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Drugmakers are increasingly turning to off-label promotions and direct-to-consumer (DTC) advertising in an effort to increase or defend market share. At the same time, the government, activists and academics are stepping up their criticism of those activities. The Department of Justice has been especially aggressive in prosecuting off-label promotions. Some experts say that may have a chilling effect on the industry; others call for reform to ensure the law is being enforced consistently. While a congressional committee has begun investigating the practice, the FDA warns that legislative interference may limit doctors’ ability to treat their patients. Congress is also taking a look at changing how the agency regulates DTC ads, although some observers doubt the efforts will be successful. One proposal, spurred by a report from the Government Accountability Office on drug industry advertising spending, is to ban all DTC ads for newly approved drugs. A group of academics has gone one step further, concluding that the ads have limited value other than increasing drugmakers’ profits. The FDA, for its part, says it does not have the funding to review the ads it currently receives and is proposing the industry help pay for the system. This issue of The Food & Drug Letter looks at these and other recent developments and how they affect companies’ efforts to market their products.