One evening in the late summer of 2015, Lisa Schwartz was watching television at her Vermont home when an ad for a sleeping pill called Belsomra appeared on the screen. Schwartz, a longtime professor at Dartmouth Medical College, usually muted commercials, but she watched this one closely: a 90-second spot featuring a young woman and two slightly cute, slightly creepy fuzzy animals in the shape of the words “sleep” and “wake.” Schwartz had a reason to be curious about this particular ad. Two years earlier, she had been a member of the advisory panel that reviewed Belsomra for the U.S. Food and Drug Administration—and the process had not gone well for the manufacturer, Merck. The company saw its new drug as a major innovation, emphasizing that the medicationin sales this year and to overtake both Ambien and Lunesta as the top-selling insomnia medication sometime within the next decade.

Up until the early 20th century, newspapers were full of ads making outlandish claims about potions and elixirs that were sometimes toxic and nearly always useless, such as Doctor Quenaudon’s Spring Cure, an “extract of green herbs for purifying the blood and the cure of all diseases arising from its impurity, also of all other chronic diseases.” Over time, a series of federal laws, starting with the Pure Food and Drug Act of 1906, took these concoctions off the shelves and put their producers out of business, giving rise to the pharmaceutical industry as we know it. In 1938, the Federal Food, Drug and Cosmetic Act mandated that