Turn It Off
The Case for Banning Pharmaceutical Commercials
You know the routine. You sit down to watch the news, and somewhere around the third commercial break, a woman is gardening in soft light while a calm voice mentions the possibility of internal bleeding. Then she goes kayaking. This isn’t a parody. It’s the country’s most successful health communication strategy, and the United States and New Zealand are the only two developed nations on earth that allow it. Every other wealthy country looked at the idea of selling prescription drugs like pickup trucks and said no.
They had good reasons. This piece lays out the case for why the United States should say no too, without leaning on outrage to make the point. The industry doesn’t need help looking bad. The numbers handle that just fine on their own.
What This Actually Is
Direct-to-consumer, or DTC, pharmaceutical advertising means marketing prescription drugs straight to patients instead of to the doctors who write the prescriptions. It’s an odd category of commerce. Normally, you decide what you’re buying, and you buy it. With a prescription drug, the ad is aimed specifically at you, but the purchase decision belongs to somebody else, your doctor, who never saw the commercial. The ad’s job isn’t to make a sale directly. Its job is to get you to walk into an exam room and ask for a product by name, so a third party can authorize the purchase you were talked into wanting.
That’s an unusual foundation for a $39 billion industry practice. It’s also a strange thing to call ordinary commercial speech, since the whole point is to route around the professional judgment that’s supposed to sit between a consumer and a powerful, sometimes dangerous compound.
It wasn’t always legal in this form. From the 1930s into the 1990s, direct advertising of prescription drugs to the public barely existed, kept in check by the FDA’s brief-summary requirement, which forced any ad to include the full rundown of side effects and contraindications. That requirement ate up so much airtime it functioned as a de facto ban. Then in 1997 the FDA issued draft guidance, finalized in 1999, letting broadcast ads satisfy that obligation through “adequate provision,” meaning companies could point viewers to a website or toll-free number instead of reciting the risks on air. That single regulatory decision is the reason your television now looks the way it does.
The Numbers
Vague complaints about “too many ads” undersell what’s actually happened, so here are some numbers.
Pharmaceutical advertising spending grew from $12.2 billion in 2015 to an estimated $39 billion in 2025, according to AdWeek data cited by industry trade groups. That’s more than triple in a decade, from an industry that tells Congress with a straight face that it can’t afford to lower drug prices.
Direct-to-consumer television advertising alone topped $6 billion in 2024. In the third quarter of 2025, prescription drug TV ad spending hit $1.25 billion, and October set an all-time monthly record: the top ten pharma brands combined spent $307.1 million in a single month. Johnson & Johnson’s Tremfya campaign alone spent an estimated $62.7 million that month, across eleven separate ads. Through early December 2025, pharma and over-the-counter brands had put more than $7 billion into linear TV for the year, up about 16 percent from the year before.
AbbVie spent $1.2 billion across three drugs in 2023, more than half its total advertising and promotion budget. Three drugs. A billion dollars. That’s not a company educating the public. That’s a company that ran the numbers and found the ad campaign outperforms almost anything else it could do with the money.
And it works. The Congressional Budget Office estimates that a 10 percent increase in DTC advertising is tied to a 1 to 2.3 percent increase in overall drug spending, and one study found that a 10 percent increase in DTC spending produced a 5.4 percent bump in product revenue. That’s the actual problem. The ads aren’t failing to move the needle. They’re succeeding at a task that has almost nothing to do with health and everything to do with market share.
The Rest of the World Made a Different Call
New Zealand and the United States are the only two high-income countries on earth that allow unrestricted direct-to-consumer advertising of branded prescription medicines, drug name, condition, all of it. Almost every other country in the world bans this kind of advertising for health products outright.
This isn’t a fringe regulatory quirk. The European Union bans it. Canada bans it. Japan bans it. Australia bans it. The entire developed world, minus one small island nation and the largest economy on the planet, looked at this practice and decided the risk outweighed the benefit. Countries that ban it typically point to distorted drug information, unnecessary prescriptions, and worse prescribing decisions overall.
Even in New Zealand, professional opinion runs against the practice. Both the Royal New Zealand College of General Practitioners and the New Zealand Medical Association have called for a ban in their own country, without success, for the same reason it persists here: a well-funded industry pushing back. New Zealand’s health ministry has preferred tighter regulation to an outright ban, which tells you plenty about how effective that pushback is, even in a country the size of a mid-sized American state.
