The industry quickly took advantage of the new guidelines: by 1998, advertising spending on DTCA had reached $1.12 billion. Despite this growth, there were concerns that some ads had an insufficient focus on properly discussing the product, while concerns were also shown for the advertising of erectile dysfunction medications during programming that may be widely watched by children. In 2005, Pharmaceutical Research and Manufacturers of America (PhRMA) instituted new voluntary guidelines for DTCA, including requirements to voluntarily submit ads to the FDA for review and educate health professionals on new medications before an advertising campaign commences, use clear language in advertising, obtain appropriate age targeting for advertisements involving subject matter that may be inappropriate to certain audiences, and to not use "reminder" ads. By 2011, spending on pharmaceutical advertising had grown to approximately US$4.5 billion per year, and increased to $5.2 billion by 2016.