The Therapeutics Initiative's objectives are unbiased review and dissemination of therapeutic evidence. Our recommendations are intended to apply to most patients; exceptional patients require exceptional approaches. We are committed to evaluate the effectiveness of our educational activities using the Pharmacare/PharmaNet databases without identifying individual physicians, pharmacies or patients. The Therapeutics Initiative is funded by the BC Ministry of Health through a 5-year grant to the University of BC. The Therapeutics Initiative provides evidence based advice about drug therapy, and is not responsible for formulating or adjudicating provincial drug policies. 

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Therapeutics Letter, issue 40, March / April 2001

Direct To Consumer Advertising:

Finasteride for male pattern hair loss 

Case: Mr. Jones (26 years old) comes in to see you about a cough he has had for 3-4 weeks. You’ve just finished listening to his chest and reassured him that it’s the aftermath of a viral infection. He asks you, "By the way, I’m wondering about this pill I saw advertised.  I think the name was Propecius. I’ve been noticing my hair seems to be thinning on top lately, and I’d like to try it."

Does this sound familiar?

Clinicians are increasingly feeling the impact of direct-to-consumer advertising of prescription drugs (DTCA). While advertising prescription drugs directly to consumers is not allowed in Canada, patients see newspaper reports, US ads, ads directed at health professionals, etc. In Canada, the average practicing physician can expect to get 10 specific drug requests per week, some of which would be for advertised drugs.  In the United States DTCA appears to increase sales (see insert below).

DTCA in the United States in 19991 (in US$)


  • Pharmaceutical companies spent $1.8 billion on DTCA, a 40% increase over 1998.

  • $1.1 billion was spent on television ads, a 70% increase over 1998.

  • 41% of DTCA spending was concentrated on ten products, among them 
    loratidine (Claritin®, $137 million), finasteride (Propecia®, $100 million)
    sildenafil (Viagra®, $94 million), omeprazole (Prilosec®, $80 million), and 
    orlistat (Xenical®, $76 million).


  • The 25 top-selling DTCA drugs accounted for 40.7%, or $7.2 billion, of the overall $17.7 billion (19%) increase in drug sales (retail) in 1999 over 1998.

  • Doctors wrote 34.2% more prescriptions in 1999 than in 1998 for the top 25 DTCA drugs. Doctors wrote only 5.1% more prescriptions for all other prescription drugs.

What should clinicians do in this situation?

Let's explore the issue using one of the products most advertised to consumers, a drug for male pattern hair loss, finasteride (Propecia®).

What questions should you answer before writing a prescription?

What happens to a company when the DTCA is deemed to be misleading?

Two ads for Propecia® in Time Magazine were found to be misleading by the Division of Drug Marketing, Advertising and Communications at the US FDA. These ads stated "One day science will create a pill for hair loss: That day is today." And "Starting today, you need not face the fear of more hair loss". In both cases the FDA found the ads claimed a broader benefit than had been demonstrated and advised the company to immediately discontinue the ads. No other action was taken.


* Abreviations used in text:

ABI=Absolute Benefit Increase
NNT=Number Needed to Treat to benefit one patient
ARI=Absolute Risk Increase
NNH=Number Needed to cause one Harmful event
CI=confidence Interval

This Therapeutics Letter contains an assessment and synthesis of published (and whenever possible peer-reviewed) publications up to March 2001. We attempt to maintain the accuracy of the information contained in the Therapeutics Letter by extensive literature searches and verification by both the authors and the editorial board. In addition this Therapeutics Letter was submitted for review to 55 experts and primary care physicians in order to correct any identified shortcomings or inaccuracies and to ensure that the information is concise and relevant to clinicians.


  1. Findlay S. Prescription Drugs and Mass Media Advertising. National Institute of Health Care Management Research Brief. Washington DC. Sept. 2000 []

  2. Propecia (Finasteride). In: Compendium of Pharmaceuticals and Specialties, 36th Edition, Canadian Pharmacists Association, 2001; pp: 1280-1.

  3. Wood AJJ, Price VH. Treatment of hair loss. N Engl J Med. 1999; 341:964-973.

  4. Price VH, Roberts JL, Hordinsky M, et al. Lack of efficacy of finasteride in postmenopausal women with androgenetic alopecia. J Am Acad Dermatol. 2000; 43:768-76.

  5. Kaufman KD, Olsen EA, Whiting D, et al. Finasteride in the treatment of men with androgenetic alopecia. Finasteride Male Pattern Hair Loss Study Group. J Am Acad Dermatol. 1998; 39:578-89.

  6. Roberts JL, Fiedler V, Imperato-McGinley J, et al. Clinical dose ranging studies with finasteride, a type 2 5alpha-reductase inhibitor, in men with male pattern hair loss. J Am Acad Dermatol. 1999;41:555-63.

  7. Leyden J, Dunlap F, Miller B, et al. Finasteride in the treatment of men with frontal male pattern hair loss. J Am Acad Dermatol. 1999; 40:930-7.

  8. Frankel S. Study of the Food and Drug Administration Files on Propecia. Dosages, Side Effects, and Recommendations. Arch Dermatol. 1999; 135:257-8.

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