Here’s a useful test for whether a domestic practice holds up: check whether every comparable country arrived at the opposite conclusion on its own. When the U.S. and New Zealand stand alone against Germany, France, the UK, Japan, Canada, and Australia, the burden of proof sits with the people defending the American approach.
How the Ads Work
Set the totals aside and look at the mechanics of a typical commercial, because the mechanics make the whole argument.
You know the structure: warm visuals, someone living an appealing life, music that suggests relief, then a recitation of risks delivered fast, often over more pleasant footage, sometimes with on-screen text competing for your attention against the narration. FDA rules require accuracy and require that ads disclose risk information. In practice, this usually means the first half shows people enjoying themselves and the second half delivers a dizzying list of warnings.
That split isn’t an accident of format. It’s a deliberate decision about where to spend your attention, made by people who know exactly how attention works. The pleasant footage isn’t filler around the warnings. The warnings are the toll the advertiser pays to keep running the pleasant footage.
The whole purpose of a drug ad is to sell something, not to educate anyone, and the language gives it away. “A leading treatment for this condition” can be true when there are only two or three drugs for that condition. “No other treatment has been proven better” can describe a drug that performs no better than a cheaper alternative, while the ad conveniently skips the option of taking nothing at all, even though plenty of minor conditions resolve on their own. None of this is lying in a legal sense. It’s built to produce a technically true statement that leaves you with a false impression, which is harder to catch than an outright lie because it survives a fact-check.
One out of every three dollars in pharmaceutical DTC spending in 2024 went toward immunology drugs, chronic, expensive biologics, with fifteen brands each spending at least $10 million on TV ads in that category alone. These aren’t aspirin commercials. These are ads for drugs that can run tens of thousands of dollars a year, aimed at a general audience whose only job in the transaction is to feel enough urgency to bring up a brand name at the next appointment.
The Celebrity Version
Somewhere along the way the industry noticed a famous face beats a soft-focus kayaking scene, and started paying accordingly. In 2020, Nurtec ODT, a migraine drug made by Biohaven and later Pfizer, ran a social campaign with Khloe Kardashian promoting it directly to consumers. She has over 306 million followers on Instagram and pulled in nearly 1.9 million likes across four posts.
Sit with that math. Four posts. No physician involved anywhere in the chain, no mention of how the drug actually stacks up against other migraine treatments, just a famous person telling millions of people a specific product worked for her. That’s the identical playbook used to sell teeth whitening kits, aimed at a prescription drug an audience has no training to evaluate.
Use of social media for pharmaceutical marketing has grown roughly 45 percent year over year, with close to half of digital ad budgets now going to social channels. That growth happened because social platforms skip the “fair balance” risk disclosure a network TV spot is required to run, and until recently nobody was checking. The FDA has now made closing this “digital loophole” an explicit priority, which tells you it had been wide open for a while.
The lesson isn’t that Khloe Kardashian did anything unusual. It’s that the industry moves its money toward whichever channel demands the least honesty, and it will keep doing that until the rules catch up, at which point it finds the next channel. Chasing the loophole one platform at a time isn’t a strategy. It’s a permanent game of whack-a-mole; the industry is better funded to win than any agency is funded to police.
The Loophole That Made It Possible
From 1962, when Congress gave the FDA authority over drug advertising, through the 1990s, the agency required a full brief summary of side effects and contraindications in every ad. That requirement made TV advertising for most drugs impractical, since reciting the full risk profile ate the entire commercial. Whether by design or accident, it worked as a ban.
The 1997 guidance, finalized in 1999, let companies satisfy that obligation through “adequate provision,” meaning they could point viewers elsewhere for the complete risk information rather than say it on air. That’s the loophole reform efforts have targeted ever since. It let advertisers keep the pleasant thirty seconds and outsource the unpleasant part to a website nobody visits.
The industry didn’t sit on that opening. It built an entire creative and media-buying operation around it and has defended that operation with political spending that dwarfs almost every other industry in Washington. Pharmaceutical manufacturers spent more than $102 million on lobbying in just the first six months of 2025. PhRMA, the trade association, logged its highest-ever quarterly lobbying spend in the first quarter of 2025, nearly $13 million in three months. In the 2024 election cycle, the industry spent $151 million on federal lobbying, through 139 companies and 738 lobbyists, close to two-thirds of whom had previously worked in government. Across all of 2024, pharmaceutical and health product companies spent $388.21 million on lobbying, and by mid-2025 they’d already spent $226.78 million, on pace to set a new record.
