It's both. State laws rule health regulations on prescriptions and what Doctors are required to disclose to patients along with laws that protect doctors and pharmicutal companies at a state level, then you have the federal government with rules and regulations and laws that are set in place to protect consumers, doctors and pharmicutal companies. The problem is that no state really follows the federal laws and guidelines when someone is hurt because the companies are always bigger than a injured person. Then the fed allows these products and medical procedures to be approved. States should have no pull if the fed approved a dangerous defective medical treatment, but they say it's never the companies fault because the doctor should have known. .. how could a doctor know if the company didn't inform them?