For most of your complaints, those things aren’t fully protected by the 1st Amendment, but clearly the laws are different.
Quackery and marketing fraud are regulated and illegal. Some of the stuff is allowed, but you can’t make certain claims (ie homeopathy, which is a think in Europe as well). Revenge porn is illegal in most states and I imagine the others will catch up. There are also anti-harassment laws etc.
Campaign reform is an issue, but Freedom of Speech is only part of the issue. This can be regulated differently in the future.
Direct to consumer pharmaceuticals ads again isn’t a right, it is just currently legal. There are limits as to how booze, tobacco, and gambling are advertised, for example. This too can change.
The rest, the hate groups, really aren’t prevalent in every day things (and I say this living an hour from the Phelps). It is a problem, yes, but is it big enough to do away with the 1st Amendment? I don’t think so.
Sure the system isn’t prefect, but the reason for the Amendment was two fold - one because so many early colonists were religious pariah and victims of persecution, and 2) past oppression of news, information, and dissenting opinions.
You are correct there are currently people abusing their rights. But one can’t also ignore the powerful protection it has given Americans under law. I mean, many people see us as Pseudo-fascists anyway, would you want us to lack the ability to question say Macarthyism? We could get real dark - what if prayer was mandatory in school, or the Pledge of Alliance? What if not standing during the anthem or burning the flag was a jailable offense? What if the gov. places limits on how you criticize it? Etc. These aren’t just what ifs, you can see consequences of it in recent history.
I concur it isn’t perfect, but please keep in mind, 1) there are some limits to free speech and 2) some of the things you have issues with could be changed, it is just now how the law is written now.