That’s what defending a loophole looks like when the loophole is worth $39 billion a year. Nobody spends that kind of money guarding a minor regulatory technicality. They spend it guarding the thing that makes the business model work.
Who Pays, and Who Profits
The standard industry line is that DTC advertising educates patients. Compare that to what the industry actually does with its money.
A 2021 study from America’s Health Insurance Plans found seven of the ten largest pharmaceutical companies by revenue spent more on sales and marketing in 2020 than on research and development. Read that last sentence again. The companies telling Congress they need high prices to fund innovation are, in most cases, spending more to sell what they’ve already got than to invent the next thing.
A January 2023 study in JAMA Network found that drugs with “high therapeutic value” account for fewer than a third of all DTC pharmaceutical ads. Most of the money goes toward promoting drugs whose actual advantage over cheaper existing alternatives is modest or unproven, and DTC advertising is specifically linked to more use of higher-cost drugs over generics. You don’t spend a billion dollars advertising a drug that already sells itself. You spend it on the one that needs help competing against something cheaper and equally effective.
Prices tell the same story. Bristol Myers Squibb and Pfizer have spent more than $1 billion in DTC advertising on their blood thinner Eliquis since 2013, while raising its price at least six percent a year for ten straight years. It launched at $250 a month in 2013. By 2022, the monthly list price was $529, more than double. The advertising and the price hikes didn’t happen despite each other. They happened together, because a drug people are trained to ask for by name is a drug that’s harder for insurers and patients to push back on.
One analysis found that taxing or banning DTC ads for just the ten largest pharmaceutical companies could save Americans more than a billion dollars a year, and a separate study found that taxpayers lose more than a billion dollars annually because companies write off these marketing expenses as ordinary business costs. The federal tax code is subsidizing the same commercials that drive up the prices the government spends billions covering through Medicare and Medicaid. The public funds both ends of the transaction, the ad and the eventual bill.
None of this requires believing pharmaceutical companies are uniquely evil. It requires taking their own budget allocations at face value. A company that spends more on marketing than research, aims most of its ad dollars at modest-benefit drugs, and raises prices in step with ad spending is telling you exactly what it’s optimizing for. Not outcomes. Revenue. The ad is the delivery mechanism.
What the Ads Do to the Exam Room
Set price aside and look at what these commercials do to the relationship between a patient and a doctor, because that’s where the real damage lands.
Direct advertising leads patients to ask for drugs they can’t get unless a doctor agrees. It eats into the time a visit spends deciding whether a condition even needs treatment and whether the advertised remedy fits best practice, and the evidence is solid that direct advertising leads to unnecessary and sometimes harmful prescribing.
A doctor’s fifteen minutes is a scarce resource. Every minute spent explaining why a patient doesn’t need the drug from last night’s commercial is a minute not spent on something they actually need. Multiply that across tens of millions of visits a year and you’ve got a quiet tax on the healthcare system’s most limited input, a physician’s attention.
Some studies find DTC advertising talks patients into demanding heavily promoted drugs, leading to worse treatment, with doctors reporting pressure to prescribe brand names simply because a patient mentioned one. One study comparing West Palm Beach, Florida, to Denver, Colorado, found that a 10 percent increase in ad exposure raised total prescriptions by 5 percent in the higher-exposure market. That’s not a correlation dreamed up by critics. That’s the business model performing exactly as designed.
The case study that should end the argument is Vioxx. It was one of the most heavily advertised drugs during its five years on the market, before being pulled worldwide for raising the risk of heart attacks. The manufacturer kept promoting it to the public in the U.S. and New Zealand after its own internal documents showed an increased risk of death. That single fact contains the whole risk of this business model: a company ran feel-good commercials for a drug it privately knew was killing people, because the commercials still sold product, and they could keep running because nobody was policing the underlying claims in real time. A similar pain reliever was pulled from the market after an unexpected rise in heart attacks and strokes, but not before millions had already seen the ad and started taking it.
