Per capita health care spending in the U.S. is by far the highest in the world, yet we don’t have anywhere near the best health outcomes compared to many other countries. One driver of these ever-increasing costs is medical advertising to both patients and health care providers, which boosts sales of costly new (though not necessarily the most effective) drugs and medical services. Direct-to-consumer (DTC) prescription drug advertising began in the U.S. in the 1980s; New Zealand is the only other country that permits it. If you watch TV, read magazines, or use the internet, you’ve surely noticed the upsurge of these ads, which almost never promote tried-and-true generic drugs, since these are off-patent and usually much less expensive.
One newer type of pharmaceutical advertising is called “disease awareness campaigns,” which are paid for by drug companies that make leading treatments for the diseases, though the ads don’t mention specific products. Instead, they suggest that people ask their doctors about treatments for conditions such as low testosterone or chronic dry eye. Such advertising is virtually unregulated. Raising awareness can be beneficial, but can also lead to overdiagnosis and overtreatment.
A major article in the Journal of the American Medical Association (JAMA) in January 2019 mapped out trends in U.S. medical advertising from 1997 to 2016. Among the key findings:
- Total medical advertising—for drugs (to patients and doctors), disease awareness campaigns, health services, and laboratory testing—rose from $17.7 billion to $29.9 billion a year.
- The biggest increase was in DTC advertising, rising from $2.1 billion to $9.6 billion a year, mostly for drugs. DTC drug ads ran 79,000 times in 1997, compared to 4.6 million times in 2016 (including, in recent years, many less-expensive online ads).
- Medical marketing to health care providers still accounted for most promotional spending, increasing from $15.6 billion to $20.3 billion a year, which included $13.5 billion for free drug samples. This occurs despite efforts by medical organizations to limit doctors’ industry entanglements.
- Regulatory oversight by the FDA Office of Prescription Drug Promotion, the FTC, and state attorneys general has remained “limited” and may even be decreasing. Despite a tripling of reviews, the number of violation letters from the FDA dropped from 156 to 11 per year.
As the accompanying editorial in JAMA noted, “DTC advertising by manufacturers increases the need for clinicians to help patients understand product claims, medical need, cost, and nonmedical alternatives.”
This article was adapted from the UC Berkeley Wellness Letter.