly the same period, prescription drug expenses increased two to five times more than spending on hospital care and physician services, according to the Kaiser Family Foundation.

Researchers have stated that it's no coincidence that as promotional spending soars, so does spending on drugs by consumers who see the ads and are encouraged to buy drugs they never used before.

Many physicians say that when a patient requests a prescription drug by name, they are unlikely to say no so long as it does not seem wholly inappropriate for the condition. Physicians say this is partly because they are too pressed for time to explore alternatives and do not want to alienate patients who can take their business elsewhere. Mary Frank, a family physician in California, said that some patients also favor prescription drugs over OTC medications because health plans generally cover prescriptions.