Fair enough to note there’s a real upside here too. Some viewers see an ad, recognize a symptom they’d been ignoring, and go get checked out. DTC ads can raise awareness of side effects, reduce stigma around conditions like depression or erectile dysfunction, and occasionally catch something the ad wasn’t even about. That’s a genuine benefit and it shouldn’t get waved off. It’s also a strange way to run a public health system, outsourcing preventive-care nudges to a for-profit marketing budget that a functioning primary care system ought to be handling anyway.
The Enforcement Record and What Changed in 2025
For most of the DTC era, enforcement was weak. The number of FDA warning letters against misleading ads held fairly steady before dipping in 2014, and enforcement didn’t pick up at all during the first Trump administration, despite plenty of stated concern about the industry. The agency had the authority. It mostly chose not to use it.
That changed, at least on paper, in September 2025. On September 9, President Trump signed a memorandum directing HHS to require more risk information in drug ads and directing the FDA to enforce the existing advertising law more aggressively. The same day, HHS and FDA announced a “crackdown on deceptive drug advertising,” sending a letter to every single sponsor of an approved drug or biologic and more than a hundred additional letters targeting specific ads the agency considered deceptive. FDA has since released 41 untitled letters and 66 warning letters from that day alone, all alleging false and misleading DTC content.
HHS Secretary Robert F. Kennedy Jr. put it plainly: pharmaceutical ads hooked the country on prescription drugs, and the administration intends to require full safety disclosure and break the cycle of overmedicalization. FDA Commissioner Marty Makary said the agency had, for too long, permitted misleading ads that distort the doctor-patient relationship and create demand regardless of clinical necessity.
The main regulatory target is the same adequate provision loophole from 1997. The plan includes rulemaking to eliminate it entirely, plus aggressive enforcement and closing the digital loophole that’s let influencers promote drugs without proper disclosure. The FDA has also pledged to require a full list of risk disclosures in every ad, which would make TV spots considerably longer and more expensive to produce. Novo Nordisk’s recent Ozempic campaign, which runs over two minutes of risk disclosures on streaming platforms, is a preview of what this might look like everywhere if the loophole closes for good.
Worth taking seriously, and worth being honest about the limits. The memorandum stops short of an outright ban, and officials have acknowledged that closing certain gaps, like the rules around telehealth companies advertising compounded drugs, would take an act of Congress, not an executive order. This isn’t the administration’s first swing at this either. Trump’s first term produced a 2019 rule requiring list prices in TV ads, which a federal judge struck down for exceeding HHS’s authority. Reform efforts here have a track record of running into court, and this one will too.
There’s bipartisan appetite behind it regardless of what anyone thinks of the current administration generally. A national survey found 88 percent support for requiring drug companies to disclose how much taxpayer money funded their research, and 86 percent support for requiring companies to list prices in their ads, with roughly equal support across the recent partisan divide. This is one of the rare issues where the public isn’t split along the usual lines. Nearly 80 percent of people surveyed said there are simply too many pharma ads on TV and streaming, and many called the genre’s cheerful imagery unrealistic set against pages of medical warnings. A separate survey found only 43 percent would support a total ban outright, with about a third opposed and a quarter undecided, but 60 percent still wanted risk information made more prominent and simpler, and a quarter wanted less mascot-and-jingle nonsense. Even people cool on an outright ban aren’t asking for more of this. Nobody is.
The Telehealth Wrinkle
One more piece worth flagging, because it shows how the marketing apparatus has already outrun the rules meant to contain it. Telehealth companies selling compounded versions of popular weight-loss drugs have found a gap that traditional pharmaceutical companies can’t use, since compounded drugs aren’t FDA-approved products in the same sense as a branded biologic, and the rules built around approved-drug advertising don’t cleanly apply.
A senior administration official pointed to a Super Bowl ad from a telehealth company promoting compounded weight-loss drugs as exactly the kind of ad the current framework can’t reach. Senators had already written to the FDA earlier in 2025 about a Hims & Hers Super Bowl ad promoting weight-loss drugs from its own pharmacy operation.
This previews what happens if reform focuses narrowly on branded ads while leaving the rest of the ecosystem alone. Close the loophole for AbbVie and Pfizer, and the same marketing impulse just migrates to a telehealth subsidiary selling a compounded version of the same molecule, built from the start to sit outside the rules. Fixing this particular gap needs Congress, since it’s beyond what current law covers. Any serious reform has to cover the practice broadly, not just the specific companies doing it today, or the industry reorganizes around the new rule the way water finds a crack in a foundation.
