Nearly $30 Billion Spent on Medical Marketing – Should Regulators Be Paying More Attention?

As pharmaceutical companies submit their budgets for a new fiscal year, we can only surmise how much of that budget will be devoted to marketing. Medical marketing has rapidly consumed the attention of drug manufacturers, clinicians and patients alike, making a particularly big splash on the economy.

In an analysis published in JAMA, Dartmouth Institute professors Steven Woloshin and his late wife and research partner, Lisa Schwartz, recount the exponential rise in medical marketing spending from 1997-2016. Spending on medical marketing rose from $17.7 billion to $29.9 billion in that time.

“Because the goal of medical marketing is to shape our perceptions of the benefits and harms of drugs, treatments, and even of diseases, themselves, it can have a very significant impact on healthcare and can even hamper efforts to control unsustainable healthcare spending,” said Dr. Woloshin.

The pair collected data on different types of marketing and advertising including direct-to-consumer (DTC) advertising, which alone has attracted significant media attention over the last few years.

The most rapid change in spending occurred in DTC advertising, increasing from $2.1 billion to $9.6 billion. The absolute number of DTC ads for prescription drugs and laboratory tests rose in that time and the types of products being advertised changed with market competition and consumer interest.

For example, spending on allergy medication declined from $307 million in 1997 to $35 million in 2016 due, in part, to the availability of generics. In 1997, frequently advertised lab tests were for fertility, HIV and glucose monitors; in 2016, this changed to genetic tests, reflecting heightened consumer interest in their ancestry and risk for disease.

There is no denying that medical marketing influences people’s behaviors and choices. According to the researchers’ study, DTC marketing often increases patient requests and prescription drugs, which could lead to overuse and adverse outcomes.

That’s not even the most worrisome fact. Woloshin and Schwartz noted that regulatory bodies did not keep up with the rise in medical marketing expenditure from 1997-2016. Taking DTC advertising for prescription drugs as an example, they found a corresponding decrease in US Food and Drug Administration (FDA) violation letters, suggesting less oversight on DTC ads.

This could mean that drugs with uncertain safety and efficacy data are being heavily marketed, and it will be the patient who pays the price.

There might also be a disproportionate number of pricey prescription drugs being advertised compared to equally effective generics.

In an editorial response to the JAMA article, Dr. Selena Ortiz and Dr. Meredith Rosenthal stressed this could prompt patients to choose less cost-effective care. Moreover, they mention that the patient-physician relationship could be jeopardized if the increase in medical marketing continues unchecked.

To keep up in an increasingly competitive market, pharma companies will undoubtedly pour more money into medical marketing. For public safety, the FDA and other regulatory bodies should strengthen or introduce guidelines to cope with unlawful promotion or misleading advertising.

“I think our findings highlight that there is a lot of room to be more active in regulating medical marketing,” said Dr. Woloshin. “Enacting better oversight of product detailing or adding tables that quantify the benefits and adverse effects of drugs to advertising are two examples we cited in the paper, but there are many feasible steps that could be taken which could potentially improve the quality of health information and cut back on overprescribing and unnecessary medical spending.”