Why Reform Isn’t Enough
The current federal approach, tighter disclosure, closing the adequate provision loophole, and cracking down on influencers, is worth doing. It’s also not enough, for a simple reason: it treats the harm as a problem of incomplete information rather than a problem of purpose.
Longer disclosures make ads more honest about what a drug can do to you. They don’t change what the ad is for. It’s still built to get an untrained viewer to walk into an exam room and request a specific product by name, ahead of whatever the doctor would have independently recommended. A better-disclosed version of that transaction is still that transaction. You’ve made the manipulation more honest about its own risks. You haven’t removed the manipulation.
European countries kept their bans specifically because of how sensitive drug information is and how DTC advertising distorts it, even alongside strict disclosure rules elsewhere in their systems. The rest of the developed world didn’t decide DTC advertising needed better warning labels. It decided the category doesn’t belong in front of a general audience at all, because persuading a layperson to want a specific prescription drug is incompatible with sound clinical decision-making no matter how the warnings are formatted. A tobacco ad with a bigger warning label is still a tobacco ad. A drug ad with two minutes of side-effect disclosures is still built, from the opening frame, to make you want the drug before you’ve heard a single one of them.
The Objections, Taken Seriously
A fair argument answers its strongest opposition, so here it is.
The First Amendment problem is real. Any ban would face immediate legal challenge, since the Supreme Court has extended First Amendment protection to commercial speech, and pharmaceutical companies would sue under the framework from Central Hudson Gas and Electric Corp. v. Public Service Commission. Industry lawyers are already asking whether the administration’s more aggressive posture, including shifting some cases from civil to criminal review, crosses that line. This is a genuine obstacle, not a talking point. A categorical ban would need to survive real scrutiny and it might lose. Some people who agree entirely with the harms described here still think tighter regulation, not prohibition, is the honest path forward, precisely because a ban may not hold up in court as things currently stand.
The educational-benefit argument has some support. Advocates argue DTC advertising informs and empowers patients and helps them learn about treatments they wouldn’t otherwise consider. There’s truth in it. A commercial for a psoriasis drug has, now and then, prompted someone who assumed nothing could be done about a chronic condition to go ask about it. That value isn’t zero.
Researchers who study this closely are genuinely split. The evidence on DTC advertising is described as roughly balanced, with real support on both sides, which is why most researchers, even ones sympathetic to the harms above, more often recommend tighter rules than an outright ban.
Fair points, and they deserve straight answers rather than a shrug.
On the First Amendment: a ban faces a hard fight, full stop. That doesn’t mean the intermediate steps are foreclosed. Removing the tax deduction for DTC advertising restricts no speech and bans nothing. It just stops asking taxpayers to underwrite the practice, the same way tobacco advertising lost its tax-deductible status decades ago. Mandatory price disclosure compels a factual statement rather than restricting speech, the same category of rule that already survives for cigarette warnings and nutrition labels.
On the educational benefit: it’s real, and it’s small, and it’s being used to justify a delivery system wildly out of proportion to what it delivers. If the actual goal is public education about treatable conditions, that doesn’t require branded advertising for a specific thirty-thousand-dollar-a-year biologic. Public health campaigns and primary care outreach handle that job in every other developed country, none of which seem to have a harder time educating their citizens about psoriasis or heartburn than we do.
On the researchers calling it balanced: that balance holds up when you weigh a real, modest, visible benefit against harms that are diffuse and statistical, higher prescribing costs, marginal overprescribing, worse doctor-patient trust. Spread-thin costs always look smaller in a debate than they are in aggregate. A 10 percent increase in DTC spending producing a 1 to 2.3 percent bump in total drug spending sounds modest until you remember the base is hundreds of billions of dollars, compounding every year as ad spending keeps climbing. Balanced evidence doesn’t mean equal weight. It means there are entries on both sides of the ledger, and once you actually total it, the entries favor pulling the plug.
What Should Actually Happen
Complaining without a remedy is just criticism with footnotes, so here’s an actual agenda, roughly ordered from easiest to hardest.
End the tax deduction. Proposals to stop pharmaceutical companies from writing off marketing costs as ordinary business expenses have been floating around Congress for years, including the Say No to Drug Ads Act, first introduced by Representative Jerrold Nadler in 2002 and reintroduced several times since. This doesn’t require winning a First Amendment fight. It just requires Congress to decide the public shouldn’t be subsidizing a $39 billion ad campaign through the tax code, the same call it made on tobacco decades ago. Most achievable item on this list. Should happen regardless of what else does.
Close the adequate provision loophole permanently, by statute. The current rulemaking effort is a start, but agency guidance can be undone by the next administration in an afternoon. A legislative fix, requiring the full risk profile in the ad itself, would survive a change in the White House.
Mandate price disclosure in every ad. If a company wants to tell you a drug exists, it should have to tell you what it costs. Eighty-six percent of surveyed voters already agree. Nothing kills a beach scene faster than a monthly list price.
Require disclosure of taxpayer-funded research behind advertised drugs. Eighty-eight percent support this too. A lot of foundational drug research traces back to the National Institutes of Health and other public funding. If the public helped pay for the science, the public is entitled to know that when the company asks them to pay again to use it.
Pursue a full ban through legislation, and expect it to be litigated. The Banning Misleading Drug Ads Act is one attempt in this direction, though it hasn’t passed. A full ban, matching what every other developed country already does, is the right end state, and it should come from Congress rather than executive memo, since a statute carries more weight against a First Amendment challenge and forces the debate into public view, where a bipartisan public that already dislikes this industry gets a say.
Restrict paid influencer promotion of prescription drugs immediately, without new legislation. The administration has already signaled it’s headed this way. This is close to the easiest fix on the list, since influencer marketing for prescription drugs is already dishonest under existing false-advertising law. It needs enforcement, not new authority.
A Word on “It’s Just Marketing”
There’s a common defense worth answering directly: advertising is how markets work, and prescription drugs are products like anything else, so why single them out?
Because prescription drugs aren’t products like anything else. That’s the whole reason they’re prescription-only. Medicines get that designation specifically because they carry a real risk of harm if used wrong, unlike over-the-counter drugs, which treat milder conditions where safe use is straightforward. The entire legal setup around prescription medicine exists to put a trained professional’s judgment between a risky substance and a consumer who can’t fully evaluate it alone. That’s not bureaucratic overhead. That’s the safety mechanism.
DTC advertising is built to go around that mechanism. It doesn’t remove the doctor’s signature on the prescription, but it does everything it can to decide what goes on that prescription before the doctor ever weighs in, by manufacturing demand in a mind with no training to judge whether the product is the right call. And it works, which is exactly why billions get spent on it every year.
Compare how we already handle other risky products. Cigarette ads are banned from broadcast TV. Hard liquor ads are heavily restricted, largely by the industry’s own choice, to avoid harsher federal rules. Firearms can’t be advertised the way a car can. American law already accepts that a product’s capacity for serious harm justifies limiting how it’s marketed to a general audience, even when the product stays perfectly legal to sell. Prescription drugs, some carrying the same boxed warnings for death or organ failure that justified those other limits, are the exception. There’s no principled reason for that exception. There’s only a well-funded lobbying operation keeping it in place.
The Bottom Line
The industry’s own numbers make the case better than any outside critic could. Seven of the ten largest pharmaceutical companies spend more on marketing than research. Companies raise prices on their most heavily advertised drugs year after year while spending more to advertise them. Fewer than a third of advertised drugs offer a real advantage over existing alternatives. The industry spends hundreds of millions a year lobbying to keep the arrangement intact. A drug company kept advertising a medication to the public after its own internal documents showed it was raising the risk of death. And the evidence is solid that direct advertising leads to unnecessary and sometimes harmful prescribing, exactly what you’d expect from a system built to make patients demand products their doctors wouldn’t have recommended on their own.
Every other developed country looked at this same set of incentives and decided it wasn’t worth the risk. The United States kept the arrangement, built a $39 billion-a-year industry around it, and is now running a federal cleanup campaign for a mess that was entirely predictable from the start. That campaign is worth supporting. It’s also not a ban, by its own architects’ admission, and a problem this well-funded doesn’t get solved by asking it to disclose its side effects more clearly. It gets solved by turning it off.
Nobody needs to watch a man doing yard work while a narrator describes the risk of liver failure to have a productive conversation with their doctor about cholesterol. The rest of the world figured that out a while ago.